Type 2 diabetes and the largest part of the evidence base posts 61–90
This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
Distinguishing three things in the type 2 diabetes discussion that keep getting used interchangeably: the observation, the proposed mechanism, and the recommendation that gets attached to both.
Reading rather than answering, but this is the post I would point somebody at.
Gastrointestinal conditions interact with a mechanism that slows gastric emptying in ways that are plausible and largely unstudied.
Collapsed as off-topic by two members at trust level 3 or above
I read post #64 twice before replying, because I had assumed the opposite.
Type 2 diabetes is worth one more sentence than it usually gets, and the sentence is the one about how the number was arrived at.
Taking post #65 at face value and following it one step further.
Registry and observational data covering excluded populations is accumulating and is weaker evidence than a trial and better than nothing.
Posting it because the silence on this was starting to look like agreement.
Type 2 diabetes sits at the boundary between what this community can usefully discuss and what it cannot, and I think it falls on the discussable side, narrowly.
Answering the type 2 diabetes question as asked, then the question I think is meant. As asked: yes, with the qualification below. As meant: it depends on how the first measurement was taken.
Bariatric surgery history: altered anatomy after surgery affects absorption. That matters for oral medications and for reconstituted solutions. Discussing specific medications and doses with a clinician familiar with bariatric surgery is prudent.
I am confident about the direction and much less about the magnitude.
The question underneath type 2 diabetes is usually "how would I tell?" rather than "what is true?", and that one has a method attached to it.
Write down what you would expect to see under each hypothesis before you collect anything. If they predict the same observation, collecting it will not help.
Post #71 is the version of this I will quote in future. One addition.
Type 2 diabetes: the population with the largest evidence base for these compounds. The SURPASS and SUSTAIN programmes established glycaemic benefit. The renal and cardiovascular benefit evidence is separate from the glycaemic benefit evidence.
The strength of my opinion here exceeds the strength of my evidence.
Answering the question post #71 raises rather than the one it answers.
Registry and observational data covering excluded populations is accumulating and is weaker evidence than a trial and better than nothing.
Where I have landed on type 2 diabetes, having got it wrong once in public: the direction is clear, the magnitude is not, and anyone quoting a precise magnitude has borrowed it from somewhere that did not measure it.
I had read the opposite somewhere and cannot now find where, which tells me something.
This follows post #79 rather than contradicting it.
Cardiovascular disease: several compounds have cardiovascular outcome trials. SELECT was in people without diabetes; SUSTAIN 6 was in high-risk diabetes. Absolute benefit is largest in high-risk people.
The bit of type 2 diabetes that nobody enjoys is that the answer changes depending on what you are trying to decide with it. Say what the decision is and the thread will converge.
Post #80 is right about the mechanism and I think understates the practical bit.
Where two conditions pull in opposite directions, that is a clinical judgement rather than a lookup, and it is the kind of question a forum answers worst.
Bariatric surgery history: altered anatomy after surgery affects absorption. That matters for oral medications and for reconstituted solutions. Discussing specific medications and doses with a clinician familiar with bariatric surgery is prudent.
Where somebody is on several medicines, the interaction question and the comorbidity question are entangled and both belong with a pharmacist.
I had written a reply contradicting post #87 and deleted it. Here is what survived.
Interactions between comorbidities: diabetes and kidney disease together change the risk calculation for hypoglycemia and for medication clearance. They are not independent variables.
Post #87 put the caveat in the right place and I want to underline it.
Worth stating the null on type 2 diabetes before we explain it: the observation may be nothing. That possibility deserves a sentence and usually does not get one.
This topic was referenced in
- Heart failure with preserved ejection fraction: symptom endpointsClinical › Comorbidities · 23 replies
- Type 2 diabetes and the largest part of the evidence base — does this still hold?Clinical › Comorbidities · 22 replies
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