Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus
Authors: Michael J. Barry, Linda L. Humphrey, Amir Qaseem
Journal: Annals of Internal Medicine (2017)

Letters4 July 2017Oral Pharmacologic Treatment of Type 2 Diabetes MellitusMichael J. Barry, MD, Linda L. Humphrey, MD, MPH, and Amir Qaseem, MD, PhD, MHAMichael J. Barry, MDFrom Massachusetts General Hospital, Boston, Massachusetts; Oregon Health and Science University, Portland, Oregon; and American College of Physicians, Philadelphia, Pennsylvania.Search for more papers by this author, Linda L. Humphrey, MD, MPHFrom Massachusetts General Hospital, Boston, Massachusetts; Oregon Health and Science University, Portland, Oregon; and American College of Physicians, Philadelphia, Pennsylvania.Search for more papers by this author, and Amir Qaseem, MD, PhD, MHAFrom Massachusetts General Hospital, Boston, Massachusetts; Oregon Health and Science University, Portland, Oregon; and American College of Physicians, Philadelphia, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L17-0234 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Drs. Inzucchi and Kosiborod question what outcomes are most important in trials of management of type 2 diabetes. We agree that intermediate outcomes, such as hemoglobin A1c levels, are less relevant to patients than the micro- and macrovascular complications of diabetes. We were struck that the systematic review on which our guideline was based, with searches through December 2015, showed that relatively little comparative effectiveness data were available on these outcomes, especially for older, less expensive oral medications for diabetes (1, 2). In addition to fewer hypoglycemic episodes, evidence of reduction in all-cause and cardiovascular mortality (and a ...References1. Maruthur NM, Tseng E, Hutfless S, Wilson LM, Suarez-Cuervo C, Berger Z, et al. Diabetes medications as monotherapy or metformin-based combination therapy for type 2 diabetes: a systematic review and meta-analysis. Ann Intern Med. 2016;164:740-51. [PMID: 27088241]. doi:10.7326/M15-2650 LinkGoogle Scholar2. Qaseem A, Barry MJ, Humphrey LL, Forciea MA; Clinical Guidelines Committee of the American College of Physicians. Oral pharmacologic treatment of type 2 diabetes mellitus: a clinical practice guideline update from the American College of Physicians. Ann Intern Med. 2017;166:279-90. [PMID: 28055075]. doi:10.7326/M16-1860 LinkGoogle Scholar3. Zinman B, Wanner C, Lachin JM, Fitchett D, Bluhmki E, Hantel S, et al; EMPA-REG OUTCOME Investigators. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373:2117-28. [PMID: 26378978] doi:10.1056/NEJMoa1504720 CrossrefMedlineGoogle Scholar4. GRADE. Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study. 2017. Accessed at https://portal.bsc.gwu.edu/web/grade on 28 February 2017. Google Scholar5. A comparative effectiveness study of major glycemia-lowering medications for treatment of type 2 diabetes (GRADE). ClinialTrials.gov: NCT01794143. Accessed at https://clinicaltrials.gov/ct2/show/NCT01794143 on 28 February 2017. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Massachusetts General Hospital, Boston, Massachusetts; Oregon Health and Science University, Portland, Oregon; and American College of Physicians, Philadelphia, Pennsylvania.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1860. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoOral Pharmacologic Treatment of Type 2 Diabetes Mellitus: A Clinical Practice Guideline Update From the American College of Physicians Amir Qaseem , Michael J. Barry , Linda L. Humphrey , Mary Ann Forciea , and Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus Silvio E. Inzucchi and Mikhail Kosiborod Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus David S.H. Bell Metrics Cited byYogliptin monotherapy in type 2 diabetes: A 12‐week randomized, double‐blind, placebo‐controlled phase II studyEfficacy and safety of DBPR108 monotherapy in patients with type 2 diabetes: a 12-week, randomized, double-blind, placebo-controlled, phase II clinical trialRELATIONSHIP BETWEEN OBSTRUCTIVE SLEEP APNEA AND THE PRESENCE AND SEVERITY OF DIABETIC RETINOPATHY 4 July 2017Volume 167, Issue 1Page: 75-76KeywordsDisclosureDrugsHemoglobinInsulin-like growth factorsMortalityPatient advocacyProtease inhibitorsRandomized trialsSystematic reviewsType 2 diabetes ePublished: 4 July 2017 Issue Published: 4 July 2017 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...