Stevia: A Sweet Sugar Substitute

Every few years a new sugar alternative hits the market. People who prefer to get their sweeteners’ calorie-free rush to buy up the local supermarket’s stock and eagerly tout the benefits of the latest and greatest sweet invention. About a decade ago sucrolose (aka Splenda) gave Sweet ‘n Low and Equal a run for their money.Agave nectar has received a “health halo” among some people, despite the fact that it is nearly all fructose and may be worse for your health than table sugar or high fructose corn syrup. Most recently, another non-sugar has made a splash in our coffees.

Stevia (sold at health food stores as Truvia, PureVia, Sun Crystals, among others) is made from the sweetest part of the South American stevia plant. The human body cannot use these steviol glycosides as fuel which means the calorie and carbohydrate count is zero.  It also tastes 200-300 times sweeter than sugar.

As with any new product, there are some questions that you may want answered. So, I got ya covered:

Is Stevia Safe?

Stevia has been used safely for a long time in South American and Asian countries. Stevia has been the subject of quite a bit of rigorous research assuring the safety of the sweetener, and has been approved by the FDA. Other calorie-free sweeteners such as saccharin (Sweet ‘n Low), aspartame (Equal), and sucralose (Splenda) have also been approved as safe.

Can I Bake with Stevia?

Unlike saccharin or aspartame, which denature (change molecular structure) under high heat, you can bake with Stevia! Check out these Truvia chocolate chip cookies as an example.

Is it Worth Switching My Sweetener?

It depends. While Stevia may be natural, and fits in with the current trend to consume less processed foods, it still should be used in moderation. It can be a great alternative to caloric sweeteners (sugar) as part of a balanced diet if you like the taste.

Here’s how I’d assess the sweetener issue:

  • If you are someone who is drinking soda, sweet tea, or other sweetened beverages, start to make the transition to water or lightly sweetened water-based beverages. You may be gulping down gobs of added sugar, which leads to diabetes and weight gain. If you already have diabetes or have been told that you are pre-diabetic, take heed now to cut back on foods and beverages with added sugars.
  • Take a look in your pantry… are you addicted to diet foods? Do you have a lot of packaged low-cal stuff that you snack on and no real food to speak of? Maybe there’s a problem. A few artificially sweetened treats may be fine, but if you are loading up on packaged snacks all day, you lose a chance to get good nutrition. Have a fat-free Greek yogurt with fruit instead of a sugar-free pudding.
  • Retrain your sweet tooth. If you really feel like you overdo it on all things sweet, maybe your whole eating plan needs a makeover. You’ll find by eating healthy, whole foods that your need for sweets goes down over time.
  • As with anything you add to coffee, cereal, or baked goods, taste makes all the difference.  Use what tastes good to you – just because Stevia comes from a plant doesn’t mean it’s any better (or worse) for your health. You have to enjoy your food. If you prefer sugar, fine. If you prefer Stevia, fine. If you prefer artificial sweetener, fine too. As long as you don’t think you are overdoing it. If you aren’t sure, you can always have your eating habits evaluated by a dietitian.

Fruit2o “Docks” at Boston Harborfest to Get Pledges for Healthy Living

Hey Beantown residents… Are you without plans for the fourth of July? Boston Harborfest ( in the Boston, Massachusetts City Hall Plaza could be just what you’re looking for! Running from the 2nd of July to the 5th, the event is free with over 200 events and Fruit2o will be there too.

Between historical reenactments, tours, concerts, and Chowderfest, stop by the Fruit2o booth to sample some of the new Fruit2o Essentials flavors and make a pledge to be healthier with “small changes”. You may have heard me talk about making small behavior changes before on my interview with Fox 5 in D.C. and other interviews throughout the summer in my work with Fruit 2o.

A small change is the best jump start to living healthier. Small changes can be anything from walking 15-30 minutes each day or drinking less sweetened beverages (sodas, energy drinks, sweet tea). Sugar sweetened drinks have little nutrition for the calories and can lead to weight gain and diabetes. According to the Massachusetts Diabetes Prevention Program, an estimated 110,388 more people in Massachusetts had diabetes in 2007. As little as one 20-oz sugar sweetened beverage a day (17 tsp) is nearly twice the recommended “sugar limit” (9 tsp) — eek!

