Wednesday, September 17, 2008

Benefits and safety of diabetes drugs

In a Perspective piece in this week’s NEJM Allison B. Goldfine, MD offers nuanced suggestions for regulatory policy and research.

If you’re having trouble sorting through the morass of opinions and controversies or don’t have the inclination or the time to read extensively on the subject, don’t worry. I’ve done it for you. Here’s the quickest read I can offer. It’s a bit of an oversimplification but it doesn’t completely distort:

The benefits of drugs to achieve glycemic control in type 2 diabetes must be considered in the perspective of time-----

Days to weeks---> Relief of polyuria, visual blurring, dehydration.

Years---> Microvascular benefit. Magic number for Hgb A1C= 7. Enhanced by blood pressure control, agent specific.

Decades---> Macrovascular benefit. Magic number= 7. Enhanced by blood pressure control, diet, exercise and drugs to manage insulin resistance and dyslipidemia.

There you have it.

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