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Type 2 Diabetes Treatment Victoza Helps Type 1, Too

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3 Star

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Type 2 Diabetes Treatment Victoza Helps Type 1, Too

Our Review Summary

This story reports on a small case series showing that a drug intended for type 2 diabetes (which typically affects adults and doesn’t require insulin injections) seems to benefit individuals with the type 1 form of the disease (which usually presents in childhood and requires insulin replacement therapy). The findings are certainly newsworthy because better glycemic control could help prevent the long-term consequences of type 1 diabetes, such as heart disease and kidney failure. However, they shouldn’t be communicated to a consumer audience without strong caveats about the preliminary nature of the research. This story didn’t meet that standard.

 

Why This Matters

Small, uncontrolled studies often report tantalizing benefits for new treatment approaches. Sometimes these benefits are real, but often they reflect factors that have nothing to do with the new therapy. Patients may get better simply because they think they are getting a useful new treatment (i.e., the placebo effect). Or, they may improve because the study researchers give them more attention and education than they were getting before. Another possibility is that patients become motivated to manage their disease more carefully while they are in a study. Controlled studies limit the influence of these factors and are important for determining the true value of a new treatment.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

The story does not discuss costs. Adding Victoza to a diabetic’s treatment regimen would cost an additional $350 per month, according to coverage of the study by MedPageToday. This is not a trivial sum.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The story attached numbers to some of the benefits reported on. We learn that patients taking the drug had less need for mealtime and all-day insulin (reductions of 7 and 8 units, respectively); that their HbA1C dropped from 6.5% to 6.1%; and that they lost an average of 10 lbs. However, no numbers are provided to back up the claim in the second paragraph that patients “felt much better overall” after treatment.

This one is close, but since the story emphasizes the drug’s effects on how patients feel (in the third paragraph, the lead researcher on the study says patients experienced a “delightful improvement”  in well-being), we felt that some data should have been provided to substantiate this.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

The story pays appropriate attention to potential harms. It notes that the weight loss caused by the drug could be detrimental to thin patients, and that the drug causes abdominal pain, nausea, and vomiting.  The study author notes that adverse effects cause about 5% of type 2 diabetes patients to stop taking the drug. The story probably should have mentioned that the drug is administered by injection, something which can’t be very appealing to type 1 diabetics who may already be giving themselves multiple injections daily or, as in this study, are using insulin pumps that only require a needle to be inserted every few days.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

We found several problems here:

  • The story didn’t caution readers about the limitations inherent in this small, unblinded, uncontrolled study. Such studies are prone to bias that can lead to inflated estimates of benefit from a new treatment. Frequently, these benefits are greatly reduced or disappear altogether when more rigorous research is conducted.
  • The story stated that the results were presented at a scientific meeting but didn’t say anything about the inherent limitation that such findings have probably received limited peer review.

In addition, while the outcomes reported in this study — insulin requirements, blood sugar levels, etc — are clinically important, it’s not clear if they will ultimately reflect improvements in the primary long-term problems associated with diabetes, such as blindness, amputations, and heart attacks. The story could have mentioned this uncertainty.

Does the story commit disease-mongering?

Satisfactory

No disease-mongering in this story.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

The story notifies readers that this study was conducted without drug company support, but that a corporate-funded trial is in the works. The story could also have notified readers that the lead researcher, Dr. Dandona, disclosed numerous relationships with pharmaceutical companies in the abstract for this study — although none with Victoza manufacturer Novo Nordisk.

The story fell short of the bar when it failed to obtain feedback from an expert who wasn’t involved with the research. Context is everything, and even hearing from a practicing diabetes expert would have been helpful.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story mentions that another drug in the same class as Victoza might have similar benefits in type 1 diabetes. The story might have included more information about the importance of testing blood sugars, frequent insulin changes, and careful dietary monitoring in improving control of diabetes.

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story states that the drug is not approved for use in type 1 diabetes, but that it could be used off-label in this population by a diabetologist since it is approved for use in type 2 diabetes.

Does the story establish the true novelty of the approach?

Satisfactory

There’s a good description of how the drug works and why it hasn’t previously been studied in individuals with type 1 diabetes.

Does the story appear to rely solely or largely on a news release?

Not Applicable

The story acknowledges in a footnote that a news release from the Endocrine Society was used as source material. However, we could not locate a copy of this release online to evaluate it. Since there were no expert sources cited other than the lead researcher on the study, we can’t be sure to what extent this story relied on the Endocrine Society release for its content. We’ll rate this one not applicable.

Total Score: 5 of 9 Satisfactory

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