If you want flavor, you can try hydrating with a zero calorie water beverage like Fruit2o. Miss soda bubbles? Mix equal parts Fruit 2o and seltzer water over ice for a zero calorie fruit flavored cooler.

When you pledge to make a small change like the ones above, you can also make a difference in the fight against diabetes. For every pledge, Fruit20 will generously give a dollar to your local American Diabetes Association. A small change for you can mean a big change for the community! What a great trade off!

Can’t make it to Boston? Visit Fruit2o on Facebook and write a pledge on their wall. They’ll still donate a buck on your behalf. Be sure to specify the Boston chapter of the American Diabetes Association.

For more information on the Boston Harborfest, follow them on twitter or visit their website.

2010 Dietary Guidelines Summary Released!

It’s big news for nutrition. We may have new advice for eating healthy… and you can give your 2 cents, if you feel so inclined. Every five years the Dietary Guidelines for Americans are updated to reflect the latest knowledge in science and research. The Guidelines are used for government nutrition initiatives, programs and education, as well as by dietitians and health professionals to help educate people about eating healthier.

Dietary Guidelines (DG) Advisory Committee released their Executive summary on Tuesday, June 15th, 2010. The full report can be found here and is currently open for public comments. (that’s you, the public…let your voice be heard and comment on the Executive Summary).

The Committee has used a state-of-the-art, web-based electronic system and methodology, known as the Nutrition Evidence Library, to answer the majority of the scientific questions it posed, about specific nutrients and foods.

What’s New in 2010?

The 2010 Guidelines are different from previous reports in that this one addresses an American public of whom the majority are overweight or obese and yet under-nourished in several key nutrients. (It may sound strange, but it is possible to be overweight and under nourished at the same time.)

This DG also focuses more on children because primary prevention of obesity must begin in childhood. They say this is the single most powerful public health approach to combating and reversing America’s obesity epidemic over the long term.
To reduce the incidence of overweight and obesity in our country they recommend that we:

  • Shift food intake patterns to a more plant-based diet that emphasizes vegetables, cooked dry beans and peas, fruits, whole grains, nuts, and seeds. In addition, increase the intake of seafood and fat-free and low-fat milk and milk products and consume only moderate amounts of lean meats, poultry, and eggs.
  • Significantly reduce intake of foods containing added sugars and solid fats because these dietary components contribute excess calories and few, if any, nutrients. In addition, reduce sodium intake and intake of refined grains.Daily sodium intake be 1,500 mg, (down from 2,300mg in the 2005 recommendations).
  • Eliminate Trans-fatty acids from the diet, and seeking to increase the amount of omega-3 fatty acids in diet.
  • Increase physical activity: adults should get at least 2½ hours of moderate-intensity physical activity each week, such as brisk walking, or 1¼ hours of a vigorous-intensity activity, such as jogging or swimming laps, or a combination of the two types. Kids and teens should do an hour or more of moderate-intensity to vigorous physical activity each day.

While I strongly support these recommendations, there are several things that must be changed about our  Food environment so that eating healthy is easy, accessible and affordable. Hopefully our government will launch initiatives that seek to improve the following points:

  • Improve nutrition literacy and cooking skills, including safe food handling skills, and empower and motivate the population, especially families with children, to prepare and consume healthy foods at home.
  • Increase comprehensive health, nutrition, and physical education programs and curricula in US schools and preschools, including food preparation, food safety, cooking, and physical education classes and improved quality of recess.
  • For all Americans, especially those with low income, create greater financial incentives to purchase, prepare, and consume vegetables and fruit, whole grains, seafood, fat-free and low-fat milk and milk products, lean meats, and other healthy foods.
  • Improve the availability of affordable fresh produce through greater access to grocery stores, produce trucks, and farmers’ markets.
  • Increase environmentally sustainable production of vegetables, fruits, and fiber-rich whole grains.
  • Encourage restaurants and the food industry to offer health-promoting foods that are low in sodium; limited in added sugars, refined grains, and solid fats; and served in smaller portions.

