The September 24 issue of the Journal of the American Medical Association (JAMA) has lots of interest to fat science aficionados.
The treatment of type 2 diabetes is the subject of 2 studies. Everybody already agrees that metformin should be the first thing you try when treating type 2 diabetes. In the first study investigators in Germany got together 6033 customers with average age of 64 years, who were being treated for type 2 diabetes and who also had risk factors for, or already had evidence of cardiovascular disease. They added either glimiperide, a sulfonyluria, or linagliptin, a dipeptidyl-4 (DDP-4) inhibitor, to their treatment and watched them for 6 years to see who got into trouble with a major adverse cardiovascular event (MACE). Both of these classes of diabetes drug are taken by mouth and work by stimulating your body to release more insulin. Sufonylurias are old and cheap an cause some weight gain. DDP-4 inhibitors are newer, expensive and don’t cause as much weight gain. After watching these German subjects for a little more than 6 years there was no difference in the incidence of bad heart outcomes or stroke (MACE).
Although metformin is pretty safe there is more worry in people who have decreased kidney function. The Food and Drug Administration had a rule that people with decreased kidny function should not get metformin. But the second study in this issue of JAMA compared the use of either a sulfonylurea or metformin in people with reduced kidney function that pushed the limits of the FDA’s rules about that. They found that people on a sulfonylurea had more MACE than those on metformin without any other problems or benefits. This had been shown before when sulfonylureas were compared to metformin in general so maybe we should be a little more liberal with metformin even in patients with reduced, but not too reduced, kidney function. More much ado about metformin.
The third study examined how we are doing with the efforts of dietary guidance to try and mitigate this epidemic of type 2 diabetes and obesity in the first place. Using data from 9 surveys by the National Health and Nutrition Examination Survey (NHANES) over 17 years of 43,996 US American adults, they found that we are eating a little better over time. They have a thing called the Healthy Eating Index (HEI) that they used to measure this. But I’m not sure how that would work because it seems the recommendations are constantly changing. Be that as it may I think we can agree on 3 more specific things – eating complex carbohydrates rather than added sugar, plant proteins rather than meat, and unsaturated fats rather than saturated. With that more limited view of eating healthy we do seem to be eating slighter better more recently. It’s slow improvement and there’s still a long way to go though.
John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- [email protected] or phone (740) 354-6605.
1. Wexlet DJ. Sulfonylureas and cardiovascular safety. The final verdict? JAMA 2019;322:1147-9.
2. US dietary guidance - is it working? JAMA 2019;322:1150-1.
3. Rosenstock J et al. Effect of linagliptin vs glimepiride on major adverse cardiovascular outcomes in patients with type 2 diabetes. JAMA 2019;322:1155-66.
4. Roumie CL et al. Association of treatment with metformin vs sulfonylurea with major adverse cardiovascular events among patients with diabetes and reduced kidney function. JAMA 2019;322:1167-77.
5. Shan Z et al. Trends in dietary carbohydrate, protein, and fat and diet quality among US adults, 1999-2016. JAMA 2019;322:1178-87.