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
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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