Does a prediabetic condition increase the risk of developing (type 2) diabetes ?

Development of type 2 diabetes mellitus in people with intermediate hyperglycaemia (‘prediabetes’)

A war on “prediabetes” has created millions of new patients and a tempting opportunity for pharma. But how real is the condition, and is it good medicine?

2018 Study Abstract

Review question
We wanted to find out whether raised blood sugar (‘prediabetes’) increases the risk of developing type 2 diabetes and how many of these people return to having normal blood sugar levels (normoglycaemia). We also investigated the difference in type 2 diabetes development in people with prediabetes compared to people with normoglycaemia.

Background
Type 2 diabetes is often diagnosed by blood sugar measurements like fasting blood glucose or glucose measurements after an oral glucose tolerance test (drinking 75 g of glucose on an empty stomach) or by measuring glycosylated haemoglobin A1c (HbA1c), a long-term marker of blood glucose levels. Type 2 diabetes can have bad effects on health in the long term (diabetic complications), like severe eye or kidney disease or diabetic feet, eventually resulting in foot ulcers.

Raised blood glucose levels (hyperglycaemia), which are above normal ranges but below the limit of diagnosing type 2 diabetes, indicate prediabetes, or intermediate hyperglycaemia. The way prediabetes is defined has important effects on public health because some physicians treat people with prediabetes with medications that can be harmful. For example, reducing the threshold for defining impaired fasting glucose (after an overnight fast) from 6.1 mmol/L or 110 mg/dL to 5.6 mmol/L or 100 mg/dL, as done by the American Diabetes Association (ADA), dramatically increased the number of people diagnosed with prediabetes worldwide.

Study characteristics
We searched for observational studies (studies where no intervention takes place but people are observed over prolonged periods of time) that investigated how many people with prediabetes at the beginning of the study developed type 2 diabetes. We also evaluated studies comparing people with prediabetes to people with normoglycaemia. Prediabetes was defined by different blood glucose measurements.

We found 103 studies, monitoring people over 1 to 24 years. More than 250,000 participants began the studies. In 41 studies the participants were of Australian, European or North American origin, in 7 studies participants were primarily of Latin American origin and in 50 studies participants were of Asian or Middle Eastern origin. Three studies had American Indians as participants, and one study each invited people from Mauritius and Nauru. Six studies included children, adolescents or both as participants.

This evidence is up to date as of 26 February 2018.

Key results
Generally, the development of new type 2 diabetes (diabetes incidence) in people with prediabetes increased over time. However, many participants also reverted from prediabetes back to normal blood glucose levels. Compared to people with normoglycaemia, those with prediabetes (any definition) showed an increased risk of developing type 2 diabetes, but results showed wide differences and depended on how prediabetes was measured. There were no clear differences with regard to several regions in the world or different populations. Because people with prediabetes may develop diabetes but may also change back to normoglycaemia almost any time, doctors should be careful about treating prediabetes because we are not sure whether this will result in more benefit than harm, especially when done on a global scale affecting many people worldwide.

Certainty of the evidence
The certainty of the evidence for overall prognosis was moderate because results varied widely. The certainty of evidence for studies comparing prediabetic with normoglycaemic people was low because the results were not precise and varied widely. In our included observational studies the researchers often did not investigate well enough whether factors like physical inactivity, age or increased body weight also influenced the development of type 2 diabetes, thus making the relationship between prediabetes and the development of type 2 diabetes less clear.

Authors’ conclusions:
Overall prognosis of people with IH worsened over time. T2DM cumulative incidence generally increased over the course of follow-up but varied with IH definition. Regression from IH to normoglycaemia decreased over time but was observed even after 11 years of follow-up. The risk of developing T2DM when comparing IH with normoglycaemia at baseline varied by IH definition. Taking into consideration the uncertainty of the available evidence, as well as the fluctuating stages of normoglycaemia, IH and T2DM, which may transition from one stage to another in both directions even after years of follow-up, practitioners should be careful about the potential implications of any active intervention for people ‘diagnosed’ with IH.

To be prediabetic : a (very) questionable condition

A third of Americans are considered prediabetic – but many may be better off without treatment

A war on “prediabetes” has created millions of new patients and a tempting opportunity for pharma. But how real is the condition, and is it good medicine?

“Practitioners should be careful about the potential implications of any active intervention for people ‘diagnosed’ with intermediate hyperglycaemia (‘prediabetes’)” cochrane.

Attacking the Devil

Harold Evans and the Last Nazi War Crime

Intrepid newspaper editor Harold Evans wages an ongoing battle to expose the truth about a dangerous drug and obtain compensation for its victims.

More info and Videos

  • Xan Brooks, Peter Bradshaw and Henry Barnes review a documentary on the Thalidomide scandal that digs into the drug’s history as an experimental compound developed by the Nazis and pays tribute to the heroic efforts of the Sunday Times, lead by Harold Evans, which persisted in an investigation into Thalidomide-affected children in the face of cover ups and lawsuits. Released in the UK on Friday 22 January 2016.
  • Watch on Netflix. Read The Guardian press release.

