The Peptide CommonsEst. May 2024
Independent. We sell nothing and are affiliated with no manufacturer or pharmacy. Every moderation action is logged in public
Clinical · Special populations · continued

Type 1 diabetes: off-label use and the evidence gap — what changed since posts 61–78

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.

EC
excursion_checkTL3Regular24 Nov 2024#61
r.mensa, post #55: 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. Go to post

Noted, and I have changed what I was going to do on the strength of it.

0 likes in reply to #55 20mo
SV
s.vanheckeTL224 Nov 2024#62
k.redgrave, post #42: 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. Go to post

The thing about Type 1 diabetes that took me longest to accept is that a plausible mechanism is not evidence of an effect. It is a reason to look, not a result.

29 likes in reply to #42 20mo
TT
taper_tableTL3Regular25 Nov 2024#63

Body weight at the extremes of the studied range affects exposure and the trials rarely reported enough to say by how much.

10 likes 20mo
TV
t.verhoevenTL225 Nov 2024#64

Picking up post #63: that is the part I would want checked first.

Medullary thyroid carcinoma history: an absolute contraindication because of the preclinical findings in rodent toxicology. The history (personal or family, especially multiple endocrine neoplasia type 2) is an important screening question.

That is the practical version. The rigorous version is longer and says the same thing.

2 likes 20mo
LC
l.chevalierTL3Regular25 Nov 2024#65
lc_gradient, post #52: 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. Go to post

Where I part company with post #63, and it is a narrow parting.

Type 1 diabetes is a good example of a question where the honest answer is boring and the interesting answers are unsupported. I would go with boring.

0 likes in reply to #52 20mo
EM
e.mensaTL225 Nov 2024#66
m.ibarra, post #38: Answering the question post #36 raises rather than the one it answers. A definition problem is doing most of the work in this Type 1 diabetes discussion. Once the term is pinned down I suspect the disagreement mostly goes away and what is left is small. Go to post

Post #63 is the version of this I will quote in future. One addition.

I have been on both sides of the Type 1 diabetes argument in this category within eighteen months, which should tell you how strong the evidence for either side is.

22 likes in reply to #38 20mo
VD
vial_deskTL3Regular25 Nov 2024#67

Being outside the studied population does not mean a treatment is unsafe. It means the usual evidence is not available and the reasoning has to be explicit.

6 likes 20mo
AE
a.eriksenTL225 Nov 2024 · edited#68

Adolescents: a distinct evidence base exists. The compounds are not approved for routine adolescent obesity but are being studied. Adolescent physiology and psychology differ from adults' in ways that matter for this medication class.

1 like 20mo
NP
n.petrovTL225 Nov 2024#69
citation_peak, post #8: Building on post #7 rather than restating it. A note on how Type 1 diabetes gets discussed rather than on Type 1 diabetes itself: the confident posts get the replies and the careful ones get ignored, and the careful ones have been right more often. Go to post

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.

2 likes in reply to #8 20mo
MA
m.achebeTL225 Nov 2024#70

Sensible. I would want the same detail before I acted on it either.

0 likes 20mo
MM
methods_marginTL3Regular25 Nov 2024#71

Nothing in this subcategory is medical advice and the questions asked here are precisely the ones that need an individual assessment.

1 like 20mo
SC
s.chowdhuryTL3Regular25 Nov 2024 · edited#72
citation_peak, post #44: 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. Go to post

Post #68 put the caveat in the right place and I want to underline it.

I changed my mind about Type 1 diabetes after someone here asked me for the source and I could not produce one. That is worth saying out loud because it is the ordinary way it happens.

6 likes in reply to #44 20mo
I
IRenaudinTL2Member25 Nov 2024#73
p.marchetti, post #60: 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. Go to post

Acknowledging rather than arguing. The reasoning holds as far as I can follow it.

22 likes in reply to #60 20mo
KO
k.ogunleyeTL225 Nov 2024#74

The useful distinction on Type 1 diabetes is between what was measured and what was inferred from it. Both end up in the same sentence and only one of them has error bars.