With over two thirds of our population either overweight or obese, this has a huge impact on the healthcare system, and our entire nation. On average, Americans of all ages consume too few vegetables, fruits, high-fiber whole grains, low-fat milk and milk products, and seafood and they eat too much added sugars, solid fats, refined grains, and sodium. Added Sugar and Fat contribute approximately 35 percent of calories to the American diet. (these are just empty calories) The current US Food environment is loaded with excess sodium, sugar, fat and refined grains, making it harder for the average consumer to eat healthy. We have to seek out healthy foods and do some detective work when eating out.

This summary is now open for public comments-so what do you have to say? Tell me here or submit your comment to the committee here! You can also read what others are saying here. Will changing the recommendations help make American healthier or do we first need to change the entire food environment?

D.C. Air Show Saturday May 15 2010 – Come Try Fruit 2 o Essentials

I’m super excited to be working with Fruit2 on a campaign to educate women about the risks of diabetes — and ways they can prevent it. Even cooler, they are putting up some serious money for the cause! Fruit2O is working with the American Diabetes Association to help promote the fight to stop diabetes.  As part of its Small Changes>Lifelong Results campaign, the Fruit2O brand is asking consumers to pledge to make a small change in their life that will have a big impact on their health. For every “small change” pledged, they will donate $1 to the local American Diabetes Association chapter. Pretty cool, huh?

Come see me and Stacy Capers (American Diabetes Association spokesperson and former Biggest Loser contestant) at the D.C. Air Show May 15. We will tell you about the Small Changes campaign and how you can get involved.

If you know me at all, you know I’m a fan of the “small change”. When it comes to preventing Type 2  diabetes, I’m looking at managing a healthy weight and minimizing “added sugars” — you know what I mean. Most of the added sugars Americans consume are in the form of empty calorie drinks like sodas, sports drinks (when you aren’t exercising over an hour), sweetened teas, slushies, etc. If you’re drinking these beverages, consider the power of making a small change. Swapping out these drinks with beverages that provide zero calories is the way to go.

I’ll be talking about the Small Changes>Lifelong Results campaign, all summer long in various locations. I’ll be giving tips for making small changes and sampling the new Fruit2O Essentials. It’s a zero calorie water beverage with vitamins and minerals. This is a great drink to try because it has fruit flavor and when you’re used to drinking sugary beverages, you might appreciate the taste. Another good one to try is sparkling water with about 1/4 cup of 100% fruit juice added.

Nearly 24 million American children and adults have diabetes while 57 million have pre-diabetes (this means they are at risk for getting diabetes soon if they don’t make changes). Diabetes runs in my family. My mom has it and she used to guzzle sweet beverages. This campaign is especially important to me. But you can do something about your risk. By improving your nutrition habits and activity levels, you can help prevent diabetes (ask me how!)

Three Easy Ways to Prevent Type 2 Diabetes

As I write this, some 54 million Americans are living with pre-diabetes, according to the Centers for Disease Control and Prevention, and they may not even know it. November is National Diabetes Awareness Month. As the daughter of a type 2 diabetic, I know first-hand what it is like living with the disease. Between medications, finger sticks, foot checks, vision tests, and the daily grind of nutrition and exercise, it can be a lot for people to manage, especially after years of unhealthy habits.

So, wouldn’t it be great if you knew what you could do to control your diabetes, or better yet prevent diabetes, in the first place? Well, you’ve come to the right place. This blog post will describe the top three steps you can take to prevent or reverse type 2 diabetes.


1. Eat healthy

If you already have type 2 diabetes, then you have (hopefully) learned about the importance of keeping carbohydrates consistent throughout the day, meaning enjoying a small amount of healthy carbohydrates with each meal. Well, this also works in preventing type 2 diabetes.

I recommend people choose carbohydrates in the form of fresh or minimally processed starchy vegetables (like potatoes), fruits, beans (like lentils), and whole grains (like brown rice, quinoa, and corn) for their meals. Non-starchy veggies have such low carbs for the calories and they are almost 100% water that you don’t need to limit those.

Just watch how they are prepared. Steamed or broiled with herbs, spices or a little olive oil is best. Refined sources of carbohydrates should be limited as much as possible: sugar, white bread, white rice, etc. You don’t need to eliminate all foods with these ingredients, but try to make a healthier swap whenever possible and limit your portion sizes of these foods.

