TOSCA[1] was a very well-conducted clinical trial that included about 3000 patients with type 2 diabetes who could not maintain good glycemic control on metformin alone. This was the first head-to-head trial comparing the combination of sulfonylureas or pioglitazone with metformin.It was great studies, as I suppose. There is only one question. How Metformin alone can maintain good glycemic control in diabetes type 2? Diabetes type 2, insulin resistant tipe of diabetes when requirement in insulin dose is higher then 200 units, and what? ..... They pretend that metformin would provide good treatment to control high blood sugar level? Pf cause not. Metformin can control level of sugar in those who has good working healthy pancreas and no any mediclal or health complications. Metformin never did worked for diabetics type 2. Every one who does not have diabetes type 2 can say, they do control blood sugar with work out and healthy meal choice. They can add to their regime Metformin, and they will have good level of sugar in blood, 101 mg/dl. No one diabetic type 2 ever had or will have this control with metformin, work out, and healthy meal choice.
Because of this is right point, another types of medicine must be added. These studies support this claim.
As I said, TOSCA was very well and carefully conducted, particularly when comparing the two drugs on glycemic control. Pioglitazone showed better and more sustainable improvement for glycemic control than sulfonylureas. Importantly, there was modest weight gain with pioglitazone compared with sulfonylureas. This was not significant and contrasted with some previous data, where there was more weight gain and fluid retention when pioglitazone was used with metformin.As it is proudly said, TOSCA was very well conducted. So, before we will go to compare Pioglitazone and sulfonylureas let us take a look what is the initial diabetic type 2 condition?We cannot say that one type of medicine is better then another without support this claime with data. Also as it is just said, it is weight gain, and fluid retention. Say me, what does it mean that medicine wich lead to water fluid retention can be better then another medicine without this side effect?
Right now I fight very hard this condition. It is Fluid retention. It started at the end of 2016 and now it is October 2017. I still fight this complication. Right now my legs, both of them wrapped with compressing bandage. Usually one wrap cost $5. I got it in big box, so it is $5 for two rolls. One roll cannot be used twice. So, every time when I use wrap I pay $5. The part below wrap is compressed and wrap started to go down. The part of leg above wrap watered, extremely swelled. When part of wrapped leg star to watering, it is such pain that I cannot stand it. Wrap go out.
Usually it is cost effect what MD count when they Ex medicine. SU and Piglitazone are not expensive, so MD easy to Rx this medicine. Insurance pay for it, no ??? asked. The cost of compressing wraps go out of victim pocket. $5 for one day, or week, if one can stand it. But nevere more. And remember, it is diabetes type 2, the chronicle endocrenilogy disorder. It stay for the rest of victim's life.
Fluid retention is not just watered heavely obese legs. With time skin start to melt, then flesh will be melting, and so infection of flesh, amputation, and all adding cost of this very cost effective treatment. No one in comments or in MD publications count those costs. They see only cost of SU or any other such as Metformin, $4 month supply.
80,000 diabetics type 2 lost lives every year due to wrong diagnose and wrong treatment. Every year. Count these lives. Insulin was discovered in 1923, almost 94 years ago. 7,520,000 lives could be safe if it was insulin therapy as first line to treat diabetes of any type, and if level of sugar would be vital. So easy to do, so easy to prevent millions of Death. In contrary, our MD pro discuss what is better, to kill Beta Cells with SU or to kill diabetic with Invokana or pioglitazone.
pioglitazone - This medicine may cause or make heart failure worse in some people. Tell your doctor if you have ever had heart failure. Do not take this drug if you have moderate to very bad heart failure or if you have any signs of heart failure. You will be watched closely for signs of heart failure when you start pioglitazone and if your dose is raised. Call your doctor right away if you have swelling in the arms or legs, shortness of breath or trouble breathing, sudden weight gain or weight gain that is not normal, or are feeling very tired. Talk with your doctor.Did someone try to call doctor when it is heart failure or swelling? Interesting, what was doctor's answer? That's right, lose weight. Eat right and healthy. be active. LOL! Trust me, it does not work.
However, recent trials using glucagon-like peptide-1 (GLP-1) receptor agonists and sodium glucose cotransporter-2 (SGLT2) inhibitors have shown that you can reduce cardiovascular endpoints. This has been the dream for clinicians who treat patients with type 2 diabetes. Although this was not shown for pioglitazone or sulfonylureas, these drugs definitely remain acceptable and available around the world, particularly as we also consider expenses of medications.Dreams are interesting point. Dreams are very personal. So, what is dream for clinicians, it is nightmare for their victims. BTW, how Invokana can be good for diabetics type 2 if this type of oral agents increase level of sugar in blood? Probably in study researchers did not pay attention to this phenomenon, but I did, and it is strong relation between level of sugar and how it is go up with any diuretics.
Diabetes type 2, Insulin Resistant type of diabetes when requirement in insulin is higher then 200 units daily dose. In this article there is no any numbers, what sugar was before studies, where it was at the end of studies. Also there is no result to confirm that after ten years on this treatment diabetics keel blood sugar under control. Thy did not control sugar with Metformin alone. Do they control sugar with metformin and Invokana? My goodness! How it can be?
Really, it hit any logic. Just for easy compare contrast. If I take cup of soup and still hungry (do not control my hunger) then I add meat and egg (Netformin and Invokana). Would be I hungry after these add-ons? Probably not. So, if I eat only soup did soup worked and my hunger get less then if I did eat nothing? Yes, it did work but additional meal needed. If in stead of soup I ate water, did I wad more hungry or not? This is logic. It is twist from one subject to another to see if statement work or not. If statement true then it does not matter if I take to compare soup and water or metformin and Invokana.
If Metformin work then the dose of metformin must be taken into consideration. But there is no dose of metformin in study or discussion. Probably, if metformin work, just add additional dose of it, and no add-on new medicine would be needed to get the same effect? Why this was out of discussion?
First of all, pioglitazone in the right patient is safe and can be easily added to metformin. Glucose control was better [compared with sulfonylureas/metformin] and there was less need of insulin therapy.Second, both of these meds did not work, why? Read the rest of study.
Importantly, there was less hypoglycemia and an almost complete lack of severe hypoglycemia.Insulin leads to low blood sugar because of it work. Metformin alone did not lead to low sugar. So, if it compare with another drug and still no low sugar, then another drug also does not reduce level of sugar in blood. SU lead to low blood sugar. SU + Metformin also lead to low blood sugar. Metformin alone does not work, does not reduce level of sugar. SU alone reduce level of sugar. Do you brain work. BTW, if dose of insulin is low, 10 units for instance, then there is no low blood sugar work type 2 diabetic. But it will lead to low effect of level of sugar reduction. It is just simple logic. Without twist.
These are important points because we want antidiabetes drugs to cause no hypoglycemia or weight gain and to have cardiovascular safety. Pioglitazone turned out to be safe.Really?
This is how fluid retention looks like. It is still not severe. With time it went off.But not for long. I do not have this condition right now. I fight. I use wrap to compress my legs, so fluid will go out. It is clollected between cells in lungs, heart, and all where it can find place to stay.
Does any one still trust in study that
Pioglitazone, Sulfonylureas Safe and Effective in Type 2 Diabetes
by Marja-Riitta Taskinen, MD, PhD
http://ift.tt/2z12unB
via Ravenvoron
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