Glycemic Therapy for Type 2 Diabetes: Choices Expand, Data Lag Behind
Authors: Judith E. Fradkin, Griffin P. Rodgers
Journal: Annals of Internal Medicine (2017)

Editorials21 February 2017Glycemic Therapy for Type 2 Diabetes: Choices Expand, Data Lag BehindJudith E. Fradkin, MD and Griffin P. Rodgers, MDJudith E. Fradkin, MDFrom National Institutes of Health; Bethesda, Maryland.Search for more papers by this author and Griffin P. Rodgers, MDFrom National Institutes of Health; Bethesda, Maryland.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M16-2883 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail A new clinical guideline from the American College of Physicians (ACP) on the oral pharmacologic treatment of type 2 diabetes mellitus (T2DM) addresses a topic important for the health of millions of Americans with this disease (1). Replacing a 2012 guideline, it focuses on significant clinical and intermediate outcomes, tolerability, and safety. The new guideline is based on a systematic review (2) of comparative effectiveness research (CER) and thus does not use data from the cardiovascular outcomes trials (CVOTs) mandated by the U.S. Food and Drug Administration (FDA) in 2008 for new diabetes drugs (3). The CVOTs were designed as ...References1. 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. doi:10.7326/M16-1860 LinkGoogle Scholar2. 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 Scholar3. Food and Drug Administration. Guidance for industry: diabetes mellitus—evaluating cardiovascular risk in new antidiabetic therapies to treat type 2 diabetes. December 2008. Accessed at www.fda.gov/downloads/drugs/guidancecomplianceregulatoryinformation/guidances/ucm071627 on. Google Scholar4. Palmer SC, Mavridis D, Nicolucci A, Johnson DW, Tonelli M, Craig JC, et al. Comparison of clinical outcomes and adverse events associated with glucose-lowering drugs in patients with type 2 diabetes: a meta-analysis. JAMA. 2016;316:313-24. [PMID: 27434443] doi:10.1001/jama.2016.9400 CrossrefMedlineGoogle Scholar5. Inzucchi SE, Bergenstal RM, Buse JB, Diamant M, Ferrannini E, Nauck M, et al; American Diabetes Association (ADA). Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2012;35:1364-79. [PMID: 22517736] doi:10.2337/dc12-0413 CrossrefMedlineGoogle Scholar6. Lipska KJ, Yao X, Herrin J, McCoy RG, Ross JS, Steinman MA, et al. Trends in drug utilization, glycemic control, and rates of severe hypoglycemia, 2006–2013. Diabetes Care. 2016. [Epub ahead of print];dc160985. Google Scholar7. Hampp C, Borders-Hemphill V, Moeny DG, Wysowski DK. Use of antidiabetic drugs in the U.S., 2003-2012. Diabetes Care. 2014;37:1367-74. [PMID: 24623020] doi:10.2337/dc13-2289 CrossrefMedlineGoogle Scholar8. Inzucchi SE, Lipska KJ, Mayo H, Bailey CJ, McGuire DK. Metformin in patients with type 2 diabetes and kidney disease: a systematic review. JAMA. 2014;312:2668-75. [PMID: 25536258] doi:10.1001/jama.2014.15298 CrossrefMedlineGoogle Scholar9. Nathan DM, Buse JB, Kahn SE, Krause-Steinrauf H, Larkin ME, Staten M, et al; GRADE Study Research Group. Rationale and design of the glycemia reduction approaches in diabetes: a comparative effectiveness study (GRADE). Diabetes Care. 2013;36:2254-61. [PMID: 23690531] doi:10.2337/dc13-0356 CrossrefMedlineGoogle Scholar10. U.S. Food and Drug Administration. FDA approves Jardiance to reduce cardiovascular death in adults with type 2 diabetes. FDA news release. Accessed at www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm531517.htm on. Google Scholar Author, Article, and Disclosure InformationAffiliations: From National Institutes of Health; Bethesda, Maryland.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2883.Corresponding Author: Judith E. Fradkin, MD, MSC 2560, 6707 Democracy Boulevard, Bethesda, MD 20892; e-mail, judith.[email protected]gov.Current Author Addresses: Dr. Fradkin: MSC 2560, 6707 Democracy Boulevard, Bethesda, MD 20892.Dr. Rodgers: 31 Center Drive, Room 9A52, Bethesda, MD 20892.This article was published at Annals.org on 3 January 2017. 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 Annals On Call - Oral Pharmacologic Therapy in Type 2 Diabetes: Choosing Therapy Wisely Robert M. Centor and Michael J. Barry Metrics Cited byMesenchymal Stem Cell-Based Therapy for Diabetes Mellitus: Enhancement Strategies and Future PerspectivesStem cells as a potential therapy for diabetes mellitus: a call-to-action in Latin America 21 February 2017Volume 166, Issue 4Page: 309-310KeywordsCardiovascular diseasesDrug therapyDrugsFood and Drug AdministrationGrading of Recommendations Assessment Development and EvaluationProgressive diseasesSafetySafety studiesTreatment guidelinesType 2 diabetes ePublished: 3 January 2017 Issue Published: 21 February 2017 PDF downloadLoading ...