Sometimes, to study a disease means we have to understand the evidence behind it.
DM has been a problem for every country in the world, we know about metformin ( Glucophage ), insulin, sulfonylureas but why are those used and still stand as an important components of tx even though many new medications have emerged ( exenatide, pramlitide, acarbose, the new DPP4 inhibitors and SGLT2 inhibitors )
These are the summaries of the landmark studies
Im not good in EBM but what i can conclude are :
1) UKPDS showed us the benefit of metformin in overweight patients
2) UKPDS-PTM showed us the benefit of early glycemic control ( = we have a window of opportunity to diagnose and treat DM and we must not miss this window; first 10 yrs of tx is important for future outcomes )
3) ACCORD trial showed us that aggressively lowering the HbA1C in high risk patients ( elders, with cardiovascular diseases ) does more harm than good
4) ADVANCE trial in contrast, showed that in LATE a target of 6.5% of HbA1C if achieved slowly over a few years, could provide good future outcomes
5) Gliclazide may have some role in late intervention ( In ADVANCE trial addition of gliclazide reduces the combined endpoint of micro and macrovascular events )
6) Insulin and sulfonylureas are used in UKPDS without any detrimental effect ( but these patients did not have pre-existing diabetic nephropathy )
Reference
Key landmark studies in the clinical management of type 2 diabetes: evolution or revolution?
D. R. Mat thews , Uni ted Kingdom
MEDICOGRAPHIA, Vol 33, No. 1, 22 2011
DM has been a problem for every country in the world, we know about metformin ( Glucophage ), insulin, sulfonylureas but why are those used and still stand as an important components of tx even though many new medications have emerged ( exenatide, pramlitide, acarbose, the new DPP4 inhibitors and SGLT2 inhibitors )
These are the summaries of the landmark studies
Im not good in EBM but what i can conclude are :
1) UKPDS showed us the benefit of metformin in overweight patients
2) UKPDS-PTM showed us the benefit of early glycemic control ( = we have a window of opportunity to diagnose and treat DM and we must not miss this window; first 10 yrs of tx is important for future outcomes )
3) ACCORD trial showed us that aggressively lowering the HbA1C in high risk patients ( elders, with cardiovascular diseases ) does more harm than good
4) ADVANCE trial in contrast, showed that in LATE a target of 6.5% of HbA1C if achieved slowly over a few years, could provide good future outcomes
5) Gliclazide may have some role in late intervention ( In ADVANCE trial addition of gliclazide reduces the combined endpoint of micro and macrovascular events )
6) Insulin and sulfonylureas are used in UKPDS without any detrimental effect ( but these patients did not have pre-existing diabetic nephropathy )
Reference
Key landmark studies in the clinical management of type 2 diabetes: evolution or revolution?
D. R. Mat thews , Uni ted Kingdom
MEDICOGRAPHIA, Vol 33, No. 1, 22 2011
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