Table 3. Myocardial Infarctions and Cardiovascular Deaths in Rosiglitazone Trials.
Table 4. Rates of Myocardial Infarction and Death from Cardiovascular Causes.
From Metform and Beyond: The Latest in Diabetes Therapies ...
From Metformin and Beyond: The Latest in Diabetes Therapies Mansur E. Shomali, MD, CM Associate Director, Diabetes & Endocrine Center, Union Memorial Hospital Program Director, Union Memorial Hospital Training Program in Endocrinology, Diabetes & Metabolism Clinical Assistant Professor of Medicine, University of Maryland School of Medicine
1500 b.c. Ebers papyrus 1922 Banting & Best 1993 DCCT published 2001 Leuven study 10,000 1,000 100 10 1 number of years ago (log scale)
Diabetes increases risk of M.I. or stroke by 4 X
22 million patients with Diabetes 300,000 die each year
Diabetes decreases life expectancy by about 10 years
What is the clinical evidence that treating diabetes can improve health and prolong life?
"It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity…” -Dickens, C. … for clinical trials in diabetes…” -Shomali, M.
UKPDS Group . Lancet. 1998;352:837-853. Effect of Glycemic Control in UKPDS Any diabetes related* MI Stroke PVD Microvascular 40.9 14.7 5.6 1.1 8.6 46 17.4 5 1.6 11.4 0.029 0.052 0.52 0.15 0.0099 11 16 – – 25 (rate/1000 pt yrs) *Combined microvascular and macrovascular events Intensive % Decrease (rate/1000 pt yrs) P Conventional Endpoints
The Steno Diabetes Study reduce dietary fat regular exercise smoking cessation A1C <6.5% BP <130/80 t. chol <175 trig <150 aspirin dietary supplement (vit E, vit C, folate, chromium) ACE-I regardless of BP Gaude P et al. N Engl J Med 348:383–393, 2003