This tightly written comparison of the side effects from a new diabetes drug compared to the most popular drugs on the market answers most of our questions but should have provided more hard numbers to address benefits, harms and costs.
Diabetes rates are climbing throughout the world, and effective treatments are needed to address the core problem and to minimize side effects. Because these drugs are for chronic conditions, they can carry a high price tag. To help readers understand whether the lower side effect profile of a new drug is worth the additional cost, stories like this should provide better quantification of benefits, harms and costs.
We were glad to see the story at least mentioned the cost issues, although we would have preferred some actual dollar figures. It says, “One expert said patients and doctors may still have to balance the superiority of linagliptin against its higher cost in comparison to older drugs.” And later it says, “millions of Americans suffer from type 2 diabetes, so ‘cost issues favoring sulfonylureas may be the only reason for preferring continued sulfonylurea use,’ he added.” Barely satisfactory.
The benefits were not fully described to back up the lead. The information on the decreased number of heart attacks and strokes with linagliptin treatment is mentioned in the Lancet abstract and could have easily been added to this article. Instead, all we got were vague comments of “worked as well” or “effectiveness of the drugs were (sic) similar. “
There was inadequate/incomplete quantification of the harms.
There’s a good description of the basic components of the study’s design. “To compare the effects of linagliptin to glimepiride (the most commonly used sulphonylurea), the researchers conducted a double-blind study over the course of two years. The study, which was funded by linagliptin’s maker, Boehringer Ingelheim, involved 1,500 people from 16 countries with type 2 diabetes. None of the patients had responded to metformin alone.”
In addition, this study is longer than most prior studies in this area which have only been over the course of 3-6 month rather than 2 full years, and therefore provides better evidence, over a longer timeframe, than prior work.
The story says quite high that the study “was funded by linagliptin’s maker, Boehringer Ingelheim,” and it quotes one independent source. More sources would have been better.
The story basically talks about three drugs. The main drug, metformin; the supplementary class of drugs known as sulphonylureas; and the new drug being studied. But it does not talk more broadly about other approaches to diabetes management, which could have been accomplished with a few more sentences.
The article is set up, as the study is, to give a comparison between two specific drug types for second-line therapy along with metformin (a sulphonylurea and DPP-IV inhibitor, linagliptin). However, there are several other “second-line therapy” drug classes out there that are used for the same purpose, including meglitinides such as repaglinide that may cause less hypoglycemia than sulphonylureas but are less expensive than DPP-IV inhibitors, and therefore may be a better option for patients than either of the drugs in this study. So one or two sentences that place this study in the larger perspective of second-line therapy for diabetes, acknowledging other possible alternatives, would have been helpful for readers.
It is not clear from the story whether this drug is available anywhere. You could interpret the story both ways. “The study authors pointed out linagliptin was licensed in 2011 and this is the first long-term study examining its safety and effectiveness. They added more research is needed to confirm their findings.”
There are no claims of novelty in the story.
The story does cite the Lancet press release as a source. We don’t understand why a major news organization would have to do this. But since an independent source was quoted, we’ll give the story the benefit of the doubt on this criterion.
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
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