Intensive glycaemic control does not reduce mortality in type 2 diabetes

Lots of different pills

More isn’t necessarily better.  This seems true in respect of glycaemic control in type 2 diabetes. More intensive control risks additional hypoglycaemia, where less intensive control risks long term complications. An updated Cochrane systematic review looked at the impact of tighter or intensive glycaemic control on overall mortality. Methods The reviewers searched bibliographic databases, the [read the full story…]

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Review finds no evidence for topiramate in treating neuropathic pain

Unhappy woman

Diabetic neuropathy is a common complication of diabetes.  This condition is very painful and substantially compromises quality of life.  Its progressive nature places a further burden on patients and their carers. Current guidance recommends a range of possible drug treatments, including the antidepressant drugs amitriptyline or duloxetine and the anti-convulsant pregabalin.  A recent Cochrane review [read the full story…]

Metformin appears to be safe in diabetic patients with heart failure

ECG readout

Heart failure is more prevalent in diabetes than in the general population.  All too often, patients with such serious co-morbidities are excluded from clinical trials.  As a result, there remains uncertainty around the benefits of diabetes medications in these sub-groups of patients.  Often, we need to look at observational data to get the best available [read the full story…]

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More evidence needed for ADP-antagonists to prevent CVD in type 2 diabetes

ECG readout

This Cochrane systematic review looked at whether adenosine-diphosphate (ADP) receptor antagonists such as clopidogrel and ticlopidine,  can prevent cardiovascular disease (CVD) in type 2 diabetes mellitus. These drugs have been shown to reduce the risk of cardiovascular outcomes in non-diabetic patients.  However, few studies have looked at the diabetic population.  As people with type 2 [read the full story…]

High-dose atorvastatin did not cause diabetes in low-risk patients with existing cardiovascular disease

Atorvastatin molecule

The Diabetes Elf once overheard a respected senior colleague: “The only treatments that don’t have any side-effects are the ones that don’t work.” So it turned out with statins, which were recently found to have increased the risk of developing type 2 diabetes.  The questions, of course, is “Are the benefits worth the harms?”  In [read the full story…]

Emerging evidence about the impact of different statins on the risk of diabetes

A pill

Recent evidence has shown that statins can increase the incidence of new-onset diabetes, leading to an official warning by the FDA.  This has huge implications for practice, as these drugs are widely used to reduce the risk of cardiovascular disease in patients with and without diabetes.  Selecting the right treatment and balancing the proven benefits [read the full story…]

Insufficient evidence of benefit for colesevelam in glycemic control in type 2 diabetes

Another drug for type 2

Colesevelam is a bile acid sequestrant drug that was originally approved in the US for the treatment of hyperlipidaemia.  It was subsequently found to help improve glycaemic control in type 2 diabetes.  This dual benefit offers significant potential in reducing the risk of complications in T2.  This Cochrane systematic review set out to summarise all [read the full story…]

Welsh NHS recommends saxagliptin as an option in type 2 diabetes

The All Wales Medicines Strategy Group has published a recommendation regarding saxagliptin, the DPP-4 inhibitor (Onglyza®) Saxagliptin is recommended as an option for use within NHS Wales for the treatment of adult patients aged 18 years and older with type 2 diabetes mellitus to improve glycaemic control in combination with insulin (with or without metformin) [read the full story…]

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Intensive blood pressure control prevents strokes in diabetic patients with hypertension

Sphygmomanometer

What target, if any, should we aim for in treating hypertension in patients with type 2 diabetes? Clinical question: In type 2 diabetes with hypertension, is intensive treatment, compared with less intensive treatment, effective at reducing the risk of stroke, death or other cardiovascular events? Intensive treatment was defined as a target maximum of 130 [read the full story…]

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Review finds weak evidence favouring moderate blood sugar targets in diabetic women during pregnancy

Taking a blood test during pregnancy

Women with diabetes are known to have a higher risk of adverse pregnancy outcomes, including birth defects and pre-eclampsia, compared with non-diabetic women. NICE recommends that pregnant diabetic women aim for a fasting blood glucose between 3.5 and 5.9 mmol/litre and 1-hour postprandial blood glucose below 7.8 mmol/litre. However, this guidance was issued in 2008 and is [read the full story…]

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