2. Exercise more

Exercise can help slow or prevent the progression of diabetes a number of ways. Exercise helps to maintain a healthy weight, lose weight, manage stress, and improve sleep (more on that next). Exercise also helps people manage a healthy blood sugar level whether you have diabetes or not.


When you exercise, you burn sugar for energy. Regular exercise also helps keep blood vessels healthy to prevent heart disease, which diabetics often get from damage to blood vessels. You don’t have to be a marathoner either. As little as 1,000 calories worth of activity spread throughout the week (walking 30 minutes and 20 minutes of strength training three times a week) causes your muscles to utilize sugar more effectively and keep it from floating around in your blood, which leads to diabetes.

3. Lose weight

Get a tape measure and take a waist measurement. Men, if you’ve got 40 or more inches around the waist you have 12 times the risk of developing diabetes than a male with 35 inches. Women, if you have 37 or more inches around the waist you are 12 times more likely to get diabetes than a female with 32.5 inches.

Eating healthy and exercising more are the best steps to losing weight. Get a trainer, dietitian, join a class, or buy a book/dvd… but do something to help yourself lose weight sensibly.

Five Easy Food Swaps to Prevent Type 2 Diabetes

Everyone loves easy. The easier something is, the more likely you are going to do it, right? Trust me, I’m right. In the spirit of easy and diabetes awareness, today I’m sharing easy changes you can make to prevent diabetes.

These five tips involve slashing sugar, saturated and trans fats, and cutting back on calories so you can lose weight and better control your blood sugar

1. Swap water for calorie beverages. Water has zero calories, that’s the bottom line. Used to sodas? Try sparkling water with a twist of lime. Need more flavor? Add some mint or unsweetened iced tea. I love using herbal teas! You’ll save 17 teaspoons of sugar for each 20-ounce soda.

2. Swap a coffee beverage with a small skim milk latte. A small pumpkin spice latte made with 2% milk has almost 40 grams of sugar (about 10 teaspoons – a day’s worth of added sugar), whereas a small, fat-free latte has only 16 grams sugar and that comes from the milk! If you would like, you can always “split the difference” and ask for one pump of pumpkin spice. That’s about 10 grams of added sugar – just under three teaspoons. Sure beats 10, doesn’t it?

3. Swap a hamburger with a portobello mushroom burger. If you’ve never had a grilled portobello mushroom you have no idea what you are missing. This large vegetable has a thick “meaty” texture. The saturated fat is no comparison. You’ll save grams of saturated fat.

4. Swap “partially hydrogenated” on packaged foods with whole or packaged foods without. If you can avoid packaged and fried foods altogether then you can avoid most of the world’s trans fat. That’s not realistic for a lot of people, so the next best thing is to cut down on the amount and frequency of those kinds of foods. Look at an ingredients list for the words “partially hydrogenated” and rethink your purchase. The good news is that most companies have taken it out of foods.

5. Swap full-fat cheese for lighter. I love cheese, but the saturated fat in that tiny thumb-sized portion is enough to make your arteries clog in sheer terror! OK, not exactly, but even so, just remember full-fat dairy products are mostly saturated fat. I like to use low-fat cottage cheese for a “most of the time” food. I also like the reduced-fat mozzarella and cheddar cheeses in the store. Up to 50% reduced fat of a good brand will slash the saturated fat in half, but you don’t notice a taste difference. I also like goat and feta cheese because they are strong. A little goes a long way and their “softness” means more water and guess what, less saturated fat per serving.

Hopefully you can choose at least one of these tips today to work on!

Using Humor to Educate – 30 Rock and Diabetes

Did you catch The Jan. 22 episode of 30 Rock? If you did, you saw the subplot of Tracy getting “bad news” from his doctor about his risk of diabetes while Tracy dismisses it as a “white myth” that diabetes is related to food intake. I found the story quite humorous. It did a good job at attacking a serious issue – getting people to take their health seriously. While looking for the clip, I found an interesting article – Tracy Morgan actually has diabetes but spent years ignoring it until his body essentially shut down on the set.

