Searching for the follow-up after breakthrough in diabetes research - Blog report 4
Published on 7 October 2020
The message was very clear
We need to move beyond ‘ISLAGIATT’ in order to optimise diabetes care. It is inefficient in that it often does not build on what we already know. It is insufficient as it may miss important factors. And, importantly, it is unscientific as it is based on implicit ideas about what drives change into practice - and implicit ideas undermine scale, spread and evidence accumulation
Whilst this is undoubtedly true for many pieces of research, what about the research that really did come from an ‘ISLAGIATT’ idea? What about those giant leaps of faith that have taken us so far in our quest to offer better treatment modalities for people living with diabetes?
The STEP Programme is one such example – using a drug, semaglutide, that was developed for diabetes, researchers have now shown it to be effective in clinically meaningful weight loss.
The commentary that accompanied these trial results highlighted that, in both the UK and the USA, the most common new year’s resolution among adults is to lose weight. So could this research take us a long way to fulfilling many countries’ needs to reduce the number of people living with overweight and obesity? Today, we have some centrally acting agents but what about tomorrow and next week and next year? Thanks to research, we’re looking at a whole new era of dual and, maybe, triple therapies – combinations of drugs that can treat diabetes and, importantly, treat obesity, one of the major contributing factors to type 2 diabetes.
In all of this new research and discussion over what is next to hit our collective medicine cupboard, let’s not forget some of the ideas, maybe crazy at the time, that got us where we are now.
Metformin, the grand old lady of diabetes treatment and management, has been recommended as a monotherapy by all international guidelines for people newly diagnosed with type 2 diabetes. So, whilst there is much hoopla from many (myself included) around the cardiovascular protection offered by expensive new drugs like the SGLT-2 inhibitors, let’s not forget that metformin is a much cheaper drug. As highlighted in the EASD’s innovative new Around the Diabetes World in 80 Days online learning initiative, the cheaper drugs are the ones that are available globally and being used to treat literally millions of people in places where the whizzy new drugs are not available.
It is a sobering thought with which to end this year’s conference and I hope that by next year’s congress, be it actual or virtual, I’ll be able to report on a system less tied to wealth and aimed more at answering genuine and very obvious worldwide need.
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