Prescribed Drug Spending in Canada, 2018

Canada’s love affair with prescription meds…

Drug spending is increasing more than the other major areas of health spending — with a large proportion of drug spending going toward high-cost drugs for a small number of individuals.

Key findings

  • In 2018, $14.4 billion (42.7%) of prescribed drug spending will be financed by the public sector.
  • About 1 in 4 Canadians received a benefit from a public drug program in 2017. Individuals living in low-income and rural/remote neighbourhoods were more likely to receive a benefit.
  • Canadians with drug costs of $10,000 or more represented 2% of beneficiaries but accounted for more than one-third of public drug spending in 2017.

More Information

In 2017 : $40 Billion

Take an in-depth look at prescribed drug spending in Canada and learn more about how different drug classes contribute to current trends in total public drug spending.

In 2013 : $29.3 Billion

Prescribed Drug Spending in Canada 2012 cover image
Canada’s love affair with prescription meds…

Millions of Canadians buy prescription drugs; we spent a record $30 billion in 2013. But the annual rate of growth that year —2.3%— was one of the lowest in more than two decades. This is due in part to an increase in the use of less-expensive generic drugs as well as government policies that help keep prices low. ”

Key findings
  • More than 40% of prescribed drug spending was paid for by the public sector, totalling more than $12 billion. In the public sector, payers include provincial and federal drug programs and social security funds (such as workers’ compensation boards).
  • Generic drugs account for almost three-quarters of use but less than half of spending in public drug programs.
  • The number of Canadians who are taking more than $10,000 worth of prescription drugs every year is on the rise, because public drug programs are spending more on high-cost drugs.
  • In 2012, high-cost beneficiaries accounted for about 25% of public drug spending, compared with only 15% in 2007.
  • Almost half of these people were taking a high-cost drug used to treat conditions such as rheumatoid arthritis, Crohn’s disease and macular degeneration.
Sources

Evaluating the Strength of the Association Between Industry Payments and Prescribing Practices in Oncology

Doctor payments drove scripts for cancer drugs from Pfizer, Novartis and more: study

New study showed that physicians who received payments over three consecutive years and tied to a specific drug boosted their prescriptions of that product.

Abstract

Background
Financial relationships between physicians and the pharmaceutical industry are common, but factors that may determine whether such relationships result in physician practice changes are unknown.

Materials and Methods
We evaluated physician use of orally administered cancer drugs for four cancers: prostate (abiraterone, enzalutamide), renal cell (axitinib, everolimus, pazopanib, sorafenib, sunitinib), lung (afatinib, erlotinib), and chronic myeloid leukemia (CML; dasatinib, imatinib, nilotinib). Separate physician cohorts were defined for each cancer type by prescribing history. The primary exposure was the number of calendar years during 2013–2015 in which a physician received payments from the manufacturer of one of the studied drugs; the outcome was relative prescribing of that drug in 2015, compared with the other drugs for that cancer. We evaluated whether practice setting at a National Cancer Institute (NCI)‐designated Comprehensive Cancer Center, receipt of payments for purposes other than education or research (compensation payments), maximum annual dollar value received, and institutional conflict‐of‐interest policies were associated with the strength of the payment‐prescribing association. We used modified Poisson regression to control confounding by other physician characteristics.

Results
Physicians who received payments for a drug in all 3 years had increased prescribing of that drug (compared with 0 years), for renal cell (relative risk [RR] 1.81, 95% confidence interval [CI] 1.58–2.07), CML (RR 1.22, 95% CI 1.08–1.39), and lung (RR 1.69, 95% CI 1.58–1.82), but not prostate (RR 0.97, 95% CI 0.93–1.02). Physicians who received compensation payments or >$100 annually had increased prescribing compared with those who did not, but NCI setting and institutional conflict‐of‐interest policies were not consistently associated with the direction of prescribing change.

Conclusion
The association between industry payments and cancer drug prescribing was greatest among physicians who received payments consistently (within each calendar year). Receipt of payments for compensation purposes, such as for consulting or travel, and higher dollar value of payments were also associated with increased prescribing.

Implications for Practice
Financial payments from pharmaceutical companies are common among oncologists. It is known from prior work that oncologists tend to prescribe more of the drugs made by companies that have given them money. By combining records of industry gifts with prescribing records, this study identifies the consistency of payments over time, the dollar value of payments, and payments for compensation as factors that may strengthen the association between receiving payments and increased prescribing of that company’s drug.

Press release.

Financial toxicity: cancer treatment’s side effect

The shock and anxiety of a cancer diagnosis can be followed by a second jolt: the astronomical price of cancer drugs

Presented by Arjun Rajagopalan,
uploaded on SlideShare. Watch it full screen.

