Type 2 Diabetes Drugs: 2 Leaders Debate

Medicines
1

Two top influencers with opposing viewpoints debate.

A lively and informative 3-part debate from Endo Sessions 2017, Chicago, 02 April 2017 (audio, video and slides available, gratis)

Heads-up, @docslotnick :slight_smile:

The Diabetes Dilemma: How to Treat Type 2 Diabetes?

The New Drugs: Are We Benefitting Anyone Other Than Pharma?
David M. Nathan, MD
Harvard Medical School,Massachusetts General Hospital

New Drugs for Diabetes: True Innovation with Real Patient Benefits
Daniel J Drucker, MD
Mt. Sinai Hospital, Toronto, ON

Debate Rebuttals and Moderated Q&A
Gordon C. Weir, MD
Joslin Diabetes Center/Harvard Medical School

Keywords:
insulin, metformin, SGLT-2 inhibitors, TZDs, sulfonylurias, DPP-4 inhibitors, GLP-agonists, insulin analogs, combinations, insulin resistance, monotherapy, polypharmacy, NPH, regular, Apidra, Novolog, potency, cost, affordability, effectiveness, pharma, side effects, adverse effects, DCCT, UKPDS, DCCT-EDIC, ACCORD, ADVANCE, VADT, Kumamoto, liraglutide, semaglutide, empaglifozin, MACE, CVD, biguanides, GLP-1 agonists, basal, rapid-acting, amylinhmimetics, Symlin, UTI, URI, yeast infection, pramlintide, hypoglycemia, lacticacidosis, pancreatitis, DKA, Invokana, risks versus benefits, patent protection, directc advertising, me-too drugs, bladder cancer, black box warnings, pharma, generic, GRADE, comparative effectiveness, personalized medicine, demagraphics, individualized therapy, hypoglycemia, bias, treat-to-target, high risk groups, elderly, post-MI, primary care, endocrinology, step-wise approach, clinicsl inertia, FDA approval process, complications, polys, study flaws, confounding factors, placebo, absolute risk reduction, ethics, fda approval process,

Note: FDA Approval Process –
Silent MIs excluded from one study!

1 Like
2

Thank you @britt_j for the link to this symposium.

I pretty much come down on the side of Dr. Drucker. I don’t like the sourceless stats that Dr. Nathan was using ( they may be right, they may be wrong, but the ©D. Nathan on all the slides is problematic).

But Dr. Nathan is certainly correct on one point–the pharma industry is broken. Drug costs are too high without cause. But that is not the fault of the drug, as Dr. Nathan is trying to argue.

EDIT: @britt_j I’ve been thinking more about this. I’m also astounded that Dr. Nathan would effectively label “individualized patient care” as a pipe dream. He could not be more wrong. In our current health care environment that has been so bastardized by overt government interference, it may be true. But that is why we must work to change it!

Also his feeling that modern drugs may have more of an effect on other conditions, why is this a bad thing? Case in point: 27 years ago under the care of a gp, I had uncontrollable hypertension and uncontrollable hypokalemia. Thankfully I went to see an endocrinologist. He diagnosed bilateral adrenal hyperplasia.

I had been taking HCTZ, and two other antihypertesives I can’t remember ( I was being switched about every two months to find the “right” combination by the gp).

The endo put me on spironolactone, which is usually prescribed as an antihypertensive but was to control the adrenal hyperplasia. Additionally he only left me with amlodopine. My BP stabilized at about 130/80. So he put me on an ACE inhibitor, not so much for BP control as much as for kidney protection because I am diabetic.

BY Dr. Nathan’s reasoning ACE inhibitors are less valuable antihyprtensives because the have a profound effect on kidney health! How wrong headed is this? And back to the point of individualized care, isn’t my example one of the absolute benefit of it?

2 Likes