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Featured in NEJM Journal Watch: Insulin or Sulfonylureas to Supplement Metformin in Patients with Diabetes? — Physician’s First Watch

Medical News |
June 11, 2014

Featured in NEJM Journal Watch: Insulin or Sulfonylureas to Supplement Metformin in Patients with Diabetes?

By the NEJM Journal Watch Editors

Insulin plus metformin was associated with higher all-cause mortality than sulfonylureas plus metformin in a retrospective study published in JAMA.

In NEJM Journal Watch General Medicine, Thomas Schwenk writes: "Clinical recommendations based on these results would be premature, because even high-quality propensity score matching might not account for all confounding factors, such as perceived disease severity, patient and physician preference for treatment approach, and adherence to medications."

Reader Comments (7)

Konstantinos Karaiskos Physician, Endocrinology, Primary National Health Net

UGDP STUDY OPPOSITE RESULTS

Dora Mendoza, MD,PhD,MSC,MPH Physician, Endocrinology, Bogota, Colombia,S.A.

The reason a diabetic are given insulin treatment is because the patient has many years with the disease and the beta cell are very few, the patient usually have complications due to the fact that the
treatment with insulin has been established too late. Due not conclude that the treatment of insulin and metformin is worse than the one of metformin with sulfonylurea because the patient treated with one of these regimes are different. The doctors who receive money from laboratories who makes drugs are usually advice the use of drugs! of course. Think in the patient as if they were yourselves.

MD Physician, Endocrinology, INDIA

Insulin+metformin reliable to PRESERVE BETA CELL- now the desired TARGET

Adalberto Fernandez Physician, Cardiology, INSTITUTO BEST

TANK YOU FOR GIVE FREE ACCESS TO NEJM. I AM FROM A COUNTRY WITH LOW INCOME.

Uzma Majid Physician, Endocrinology, karachi

I dont agree with it there must be some other reasons as diabetics are already prone to other communities. But we should clear our minds by doing more work on this matter.

Navin Mehta, M.B.,B.S. Physician, UK

I was part of the Insulin+metformin change many years ago. I think careful selection of the patient and matching treatment cannot be replaced by dogmatic approaches

Lara Wibell, MD, MSci Physician, Internal Medicine, university hospital,Sweden

Conclusionas seem premature. Dr Mehta rightly points out ithat knowledge and exoerience influence our choice of therapy in a a retroprospective study. Nevertheless the observed outcome could be logical. Any potentially harmful hypoglycemic episode might be better couneracted when aan SU is uedd than when due to injected insulin. The paracrine stimulus for a momentary glucagon production probablydepends on a rapid and strong shut off of active beta-cell secretion.

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