July 29, 2013

Insulin's Place in Type 2 Diabetes Treatment

This is scientific research at its poorest. When it comes to certain oral medications and their comparison or companionship with insulin, researchers do not want to expend the resources required or the time. The drug companies, of course, will not admit that there is anything at fault with their drugs and therefore will not help with any funding. And then we have the self-anointed “experts” at the American Diabetes Association and the American Association of Clinical Endocrinologists saying that the oral medications are the first line of treatment for type 2 diabetes. When you examine the funds that the two associations receive from Big Pharma, you will understand why they would say this.

And when people will make statements like this, “In some cases, insulin is the only therapeutic option remaining,” what does this tell us? Bold is my emphasis. This has to mean that doctors have waited too long to switch to insulin therapy and have forced patients to remain on oral medications longer than should have been used. Not only have doctors done harm to patients, they don't seem to care if they can avoid prescribing insulin. This is why we need more research and well funded research to identify people that have been kept on oral medications too long.

We also need research to identify problems researchers are loathe to do because they might learn something that could prevent certain oral medications from being used with insulin.

In this study, an epidemiologic analyses, they are able to establish associations between medications and outcomes, but they can never be completely positive that the findings are unbiased. Even though many covariates were included, such as the duration and glycemic control of diabetes, one factor is fairly important, the risk of each individual outcome produced similar results suggests 1 of 3 possibilities. These are that the residual confounding remains, the outcomes are associated with each other, or that they share the same causing event.

In this, the researchers blame insulin and quote previous studies for what they lack in results and then they do what is expected for a lackluster study and say that caution is warranted and demand further study. This tells me that their study was flawed to begin with and not well planned. Why they received funding for these flawed studies still remains a mystery and why the group or committee overseeing the funding allowed the study needs investigation. Funds for studies will continue to be short in the current economy, yet poorer and more faulty studies are being funded.

As a side note, it is interesting that metformin plus insulin went a long way to lessening the increased risk found in insulin monotherapy. This may be the impetus for continuing to add metformin when insulin therapy becomes necessary.

In a recent blog here, I discussed PCORI. PCORI is the Patient-Centered Outcomes Research Institute, and is a new federal institute mandated to figure out how meaningfully to involve patients in research. Under PCORI, patients will have the rare opportunity to help make decisions about what research is conducted, some of the design, and to be involved in the research activity from the beginning. After all, isn't it the patients with the disease that have the most at stake and the largest to gain from research?

I also think there is much to be gained from research conducted under PCORI. This may also open the door to putting patients on some committees overseeing funding approvals at academic centers that are currently mishandling research funds for poorly constructed studies. I can envision patients with the disease being placed on funding boards and in other capacities for oversight.

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