Dr. Roach: Diabetes and hypertension often go hand in hand
Dear Dr. Roach: My 72-year-old aunt has hypertension and Type 2 diabetes. She is not on any medications yet. If she took medication to correct her hypertension only, would her blood sugar levels normalize? Or, if she took medication to correct Type 2 diabetes only, would her hypertension be eliminated?
I need to know what advice to give her as she wants to take the least amount of medications due to possible bad side effects.
Dear J.I.: High blood pressure and Type 2 diabetes often go together, to the point where we recommend people with high blood pressure get tested for diabetes, and every person with diabetes gets his or her blood pressure checked every visit.
However, the treatments are separate, and it is common that people need multiple medications. But not everyone with either of these conditions needs treatment with medication. In some people, salt restriction, stress reduction, regular exercise and a few pounds of weight loss can bring the blood pressure down to the point where medicine is no longer necessary. The same good diet, exercise and weight loss usually bring down the blood sugar as well, sometimes enough that no medications are required.
However, both diabetes and high blood pressure have bad effects on blood vessels, especially the ones that go to the heart and brain, predisposing people with either condition to heart attack and stroke. Having both these conditions further increases risk. The good news is that medications are much better than even a few years ago, and most people can find treatments without bad side effects.
Dear Dr. Roach: You have mentioned acupuncture as a treatment for several conditions. I have read otherwise. How strong is the evidence for its use?
Dear J.B.: The effectiveness of acupuncture for over 50 different medical conditions was reviewed by the Cochrane Collaboration, an evidence-based medicine group. Some of these show significant benefit; for example, acupuncture improves pain and function in people with fibromyalgia and osteoarthritis, when compared with placebo pills. Acupuncture also was better than doing nothing and better than some other treatments.
On the other hand, the Cochrane group could not find enough evidence to say whether acupuncture is effective for many other conditions, such as depression or shoulder pain. More importantly, some authors have argued that the benefit from acupuncture is a placebo response, and that the apparent benefit of acupuncture compared with a placebo pill is merely that acupuncture is a more effective placebo than just a pill. There certainly is evidence that even surgery has a potential for a placebo response, and one interesting recent study showed that people with Parkinson’s disease got more improvement in motor skills from a placebo pill they were told cost $1,500 than they did with the identical placebo if they were told it cost only $100. This shows me that our minds have a tremendous ability to improve our bodies if we really believe we can. I think that to a very large extent, and perhaps entirely, the real benefits seen by people who undergo acupuncture are a manifestation of the placebo response.
Acupuncture has far fewer side effects than many medications and helps people with a variety of conditions. Whether its effect is “real” or placebo is almost not an issue.
Email questions to ToYourGoodHealth@med.cornell.edu.