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Thursday 31 March 2016

Diabetes meds vary in safety and effectiveness, study shows

(HealthDay)—A study of nearly a half-million people with type 2 diabetes shows there are pros and cons to nearly every form of drug therapy for the disease.

In the British study, researchers looked at patient outcomes from a large U.K. database of almost 470,000 adults with type 2 diabetes, tracked between 2007 and 2015.

Julia Hippisley-Cox and Carol Coupland, of the University of Nottingham, sought to parse out differences among a variety of diabetes drugs. They accounted for complicating patient factors such as age, sex, smoking and poverty, as well as how long a person had been diagnosed with type 2 diabetes.

The researchers also focused on five major outcomes linked to diabetes: blindness, amputation, severe kidney failure, and high or low blood sugar.

Reporting March 30 in BMJ, they found that when a class of drugs called glitazones (Actos, Avandia) was prescribed along with the standard diabetes drug metformin, there was a higher risk for kidney failure than with metformin alone.

The same was true when another class of meds called gliptins (Januvia, Onglyza and others) was combined with metformin.

However, there were "up" sides to these drug combos as well. People who took a gliptin or a glitazone plus metformin had "significantly lower" risks for high blood sugar than those who took metformin alone, the research found.

Finally, the study looked at "triple" therapy: patients taking metformin, a gliptin or a glitazone, and a sulphonylurea, another type of diabetes drug. This combination was linked to "significantly higher" odds for episodes of potentially dangerous low blood sugar, the British researchers said, compared to people taking metformin alone.

On the other hand, triple-therapy users had a reduced risk for diabetes-linked blindness, compared to the metformin-only group.

The study doesn't establish direct cause-and-effect relationships between the various drugs and these outcomes. Still, according to experts, the findings support the notion that diabetes care is never a "one-size-fits-all" endeavor.

"There are many treatment options for diabetes—they have the benefit of lowering blood sugar levels, but they also carry risk," said Dr. Robert Courgi, an endocrinologist at Northwell Health's Southside Hospital in Bay Shore, N.Y.

He said that standard guidelines typically list metformin as a first-line therapy against type 2 disease, but additional drugs may be needed. "Ultimately, the physician and the patient need to work together to find the best treatment possible," Courgi said.

Dr. Gerald Bernstein coordinates the Friedman Diabetes Program at Lenox Hill Hospital in New York City. He believes the field of diabetes care is constantly evolving.

"Treating type 2 diabetes used to be like a singles pingpong game—give a pill, lower blood sugar," he said.

However, "over the last 75 years or so we have learned that it is more of a team effort, because the process of safely lowering blood sugar is more complicated than previously thought," Bernstein explained. "The goal of treatment for all diabetes is to prevent complications and have a high quality of life."

Different medications have different targets and effects, he said, and "the art of treatment today mixes and matches these medications depending on age, weight, activity."

http://medicalxpress.com

Ditch the drugs go Low Carb and achieve the desired results without the side effects simples

Graham

9 comments:

Anonymous said...

So you think Bernstein is wrong?
He is well respected, and his view is

"the art of treatment today mixes and matches these medications depending on age, weight, activity."

You state to ignore that advice, and simply to ditch all medicine regardless?

You have proof that is the safest option?

Lowcarb team member said...

Anonymous said...
So you think Bernstein is wrong?
He is well respected, and his view is


Nope I have the utmost respect for Dr Bernstein

"the art of treatment today mixes and matches these medications depending on age, weight, activity."

I'm sure the good Dr would use Low Carb as the first option for treatment of T2, drugs would be a last resort, and again I feel sure some of those in the study he would be reluctant to prescribe due to their poor safety and efficiency. That said going against the usual prescribed diet and restricting carbs would in most cases negate the need for these medications

You state to ignore that advice, and simply to ditch all medicine regardless?

You have proof that is the safest option?


Proof as in my eight year T2 journey still only medication metformin and I'm not alone many others have reduced or eliminated medications after switching to Low Carb, I have yet to see any convincing evidence that my diet is in anyway unsafe, conversely there are many studies questioning the safety and efficiency of medications most of which are useless as stand alone therapy and are often used in combination with metformin.

