It only within the last few months that I have been made aware of the huge scandal that arises from the promotion, sales and use of the painkillers, opioids in the USA. It has been described by Time Magazine as “the deadliest drug crisis in American history”. Overdoses of this drug are responsible for the deaths of almost 100 people every day. Since 1999, the number of these deaths has quadrupled. In 2015, drug overdoses caused more deaths than road traffic accidents and gun violence. In 2016, there were nearly 64,000 deaths due to drug overdoses, which roughly the same number of deaths due to the entire Vietnam, Iraq and Afghanistan wars combined. According to the Centers for Disease Control, opiods have contributed to a reduction in life expectancy in the USA between 2000 and 2015. It all started in 1995 with a prescription painkiller, OxyContin, developed by Purdue Pharma, a privately-owned company (1). At the time, it was regarded as a major breakthrough, because it was long-lasting and would therefore help patients suffering from moderate to severe pain. However, it has been controversial from the beginning because it is closely related to heroin and can be much more powerful than morphine. Traditionally doctors have been reluctant to prescribe opioids because of genuine fears that they are likely to be addictive. David Kessler, who is a former commissioner of...Read More
For some time, I have been urging Diabetes UK to take account of the work of Dr David Unwin, the Southport GP, who has been extremely successful in treating those with T2D. As a result, he has achieved national and international recognition. In 2016, Dr Unwin was selected as NHS Innovator of the Year. Within the last few days, I have been informed that a poster he presented at a Diabetes UK conference by Dr Unwin has been awarded a prize. So perhaps this would be a good time to compare the approach adopted by Dr Unwin with that of Diabetes UK. Dr Unwin The most significant fact to emerge is that those who follow the advice of Dr Unwin are so often successful. In a paper published in 2016, Dr Unwin presents the results for 68 out of 69 patients who had completed an average of 13 months, in which they had complied with the lifestyle advice (1). Patient satisfaction was high from reports of feeling better and having more energy. Mean body weight fell by 9.0 kg, waist circumference fell by 15 cm, blood glucose (BG) control measured as HbA1c, fell by 10 mmol/mol or 19%, liver function measured as serum glutamyl transferase (GGT) improved by 39% and total cholesterol (TC) fell by 5%. Systolic and diastolic BPs dropped significantly too. Plasma triglycerides were not measured, but...Read More
304. Sulphonylureas increase cardiac deaths but are still recommended for use after Metformin in type two diabetics in Scotland.
This article is by kaitiscotland and was first published on 15th February 2018. The original article can be sourced here: diabetesdietblog.com/2018/02/15/sulphonylureas-increase-cardiac-deaths-but-are-still-recommended-for-use-after-metformin-in-type-two-diabetics-in-scotland/ I am most grateful to Emma Baird for permission to re-post on this blog. Background After the cardiovascular issues with rosiglitazone, cardiovascular safety trials had to be conducted for all new anti-hyperglycemic agents. However, approval for older medications was based simply on evidence of a reduction in glucose parameters; cardiovascular safety was not a concern back then. But, data from the UKPDS trial shows that metformin reduces CV events, so, it was never in doubt (1). The ORIGIN trial has shown no increased harm with early initiation of insulin (2). However, some questions linger regarding the cardiovascular safety profile of sulfonylureas. Data exist on the weight gain and risk of hypoglycemia associated with sulfonylureas, but the associated cardiovascular events have not been well-quantified. Sulfonylureas are used commonly across the world and are very effective in lowering HbA1C, but often the effect wears off, as shown in the ADOPT study. Doubts about the use of sulphonylureas as treatment for Type 2 Diabetes (T2D) Recent randomized trials have compared the newer antidiabetic agents to treatments involving sulfonylureas, drugs associated with increased cardiovascular risks and mortality in some observational studies with conflicting results (3). They reviewed the methodology of these observational studies by searching MEDLINE from inception to December 2015 for...Read More
How often are we told that a specific drug is wonderful and is therefore essential if a disease is to be treated successfully or to be prevented. The hard reality is that this begs an awful lot of questions and is only one minor aspect of the information that anyone considering the use of the drug should fully appreciate. I suggest that most people would be interested in the following issues: What are the chances that the person will benefit? Most people assume that any drug will have a beneficial effect if/when the drug is taken. In fact, there are extremely few where the likelihood is 100% certain that it will work for all. It is important to understand the “Number Needed to Treat (NNT)”. This is the number of people who have to be treated for ONE to benefit. In those who have had previous heart disease the NNT website concludes that after 5 years of daily statin therapy study subjects achieved a 1.2% lower chance of death, a 2.6% lower chance of heart attack, and a 0.8% lower chance of stroke (1). Or to put it another way 19 out of 20 people who took the drugs for five years saw no effect. The other side of the coin is that there are risks of side effects, which can be damaging to a person’s health. This is...Read More
I have just been reading a paper published in 1999, which considers data from the UK Prospective Diabetes Control (UKPDS) (1). It is based on the results of patients who have been advised to alter their diet and/or be treated with different drugs. The focus is on the blood glucose (BG) and glycated haemoglobin (HbA1c) levels. Those who have an HbA1c of 7% or less are regarded as successful. The patients were followed for up to 9 years. Treatments Patients were encouraged by a dietitian to consume a diet that was low in fat, high in carbohydrates and high in fibre. The results for the different treatments are shown in Table 1. Table 1. The proportions of patients that achieved HbA1c lower than 7% as the study progressed. HBA1c < 7% 3 years 6 years 9 years Diet 25 12 9 Insulin 47 37 28 Chlorpropamide 53 39 28 Glyburide 47 29 20 Sulphonyl urea 50 34 24 Values are expressed as percentages of those who commenced the treatment. What comes through here very clearly is that without exception the diet and all the drug treatments were not successful in the long term. It is clear that the proportion that manage to stay below the 7% HbA1c decreased with time. So essentially what this means is the disease deteriorates with time for most of the patients. As...Read More
- 306. Opioids
- 305. A Comparison between the approaches to Type 2 Diabetes (T2D) by Dr David Unwin and Diabetes UK
- 304. Sulphonylureas increase cardiac deaths but are still recommended for use after Metformin in type two diabetics in Scotland.
- 303. Statins: Why it is crucial to have a comprehensive picture
- 302. The Conventional Treatment of Type 2 Diabetes (T2D)
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