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    Prevention of complications in type 2 diabetes: is drug glucose control evidence based?

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    graham64
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    Prevention of complications in type 2 diabetes: is drug glucose control evidence based?

    Post by graham64 on Sun Jul 30 2017, 22:45

    INTRODUCTION

    To answer the questions that arise in relation to a patient’s clinical situation, medical decisions need to be made according to the principles of evidence-based medicine. At this time, the benefits and risks of glycaemic control in patients with type 2 diabetes require painstaking reconsideration.1

    Even if chronic hyperglycaemia is a risk marker for some macro- and microvascular complications, that does not mean ipso facto that its reduction by one or several hypoglycaemic drugs is systematically beneficial to patients from a clinical point of view. The potential benefits derived from pharmacological glycaemic control can be counterbalanced by frequent and/or severe clinical adverse events. For example, numerous hypoglycaemic drugs have either not been made commercially available or have been withdrawn from the market in France because their risk–benefit ratio was deemed unfavourable: tolbutamide, phenformin, troglitazone, rosiglitazone, pioglitazone, benfluorex, rimonabant, muraglitazar, and aleglitazar. This was even though they pronouncedly reduced blood glucose level (on average from 0.5% to 2% of HbA1c). The main reason has had less to do with their clinical adverse events than with the lack of evidence of their clinical benefits. Had the efficacy of these drugs been demonstrated in terms of reduced morbidity and/or mortality, they would probably be on the market.

    To sum up, the scientific rationale for pharmacological treatment of patients with type 2 diabetes depends on the answers to two major questions:

    Is there any evidence derived from randomised controlled trias (RCTs) demonstrating that glycaemic control reduction translates into clinical benefits?

    If yes, do current treatments have a clinically favourable risk–benefit ratio?

    http://bjgp.org/content/67/655/85

    Not to worry DUK reckons there's a wealth of evidence that T2 drugs are safe

    Bear in mind DUK need to keep their Big Pharma partners happy  Rolling Eyes 


    • Johnson & Johnson
    • Lilly Diabetes
    • Novo Nordisk
    • Sanofi

    https://www.diabetes.org.uk/Get_involved/Corporate/Acknowledgements/


    _________________
    I'm a skinny T2 diagnosed 4/4/2008, a high calorie LCHF diet and one metformin a day A1c 6.2 and no complications.

    Proving the LowCarb sceptics wrong for over nine years,

    Not all cherubs are Angels  Wink nor all diabetics Bonkers  Rolling Eyes
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    chris c
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    Re: Prevention of complications in type 2 diabetes: is drug glucose control evidence based?

    Post by chris c on Fri Aug 04 2017, 00:05

    Yup, sounds like ACCORD all over again. Instead of looking to reduce BOTH glucose and insulin they will be trying to "prove" that high BG is not a danger, and I just bet they will target LCHF as being "as dangerous as the drugs we no longer prescribe".

    A good time to buy shares in the manufacturers of bone saws, wheelchairs and dialysis machines. The use the profits to buy meat and vegetables. Oh and butter and coconut oil of course, you can not only eat the latter but rub it on your cardiologist.

      Current date/time is Sat Oct 21 2017, 22:07