What We Don’t Know About Diabetes – Part 2

In February I wrote about the results of the ACCORD trial, a study designed to test whether strict glucose control in patients with diabetes helps prevent strokes and heart attacks and prolongs life.  The startling results were that the patients with diabetes who were randomized to have their glucose lowered to normal levels died sooner than those with more lax sugar control. This week the New England Journal of Medicine published the results of another study, the ADVANCE trial, which ...
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What We Don’t Know About Diabetes

This week we learned something very important about diabetes.  We learned that we don't know something we thought we knew.  (Regular readers will note that this keeps happening in medicine.  For a generation everyone assumes something.  Then we check and discover it isn't so.) We've always assumed that in type 2 diabetes, the closer to normal that blood sugar is lowered the fewer complications of diabetes patients would have.  Why?  Because diabetes is known to be a major cause of kidney diseas...
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Laparoscopic Gastric Banding Can Cure Diabetes in Obese Patients

The scientific evidence for treatment of obesity is trending in a very interesting direction.  For years a safe and effective medication for weight loss has been sought, with only modest results.  (I wrote about orlistat, the medication in Xenical and Alli, a year ago.)  Surprisingly, for obese patients evidence is increasingly mounting in favor of surgery for weight loss, rather than medications or even diet and exercise. In 2006 ...
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Turning that Frown Upside-down

A patient of mine told me yesterday that she thought too many of my posts were negative:  this supplement doesn't help, that medication doesn't work, this intervention doesn't make a difference.  She's right.  A lot of my posts are negative.  There are two reasons for that.  One is that we're constantly bombarded by advertisement and bogus information in the mass media about the latest and greatest medical wonder, usually long before any evidence exists about its effectiveness.  So I partially s...
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Shocking News: Diabetics Should Exercise

This week's Annals of Internal Medicine has a very well designed study that examined the effect of exercise on patients with diabetes.  Previously sedentary diabetics were randomized to four groups:  one group was enrolled in an aerobic exercise program, a second group was enrolled in a resistance training program, a third group was enrolled in a program with both aerobic exercise and resistance training, and...
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Medication Options in Newly Diagnosed Type 2 Diabetes

Over a dozen years ago, when I was a medical student, treatment of type 2 diabetes was very simple. There was only one family of oral diabetes medicine -- sulfonylureas. In patients for whom the sulfonylureas failed, the only option was insulin injections. Sulfonylureas suffer from two serious side effects. They cause weight gain, an especially frustrating problem since weight loss is so important in diabetes. They can also cause blood sugar levels to become too low (hypoglycemia) which can have...
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Lipitor Helps Prevent a Second Stroke

An important study in this week's New England Journal of Medicine expands what we know about the benefits of cholesterol lowering medications. Statins, a family of cholesterol lowering medications which include Crestor (rosuvastatin), Lescol (fluvastatin), Lipitor (atorvastatin), Mevacor (lovastatin), Pravachol (pravastatin), and Zocor (simvastatin), have already been proven to have many benefits. We al...
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