The story reports that several types of blood sugar lowering drugs have similar benefits, despite dramatic differences in cost among the various drug types. The story met many of our review criteria, including availability, cost, type of evidence, and benefits. It would have been better if more details about the impact of these drugs on cardiovascular endpoints, like heart attack, could have been included in addition to impact on blood sugar. One area that could have been improved was harms of treatment. Since the story’s headline claims older drugs are safe, there should have been some data to support this in the story. As it was, only patterns of side effects were reported for various drugs, which doesn’t tell the reader how often these might occur or how serious these might be. Another area that could have been improved was treatment alternatives. Although perhaps not the focus of the study, lifestyle efforts to lower blood sugar are another important treatment step that is not mentioned.
The story does mention costs of some, but not all, drugs. Importantly, though, it does compare costs of both a high-cost drug (Avandia) and a low-cost drug (metformin), which provides readers an idea of the price difference that’s at issue here. However the cost estimate of $100 a year for metformin is probably lower than what most consumers can actually get access to.
The article does report that most diabetes medications studied reduced blood sugar (A1C) by about 1%, which is an absolute benefit. Importantly, the article points out that since this reduction applied to most drugs tested, there wasn’t a real benefit to choosing newer, more costly drugs.
The story does mention some harms of various drugs, which are named followed by a relative description that these occur more than with other drugs. Side effects mentioned included increases in cholesterol, weight gain, low blood sugar, diarrhea or digestive problems, and heart failure. However, given that the headline of the story claims these drugs are safe, some data supporting that these are safe should have been included. Readers aren’t provided with actual numbers of people experiencing or an indication of how serious these might be. In addition, an extremely rare side effect of metformin, lactic acidosis, is given as much attention and weight as low blood sugar for sulfonylureas. Yet the article does attempt to give readers a relative idea of which ones have which pattern of side effects and notes that all medicines have side effects and that people with diabetes should pick the medication with the side effect profile that matters most to them.
The story does describe the type of study that the Agency for Healthcare Research and Quality commissioned, namely a review, which is not a randomized clinical trial in and of itself, but another type of evidence which can be robust. It also describes that the researchers reviewed 200 studies and obtained both published and non-published data for analysis. The article would have been strengthened if it had emphasized a bit more that there is very limited clinical trial data that actually compares each of these medications to each other and that most of the studies incorporated were of inadequate size of duration to measure many of the outcomes that are of the greatest interest to patients and clinicians, such as myocardial infarctions and strokes.
No obvious disease-mongering. The story does mention diabetes risk factors and provides a measure of how many people are affected by this condition.
Multiple sources are used, both in opposition to and in support of the findings.
The story describes multiple oral medications to lower blood sugar and additionally mentions insulin, although not in detail. What isn’t mentioned is lifestyle changes to lower blood sugar as a treatment alternative or adjunct. Specifically the role of diet, exercise, and weight loss, three of the mainstays of treatment for diabetes, were not mentioned.
The story mentions that a study compared "older" drugs, some of which have come out 50 years ago, to "newer" drugs which have come out in the past 10 years.
The article states the study compares "older" and "newer" drugs. It is true, most of the medications that are categorized as "new" are more than 5 years old. At the same time, only once these medications are used in large numbers of persons in the population do we get an accurate impression of the real benefits and harms.
Multiple sources are used, so does not appear to rely on press release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
Comments
Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.
Our Comments Policy
But before leaving a comment, please review these notes about our policy.
You are responsible for any comments you leave on this site.
This site is primarily a forum for discussion about the quality (or lack thereof) in journalism or other media messages (advertising, marketing, public relations, medical journals, etc.) It is not intended to be a forum for definitive discussions about medicine or science.
We will delete comments that include personal attacks, unfounded allegations, unverified claims, product pitches, profanity or any from anyone who does not list a full name and a functioning email address. We will also end any thread of repetitive comments. We don”t give medical advice so we won”t respond to questions asking for it.
We don”t have sufficient staffing to contact each commenter who left such a message. If you have a question about why your comment was edited or removed, you can email us at feedback@healthnewsreview.org.
There has been a recent burst of attention to troubles with many comments left on science and science news/communication websites. Read “Online science comments: trolls, trash and treasure.”
The authors of the Retraction Watch comments policy urge commenters:
We”re also concerned about anonymous comments. We ask that all commenters leave their full name and provide an actual email address in case we feel we need to contact them. We may delete any comment left by someone who does not leave their name and a legitimate email address.
And, as noted, product pitches of any sort – pushing treatments, tests, products, procedures, physicians, medical centers, books, websites – are likely to be deleted. We don”t accept advertising on this site and are not going to give it away free.
The ability to leave comments expires after a certain period of time. So you may find that you’re unable to leave a comment on an article that is more than a few months old.
You might also like