Tracy and Kenneth: Dr. Spaceman has some bad news for Tracy. “I don’t know how to say this: Dee-AY-buh-tees?” He also notes that Tracy needs to make some serious lifestyle changes, or he could lose a foot to the disease. “Could I replace it with a wheel, like Rosie from The Jetsons?” a hopeful Tracy asks. Sure, Dr. Spaceman says, “but then you’ll have to register yourself as a motor vehicle.”

Kenneth, for one, is very concerned about Tracy’s medical news and launches a campaign to get him to eat healthy. Tracy, however, dismisses the link between diet and diabetes as “a white myth — like Larry Bird, or Colorado.” Twofer chimes in with a conspiracy theory about how the government promulgated false information about diabetes after the Civil War to keep newly freed slaves sluggish, which is why so few people know that it’s really caused by sleeping on your back. (I can see the show getting some heat from diabetes groups about this, but I rather doubt that anyone would turn to 30 Rock for sound medical advice.)

Kenneth, then, is forced to pull out his big weapon: the Hill Witch, his meemaw’s scare tactic to get the kids to eat their veggies. It’s such a weak gambit that even Tracy isn’t biting — until a freaked-out Jenna, her hair ravaged by a jealous Katie, shows up with a broom, screaming “I’m a monster!” Cut to Tracy shoveling broccoli and carrots in his face, and scene.

When I studied health psychology and behavior change, I learned that decision to confront or avoid personal health can be culturally or personality driven. Can anyone else attest to that? Do you think it is helpful when TV shows address health issues?

Diabetes: A Serious, But Preventable Disease

This NYT article about consumers’ perceptions of diabetes was interesting. Basically, focus group data shows that people don’t take diabetes as seriously as cancer and heart disease, even though there are debilitating and life-threatening complications facing a person with uncontrolled diabetes (heart attack, kidney failure, stroke, blindness, amputations).

The article misses the mark, unfortunately, because it doesn’t stress that Type II diabetes is preventable nor does it tell people what they can do help prevent it. What a missed opportunity to encourage eating health and regular exercise. There are so many reasons to make eating healthy and exercise a life priority and preventing diabetes is just another one. These behaviors help maintain a healthy weight – a key to Type II diabetes prevention.

Even more good news, you can be overweight but still eat healthy and exercise and your blood sugars may stay in control.  Don’t feel like you need to get to stick-size proportions. Instead, take a good look at your overall nutrition behaviors. Do you frequently say “yes” to desserts, candy and soda? Do you overdo it on carbs? Many people do… a simple bagel from a pastry shop can have up to 5 carbohydrate servings – almost an entire day’s worth! You’d be surprised with the benefits if you just replaced your daily dessert fixes with a homemade fresh fruit smoothie and switched to whole grain carbohydrates. Take advantage of the free diet tracker and menu planner tools at to see how your food choices add up.

An estimated 54 million Americans have pre-diabetes and are at increased risk for developing the disease. Are you one of them? Find out by asking your doctor to do a fasting blood sugar test or “A1C” test. Even if you are at a healthy weight, you can have pre-diabetes if you love those sugary sweets and carbohydrates a little too much. It’s better to know before you have diabetes because you can make some small changes and see major healthy returns. But if you do have diabetes it is possible to control it with a healthy diet and good exercise. I’m not talking marathons here, walking and swimming do the trick.

Speaking of marathons… I decided to run Marine Corps Marathon on October 26, 2008 and I am raising funds for diabetes research as part of the Diabetes Action Team. You can join my Facebook group to cheer me on and keep updated on how the training is going. Better yet, kick a little coin in the can for me by donating at my fundraising page. Every bit counts!

Diabetes Drug Therapy Inadequate for Many

News on the diabetes research front…

Pfizer is funding the three-year and $14 million Insulin Resistance Pathway (IRP) Project to look at insulin signaling in adipose (fat) cells to increase understanding of diabetes and obesity, inextricably linked conditions that affect 7 percent of the U.S. population. While diabetes has been the subject of intense study in the academic community and pharmaceutical industry for nearly 50 years, the diabetes and obesity medicines that have reached the market do not meet the needs of many patients. Nearly 60% of patients do not respond adequately to currently available drug therapies.

Wow… I had no idea that this many people didn’t respond to diabetes medication. I wonder how much of it has to do with non-compliance (e.g. not taking blood sugars, skipping medications, or not following the carbohydrate controlled diabetic diet).

