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Another Guideline, This One's For Diabetes

Friday, October 29, 2010 // Uncategorized

10/29/2008 12:00:00 AM

We have lot’s of guidelines in medicine.  If you have high cholesterol or diabetes we have recommendations on where you cholesterol or blood glucose should be.  What we don’t know is are the ways to getting to goal of equal benefit?  For example, we know that Vytorin ( simvistatin  or Zocor plus ezitimbe or Zetia) works better at lowering cholesterol than simvistatin alone.  We don’t know if outcomes are better.  That is, we don’t know if patients will have fewer heart attacks and live longer with Vytorin thansimvistatin).  Similarly, with diabetes, we have newer medications which can get the blood glucose down (and are much more expensive), but we don’t know if patients have better outcomes.  With Rosiglitazone (Avandia) patients had more cardiac events and, according to the guidelines, it is no longer recommended.  The amount spent on diabetic medication has skyrocketed and the newer drugs may not pan out to be better.

ADA Updates Algorithm for Management of Hyperglycemia in Type 2 Diabetes
The American Diabetes Association and the European Association for the Study of Diabetes have updated their 2006 consensus statement for managing hyperglycemia in type 2 diabetes. The newer version, in Diabetes Care, includes additional information on thiazolidinediones.
Among the updates:
Exenatide or the thiazolidinedione pioglitazone may be considered for patients in whom hypoglycemia is particularly undesirable, such as those holding hazardous jobs.
Rosiglitazone, which has been linked to increased risk for MI, is no longer recommended.
The groups continue to advise the following:
Patients should strive to achieve and maintain hemoglobin A1c levels under 7%.
At diagnosis, physicians should begin treatment with lifestyle intervention and metformin.
If that regimen does not achieve or sustain the glycemic goals, then additional medications (e.g., sulfonylureas, basal insulin) should be started within 2 to 3 months.
If the above therapies do not work, then insulin should be started or, if already begun, intensified.
Diabetes Care article (Free PDF)

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