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Comparing Diabetes Medications:  Where Do We Set the Bar?

Kasia J. Lipska, MD, MHS1; Harlan M. Krumholz, MD, SM2,3,4
[+] Author Affiliations
1Section of Endocrinology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
2Section of Cardiovascular Medicine, Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
3Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut
4Section of Health Policy and Administrations, Yale School of Public Health, New Haven, Connecticut
JAMA Intern Med. 2014;174(3):317-318. doi:10.1001/jamainternmed.2013.13433.
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More than 25 million Americans have type 2 diabetes mellitus and face decisions about which medications to use to lower glucose levels. These decisions are increasingly complex (now involving 12 different classes of glucose-lowering agents) and increasingly costly (resulting in over $18 billion in annual expenditures1). Yet, despite the enormous health and economic implications of these decisions, there are few comparative effectiveness outcomes studies to guide clinical practice. The major goals of glycemic control in type 2 diabetes are to prevent severe hyperglycemia and to reduce the risk of long-term diabetic complications, with the majority of the effort devoted to the latter. Therefore, clinicians, patients, and health systems need to know how well glucose-lowering agents (or combinations) improve the chances of living longer without cardiovascular events, painful neuropathy, kidney failure, amputation, and blindness, as well as the risks of adverse effects and other burdens of these treatments. Comparative effectiveness studies designed to assess these outcomes may not appear feasible. But what are the alternatives?

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