“Insulin actually initiates a three-dimensional network of interconnected responses. Our goal is to understand this network and how it changes in diseases like diabetes. Collaborating in this way will help us to identify better possibilities for new treatments.”

Improving treatment regimens is an important goal for drug therapy. But I can’t help being a little dejected that $14 million is getting spent by one company to research one aspect of one disease. Nowhere near this amount is spent on disease prevention.  I bet this money could be stretched very far if it were spent on community-based nutrition and exercise programs that can help people change diet and exercise behaviors, achieve a healthy weight, maintain normal blood pressure and cholesterol, and essentially help prevent the behavior-related diseases.

Changes to Strategy in Diabetes Clinical Trial

For Safety, NHLBI Changes Intensive Blood Sugar Treatment Strategy in
Clinical Trial of Diabetes and Cardiovascular Disease

The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health has stopped one treatment within a large, ongoing North American clinical trial of diabetes and cardiovascular disease 18 months early due to safety concerns after review of available data, although the study will continue.

In this trial of adults with type 2 diabetes at especially high risk for heart attack and stroke, the medical strategy to intensively lower blood glucose (sugar) below current recommendations increased the risk of death compared with a less-intensive standard treatment strategy. Study participants receiving intensive blood glucose lowering treatment will now receive the less-intensive standard treatment.

The ACCORD (Action to Control Cardiovascular Risk in Diabetes) study enrolled 10,251 participants. Of these, 257 in the intensive treatment group have died, compared with 203 within the standard treatment group. This is a difference of 54 deaths, or 3 per 1,000 participants each year, over an average of almost four years of treatment. The death rates in both groups were lower than seen in similar populations in other studies.

“A thorough review of the data shows that the medical treatment strategy of intensively reducing blood sugar below current clinical guidelines causes harm in these especially high-risk patients with type 2 diabetes,” said Elizabeth G. Nabel, M.D., director, NHLBI. “Though we have stopped this part of the trial, we will continue to care for these participants, who now will receive the less-intensive standard treatment. In addition, we will continue to monitor the health of all participants, seek the underlying causes for this finding, and carry on with other important research within ACCORD.”

In stopping this part of the trial, Nabel accepted the recommendation of the 10-member Data and Safety Monitoring Board (DSMB) – an independent advisory group of experts in diabetes, cardiovascular disease, epidemiology, patient care, biostatistics, medical ethics, and clinical trial design that has been monitoring ACCORD since it began. A specific charge of any DSMB is to monitor participant safety.

ACCORD participants will continue to receive blood sugar treatment from their study clinicians until the planned trial conclusion in June 2009. Those participants in the intensive treatment group will now be treated to the same A1C goals as those already in the standard treatment group.

The intensive treatment group had a target blood sugar goal, measured by hemoglobin A1C, of less than 6 percent. This is similar to blood sugar levels in adults without diabetes. The standard treatment group aimed for a target similar to what is achieved, on average, by those with diabetes in the United States (A1C of 7 to 7.9 percent) and lower than at study entry.

“The ACCORD findings are important, but will not change therapy for most patients with type 2 diabetes. Few patients with high cardiovascular risk like those studied in ACCORD are treated to blood sugar levels as low as those tested in this study, “ said Judith Fradkin, M.D., director, Division of Diabetes, Endocrinology, and Metabolic Diseases at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). “People with diabetes should never adjust their treatment plan or goals without consulting their health care providers.”

In ACCORD, intensive treatment group participants achieved, on average, A1C values lower than standard treatment group participants. Half of the participants in the intensive treatment group achieved an A1C of less than 6.4 percent, and half of the participants in the standard treatment group achieved an A1C of less than 7.5 percent. The average blood sugar levels for both groups were lower than when they entered the study.

The ACCORD trial was designed to determine whether intensively lowering blood sugar would reduce the risk of cardiovascular events such as heart attack, stroke, or death from cardiovascular disease, specifically in people with type 2 diabetes who are at particularly high risk for a cardiovascular event. Prior studies suggested that reducing blood sugar to levels found in non-diabetic adults may reduce the rate of cardiovascular diseases among those with diabetes. However, a randomized clinical trial was needed to determine whether that hypothesis is accurate.

