Type 1 diabetes: off-label use and the evidence gap — what changed since posts 31–60
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1 · go to the accepted answer.
Almost every population discussed here was excluded from the pivotal trials, which means the evidence base is observational at best and absent at worst.
Speaking for myself and not for anyone else who has posted here.
Adolescent evidence exists for some compounds in this class and is a separate approval decision with its own trials rather than an extension of the adult data.
I am reporting what happened, not recommending it.
Post-surgical populations, particularly after procedures affecting the gastrointestinal tract, interact with a delayed-emptying mechanism in ways that need specialist input.
Someone should write this up properly, and it should probably not be me.
The most useful contribution here is usually a citation to whichever published document comes closest, with a plain statement of how far it is from the question.
I would want the raw data before agreeing with my own summary of it.
Filing a mild objection to the consensus on Type 1 diabetes. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit.
Everything in post #37 holds. The case it does not cover is the one I have.
Type 1 diabetes would be much easier to settle if anyone reported the denominator. Almost nobody reports the denominator.
Collapsed as off-topic by two members at trust level 3 or above
Athletes and people in substantial training loads are effectively unstudied, and the questions asked here about performance have no trial evidence behind them at all.
The literature is thinner on this than the confidence in the thread implies.
I think the Type 1 diabetes question is answerable and has not been answered, which is a more optimistic position than most of this thread.
Where the Type 1 diabetes reasoning breaks down for me is the step from the group result to the individual case. That step is almost never argued for.
Right, and stated more narrowly than I would have dared to state it.
Collapsed as off-topic by two members at trust level 3 or above
Body weight at the extremes of the studied range affects exposure and the trials rarely reported enough to say by how much.
Adding the measurement that post #47 says would settle it.
I would rather this thread reach "we do not know" about Type 1 diabetes than reach a confident answer that nobody can support when asked.
I will take the caveat as seriously as the claim, which is the point of putting it there.
Type 1 diabetes is well covered in the tag pages, and the older discussions are better than the recent ones because they were argued out properly. Worth twenty minutes before adding to this one.
Pregnancy and planning: these compounds are not approved for use in pregnancy. Planning windows (how long to wait before attempting pregnancy) are not formally established. Conservative approaches wait several months to allow clearance.
Confirming post #52 from a second method, which matters more than confirming it from a second person.
Genetic and ancestry-related differences in response are asked about regularly and the published evidence is thin enough that the honest answer is short.
I have left out the parts I could not verify.
I had written a reply contradicting post #54 and deleted it. Here is what survived.
The absence of a reported signal in a population that was barely enrolled is not evidence about that population.
Reading it again, the caveat matters more than the finding.
Taking Type 1 diabetes seriously for a moment rather than deflecting: the honest position is that the community has observations and no controlled comparison, and those two things support very different sentences.
Extrapolating a point estimate to somebody well outside the enrolled range should be described as an extrapolation every time it is done.
The version of Type 1 diabetes that circulates here is a simplification of a simplification. It is not wrong, but it has lost the conditions under which it holds, and those conditions are where the interesting cases live.