A Dilemma for Diabetes Patients: How Low to Push Blood Sugar, and How to Do It?

“Daunting” is how Dr. JoAnn Manson, the chief of preventive medicine at Brigham and Women’s Hospital, describes the situation for patients and their doctors. She explained the option and uncertainties in a recent commentary in JAMA.

There are 12 classes of drugs on the market and two or three different agents in each class. The drugs range in price from about $4 a month for older drugs to $700 a month for newer ones, and they have varying side effects. Many patients take more than one drug.

The older, cheaper and more popular diabetes drugs were never tested for their effects on the heart — they were approved before any links were noticed.

A particular drug’s effect on blood sugar does not predict its effects on the heart. Even understanding the chemistry at work — the drugs act in very different ways to lower blood sugar —…

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