Questions for you now, do you have proof that Low Carb is in any way unsafe? Or that a multi meds regime to counter a higher carb diet is a safer option

Graham

Anonymous said...

'I'm sure the good Dr would use Low Carb as the first option for treatment of T2,'

So, guess work and speculation, and you presume to speak for the good Dr Bernstein you claim to respect?

'Proof as in my eight year T2 journey still only medication metformin'

So, you haven't chosen to follow your own advice, it's others you advise should 'ditch the drugs', but you choose to continue with them yourself?
You choose not to follow even the first choice you presume Dr Bernstein would advise?

An interesting, if hypocritical viewpoint.

Anonymous said...

I do love this website - so informative, up to date, relevant and variable in content! This is the first website I check of a morning - with a nice warm cup of tea! Great work! Have a great day and enjoy the sunshine - summer is nearly here! Kath

Anonymous said...

This report features Dr Gerald Bernstein
Gerald Bernstein, M.D., F.A.C.P. graduated from Dartmouth College and Tufts University School of Medicine. He is board certified in internal medicine (1966) and endocrinology and metabolism (1973). He entered practice in 1966 after completing a research fellowship. Dr. Bernstein is an associate clinical professor at the Albert Einstein College of Medicine in New York.
https://www.sharecare.com/doctor/dr-gerald-bernstein

Not to be confused with Dr Richard Bernstein
Dr. Bernstein has been a diabetic for 69 years — since the age of twelve. He was trained as a management engineer and had been a business executive most of his life. In 1969, while suffering from a number of the complications of this disease, he desperately sought a a means for normalizing his own blood sugar. He aquired a device used in emergency rooms to measure blood sugars at night when the labs were closed. He then began to measure his blood sugar throughout the day, hoping to find what made it go up and down. This led to the development of “self-monitoring of blood glucose”, a simple procedure that uses one drop of finger tip blood. The technique has since become widely accepted by the medical profession throughout the world.

Dr Bernstein has authored six of the leading books for diabetics who are interested in controlling their blood sugar to prevent the complications of diabetes. The two most recent books, Diabetes Diet, and Diabetes Solution are used by people across the world to help them in their quest to normalize their blood sugars.
http://www.diabetes-book.com/about/

Richard K. Bernstein is a physician and an advocate for a low-carbohydrate diabetes diet to help achieve normal blood sugars for diabetics. Bernstein has type 1 diabetes
https://en.wikipedia.org/wiki/Richard_K._Bernstein

As a previous comment said I do love this website - so informative, up to date, relevant and variable in content!

Hear hear!

Low Carb Fan

Snowbird said...

How interesting. I'll have to lose the fruit juice!xxx

Lowcarb team member said...

Anonymous said...
'I'm sure the good Dr would use Low Carb as the first option for treatment of T2,'

So, guess work and speculation, and you presume to speak for the good Dr Bernstein you claim to respect?


I don't claim to speak for Dr Bernstein don't think he needs any help with that, what I did say I have the "utmost respect for him" and all he has achieved

'Proof as in my eight year T2 journey still only medication metformin'

So, you haven't chosen to follow your own advice, it's others you advise should 'ditch the drugs', but you choose to continue with them yourself?
You choose not to follow even the first choice you presume Dr Bernstein would advise?

An interesting, if hypocritical viewpoint.


Yes I take 1x500mg metformin daily keeps my DSN happy as she wanted me to use it for the extra health benefits it's supposed to bring see here

Hardly hypocritical when the effects of one metformin is not going to make a big impact on A1c the LC diet sees to that.

As you seem in favour of the dual and triple therapy's with somewhat dubious drugs shown in my post can I take it your one of the "carb up and shoot up" enthusiasts

Graham

Lowcarb team member said...

@Low Carb Fan

Thanks for your comment couldn't agree more

Cheers
Graham

chris c said...

Astonishing isn't it, take a bunch of drugs that cause heart disease, make you piss your bones down the toilet, burn out the remaining beta cells, but don't whatever you do reduce your carbs, that's REALLY DANGEROUS!