There is, we are told, an “epidemic” of diabetes 2 in the U.S. Never mind that the definition of who has this condition was expanded in the 1990s, thus turning more than a million people into diabetics overnight. One of the worst things about diabetes 2 is its increased risk of potentially fatal heart problems. In time, however, research would show the drugs prescribed to cut the chance of this happening will themselves increase the risk of potentially fatal heart problems. Now a new study shows that people who receive a diabetes diagnosis after the age of 60 are not at same risk for heart problems as those diagnosed at younger ages.

Well, if you’re straining to find something positive in this bleak picture, as I am right now, this seems like something to cling to.

The new study, called the British Regional Heart Study, included only men—a problem right there for the other half of the population. The 4,045 men, age 60 to 79 years, were screened for diabetes 2 from 1978 to 1980 and asked to answer extensive questionnaires. The research team was led by Dr. S. Goya Wannamethee, University College, London, UK.

All were divided into four groups: Men who did not have diabetes or a heart attack; men with a prior heart attack but no diabetes; men with diabetes for more than 16 years and diagnosed before age 60 (early onset); and men with diabetes for at least 4 ½ years and diagnosed with diabetes after age 60 (late-onset).

Here’s what the British researchers found in the nine-year duration of their study: 9% of the men without diabetes or heart attack died from heart disease or suffered a major cardiovascular event (e.g., stroke, heart attack). Although a heightened chance of these “events” goes with a diabetes diagnosis at any age, the late-onset diabetics had a lower risk.

So how large is a man’s chance of suffering a cardiovascular complication of diabetes 2? The risk rises to 22% in the early-onset diabetes group and 16% in late-onset group. Put another way: 78%of the diabetics at either level of risk will not have a heart attack or premature death in the next nine years. The highest risk (26%) is for the men without diabetes who have suffered a heart attack. Are you ever old enough to stop thinking that diabetes will do you in prematurely? Yes, according to the editorial that accompanied this study. By the time a man hits age79, his risk of heart disease death is already high.

This is a small study that didn’t have enough participants to come to a firm conclusion—only 107 of the 4,045 men had early-onset diabetes. Still, the British researchers noted, earlier studies have also “suggested that the impact of diabetes on mortality decreases with increasing age at onset.”

In the editorial, Dr. Iskandar Idris, University of Sheffield, UK, cites a common, but evidence-free, treatment that is also based on the assumption that diabetes 2 confers the same level of heart disease risk to all. “Current cholesterol guidelines urge doctors to treat patients with diabetes to low LDL-cholesterol targets—less than 100 mg/dL—even though there is a lack for evidence to support this target.”

This study appeared in a recent issue of Archives of Internal Medicine as part of its ongoing “Less is More” series that illustrates “How Less Health Care Can Result in Better Health.”

More to think about

-In his book Overtreatment, H. Gilbert Welch, MD, describes how the definition of diabetes 2 changed since he was in medical school (1970s), “If you had a fasting blood sugar over 140, then you had diabetes. But in 1997 the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus redefined the disorder. Now if you have a fasting blood sugar over 126, you have diabetes. So everyone who has a blood sugar between 126 and 140 used to be normal but now has diabetes. That little change turned over 1.6 million people into patients.”

-Nortin Hadler, MD, believes what is now called diabetes 2 is largely a construct invented by the pharmaceutical industry. Read this 2009 interview. He is the author of Worried Sick. A prescription for health in an overtreated America, which has a section on diabetes 2.

-See this 2009 study showing which oral diabetes 2 drugs are riskier than others. Only generic and drug class names are used throughout this medical journal article.

Maryann Napoli, Center for Medical Consumers