What is the annual cost of pursuing this
reductionist, drug based approach? In the past decade, spending on insulin in
the UK has risen 300%, to £311m4 (€356m; $463m), and on
oral diabetic drugs 400%, to £277m. And have you ever wondered why companies
generously give away glucose meters? Test strips are a £166m market, the value
of which has risen 300% in 15 years.4 Factor in staff time
(when not attending more educational updates sponsored by the drug industry) and
the patient and family’s time, and you have a great but expensive business. But
do analogue insulins, new diabetic drugs,
and self monitoring of blood glucose improve outcomes? Does even tight
glycaemic control make a difference? No data on mortality or morbidity exist
for the new therapeutics.5 6 7 8 9 10 11 Likewise intensive
glycaemic control is not superior with respect to mortality and cardiovascular
disease.12 So billions of pounds
are being spent chasing a ghostly surrogate endpoint: low blood sugar. Worse,
there is evidence that these new drugs cause harm. Rosiglitazone has already
been withdrawn; pioglitazone has been linked to bladder cancer; and exenatide
and sitagliptin double the risk of acute pancreatitis.13 14 All this is an example
of the scientific illusion that is so called evidence based medicine, where
research is just mechanically reclaimed statistics pulped into junk educational
nuggets—mere marketing by another name. There
remains another fundamental question. Can diabetes be reversed or cured by
weight loss? A small, well designed study of 11 patients irrefutably showed
that it can.15 And clinical effect is
more important than any statistically significant yet clinically undetectable
effect that a huge study funded by the drug industry might find. The
therapeutic approach in diabetes is upside down. Incredibly, spending on
diabetes drugs could employ 40 000 personal trainers. The complicity of doctors
and lack of dissent against the drug model of diabetes care is bad medicine.
Cite this as: BMJ 2013;346:f2695
and peer review: Commissioned; externally peer
Des Spence on Twitter @des_spence1
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