The mechanism by which a drug’s market price is fixed is opaque and mostly arbitrary. Medical research, particularly new drug discovery, is a very expensive endeavour; the drug industry uses this argument to price new drugs at levels that are breathtakingly high. With the backing of currently enforced patent protection laws, drug companies can insulate themselves against market forces that are operational in most other consumer markets where competition assures reasonable prices. The Indian drug industry which used to pride itself on its ability to reverse engineer and deliver generics substitutes at low prices, can no longer indulge in this tactic.

Cancer treatment is a large area of interest for drug research. Unlike other noncommunicable diseases like hypertension, diabetes and the like, patients with a diagnosis of cancer are usually keen to seek the best available treatments. Newer generations of cancer drugs are priced at astounding figures. Treatment costs can exceed 100,000 US dollars a year. Even for those in wealthy, developed nations, the burden can lead to far reaching domains: a complication that has been labeled as “financial toxicity”.

Quand le prix élevé et insupportable des médicaments devient un effet secondaire du cancer

Très chères minutes de vie, Luc Perino, 2018

Publié par Luc Perino, médecin généraliste, humeur du 22/10/2018

En cancérologie de l’adulte, la chirurgie et la radiothérapie ont permis de prolonger la vie de certains patients. On a longtemps et honnêtement pensé que la pharmacologie pourrait encore améliorer les choses. Mais depuis une vingtaine d’années, les études indépendantes montrent l’inefficacité globale des anticancéreux anciens ou modernes.

Pour évaluer l’action des anticancéreux lors des essais cliniques, on utilise principalement trois critères :

  1. les biomarqueurs (analyses biologiques),
  2. l’amélioration clinique
  3. et la survie sans progression tumorale.

Il s’agit de critères dits « intermédiaires ». Le seul critère important pour le patient et ses proches étant celui de la survie globale assortie ou non d’une qualité de vie acceptable. Les critères intermédiaires ne sont que des leurres. Certes la baisse d’un biomarqueur ou la diminution du volume tumoral à l’imagerie sont une grande source de satisfaction pour les patients et les médecins, mais elles ne sont pas corrélées à une augmentation de la quantité-qualité de vie.

Il peut paraître cruel de dire les choses aussi brutalement, mais peut-on vraiment faire progresser la médecine sans admettre les faits cliniques ?

Par rapport aux anciens antimitotiques, les nouvelles thérapies ciblées, et plus récemment, les immunothérapies, ont trois caractéristiques nouvelles :

  1. un support théorique séduisant,
  2. des tests de surveillance auto-satisfaisants
  3. et un coût faramineux.

Hélas, à une ou deux fragiles exceptions près, elles ne prolongent la vie que de quelques mois ou semaines.

Ces coûts exorbitants et injustifiés ont deux effets pervers inattendus.

  1. D’une part, ils deviennent la plus importante part de l’effet placebo,
  2. d’autre part, en politisant le sujet, ils majorent les revendications des associations de patients.

« Le cancer est un fléau » et « la vie n’a pas de prix » sont devenus des arguments indirects bougrement efficaces qui détournent l’attention hors de l’examen objectif des résultats. Les lobbyistes de l’industrie ont bien compris la puissance de ces arguments indirects et ils misent diaboliquement sur la détresse des patients en utilisant leurs associations pour faire pression sur les ministères. Ils savent aussi que les élus sont piégés par l’électoralisme et la démagogie et que les médias sont à l’affut de leurs moindres ambiguïtés.

Enfin, la validation de ces supercheries par les agences du médicament soulève inévitablement la question de la corruption.

Quand bien même certaines thérapies feraient gagner quelques minutes de vie, aucune société, quel que soit son niveau de richesse, de compassion ou de solidarité, ne peut supporter les coûts indécents de chacune de ces minutes, sans se mettre toute entière en péril.

Il est difficile d’expliquer ceci à des patients en détresse et à leurs proches, mais ce n’est pas une raison pour laisser de séduisantes théories renouer avec l’obscurantisme médical des siècles d’antan.

En Savoir Plus

Vaxxed: From Cover-Up to Catastrophe

Doctor behind film that links autism to vaccines speaks out featuring Dr. Andrew Wakefield & Polly Tommey

A 2016 American film alleging a cover-up by the Centers for Disease Control and Prevention (CDC) of a purported link between the MMR vaccine and autism.

Official site.

It’s a moral requirement to make money when you can to sell the product for the highest price, Pharma CEO says

Pharmaceutical executive defends 400 percent price hike

“I think it is a moral requirement to make money when you can . . . to sell the product for the highest price.”

“The point here is the only other choice is the brand at the higher price. It is still a saving regardless of whether it is a big one or not,”

“I agree with Martin Shkreli that when he raised the price of his drug he was within his rights because he had to reward his shareholders,”

“If he’s the only one selling it then he can make as much money as he can,”
“This is a capitalist economy and if you can’t make money you can’t stay in business.”

said Nirmal Mulye. Nostrum chief executive, in an interview…
read Pharma chief defends 400% drug price rise as a ‘moral requirement’ in the Financial Times September 11, 2018