“ACCORD is an important study intended to find new answers to help people with type 2 diabetes reduce their high risk of heart disease,” said Denise G. Simons-Morton, M.D., Ph.D., NHLBI project officer for ACCORD and a member of the ACCORD steering committee. “Hypotheses about treatments to prevent cardiovascular disease in people with type 2 diabetes need to be tested in clinical trials such as ACCORD. The ACCORD results, along with results from other studies, will contribute to determining what the treatment goals should be in patients with various characteristics.”

Conducted at 77 sites nationwide and in Canada, the trial includes adults between the ages of 40 and 82 at enrollment who, in addition to type 2 diabetes, also have two or more other risk factors for heart disease or had been diagnosed with heart disease before entering the study. Thus, participants were included in the ACCORD trial because they were at especially high risk—more risk than is associated with diabetes alone—for having a heart attack, stroke, or of dying from cardiovascular disease. Participants, who on average had diabetes for 10 years at enrollment, were randomly assigned to either standard (5,123 participants) or intensive (5,128) blood sugar treatment goals. They were also enrolled in one of two other ACCORD randomized clinical trials examining effects of treatments for blood pressure or blood lipids; those study components will continue. Participants had been followed for 2 years to 7 years at the time the intensive blood sugar control treatment was stopped.

These results from ACCORD do not apply to patients with type 1 (juvenile) diabetes, according to Fradkin. It is also unclear whether the results apply to patients with recently diagnosed type 2 diabetes or those whose cardiovascular risk is lower than the participants studied in ACCORD.

Extensive analyses by ACCORD researchers have not determined a specific cause for the increased deaths among the intensive treatment group. Based on analyses conducted to date, there is no evidence that any medication or combination of medications is responsible.

Most participants in the intensive treatment group achieved their lower blood sugar goals with combinations of Food and Drug Administration-approved diabetes medications. For both the intensive and standard treatment groups, study clinicians could use all major classes of diabetes medications available: metformin, thiazolidinediones (TZDs, primarily rosiglitazone), insulins, sulfonylureas, exanatide, and acarbose.

“Because of the recent concerns with rosiglitazone, our extensive analysis included a specific review to determine whether there was any link between this particular medication and the increased deaths. We found no link,” said William T. Friedewald, M.D., ACCORD Steering Committee Chair and Clinical Professor of Medicine and Public Health at Columbia University.

ACCORD researchers will continue to monitor participants and conduct additional analyses to try and explain the findings. Investigators are preparing a report of the findings for a peer-reviewed publication.

An estimated 21 million Americans have diabetes and 284,000 die from it each year. Sixty-five percent of the deaths are related to cardiovascular causes. Type 2 diabetes increases the risk for heart disease 2 to 4 times.

The National Diabetes Education Program, a program of the NIDDK and the Centers for Disease Control and Prevention (CDC), promotes the diabetes care guidelines of the American Diabetes Association (ADA), which recommend an A1C goal of less than 7 percent for most people with type 2 diabetes. The ADA guidelines are based on established evidence that blood sugar control to this level reduces microvascular complications resulting from diabetes including eye, kidney, and nervous system diseases in people with type 1 or type 2 diabetes, and reduces cardiovascular disease in type 1 diabetes. The guidelines also state that treatment goals should be tailored to the individual. For example, a less stringent A1C goal should be considered for people with severe or frequent low blood sugar or with other medical conditions. These important ACCORD results can now be considered in addition to the guidelines when individualizing treatment.

NIDDK contributed funding and scientific expertise to ACCORD. The NIH’s National Institute of Aging and National Eye Institute, as well as the CDC, are also contributing in order to conduct sub-studies in ACCORD. The following companies provided study medications, equipment, or supplies: Abbott Laboratories, Amylin Pharmaceuticals, AstraZeneca LP, Aventis Pharmaceuticals, Inc., Closer Healthcare, GlaxoSmithKline Pharmaceuticals, King Pharmaceuticals, Inc., MediSense Products (Division of Abbott Laboratories), Merck & Company, Inc., Novartis Pharmaceuticals, Inc., Novo Nordisk Pharmaceuticals, Inc., and Omron Healthcare, Inc.



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