0 likes 20mo
AT
a.thorneTL226 Nov 2024#75
JS
j.sandvikTL226 Nov 2024#76

Being outside the studied population does not mean a treatment is unsafe. It means the usual evidence is not available and the reasoning has to be explicit.

10 likes 20mo
CR
crossover_reviewTL3Regular26 Nov 2024#77
m.dalgaard, post #56: 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. Go to post

The arithmetic in post #74 is right; the assumption feeding it is the part to check.

On Type 1 diabetes, the part that usually goes wrong is that the question is asked as though it has one answer. It has a range, and the width of the range is the interesting bit.

If you can post the two or three numbers you are working from, several people here will check the arithmetic rather than argue about the conclusion.

30 likes in reply to #56 20mo
EB
e.bakkenTL226 Nov 2024#78

Two claims get bundled together under Type 1 diabetes and they need separating. The descriptive one — this is what was observed — is usually well supported. The causal one — this is why — usually is not.

Almost every disagreement in threads like this one dissolves once you say which of the two you are making.

0 likes 20mo

Suggested topics

TopicParticipantsRepliesViewsActivity
Older adults, sarcopenia risk, and the trade-off nobody quantifies — does this still hold?
Asking directly, because I could not find a straight answer: Older adults, sarcopenia risk, and the trade-off nobody quantifies — does this still hold? Older adults: setting out the arithmetic in full,…
EFBPWM 2 22k 11mo
Hepatic impairment and the absence of data — a second dataset
On the subject in the title: Hepatic impairment and the absence of data — a second dataset Working notes rather than a conclusion. Posting a small dataset on Hepatic impairment. It is mine, it is…
ACMODN 2 4.3k 4mo
Coming back to: Renal impairment: what the labelling says about dose
Renal impairment: what the labelling says about dose — setting out what I have, and where I think it stops being reliable. Renal impairment — I have the observation and I do not trust my interpretation of it,…
NGDBCTJROF+30 34 48k 18mo
Follow-up: History of disordered eating and why it changes the conversation
Posting this under the heading it deserves: History of disordered eating and why it changes the conversation Everything below is what sits behind that. What changes if the standard account of History of…
LWFDAIRMRN+75 81 23k 10mo
Second pass at: Pregnancy and pregnancy planning: contraindication and washout
Second pass at: Pregnancy and pregnancy planning: contraindication and washout Writing it up because I had to work it out twice and would rather nobody else did. Something about Pregnancy and pregnancy…
BTJCOHNT+111 127 1.6k 6mo

Related topics — sharing the tags adolescents, disordered eating, older adults

TopicParticipantsRepliesViewsActivity
Severe gastroparesis and why this class is a poor fit — one year on
Severe gastroparesis and why this class is a poor fit — one year on — setting out what I have, and where I think it stops being reliable. Asking about Severe gastroparesis directly, because I have read four…
ASBRACLSB+19 23 23k 7mo
When to stop reading forums, including this one — the long version
Asking directly, because I could not find a straight answer: When to stop reading forums, including this one — the long version Something that has come up for me and that I suspect is more common than the…
MISKBVDFBD+23 27 8.3k 14mo
Revisiting: Body image changing more slowly than the body
Posting this under the heading it deserves: Revisiting: Body image changing more slowly than the body Everything below is what sits behind that. What changes if the standard account of Body image is wrong? I…
JNCNSFOCPB+5 9 28k 8h
Renal impairment: what the labelling says about dose
On the subject in the title: Renal impairment: what the labelling says about dose Working notes rather than a conclusion. A methods question rather than a substantive one, about renal impairment. Everyone…
OVJPZOFKJB 4 8.9k 19mo
Older adults, sarcopenia risk, and the trade-off nobody quantifies
Older adults, sarcopenia risk, and the trade-off nobody quantifies — setting out what I have, and where I think it stops being reliable. Older adults: setting out the arithmetic in full, because I have had to…
VJSATYAJR+103 109 12k 5mo