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Evidence & Efficacy: Glucose-Lowering Therapy
by DW Haslam
Evidence & Efficacy
Paperback Book (96 Pages)
May 2012
This slim volume attempts to bring together and interpret the most important papers and research that have so drastically changed the clinical management of diabetes in recent years. In 1921, diabetes was a rapidly terminal illness; in 1922, it was a treatable condition. Recent papers have hinted at a cure, but most papers discussed herein have gradually added to our knowledge of the subject and are slowly but surely improving our ability to improve outcomes, most importantly to individualize care to the patient in front of us. Everyone has their favourite landmark papers, but not all can be included. Rollo’s work on lowcarbohydrate diets from 1797, Vague’s description of android versus gynoid obesity from 1947, hidden gems such as the DECODE study from 2002 that revealed postprandial rather than fasting glucose is by far the greater risk factor for cardiovascular events: they wouldn’t all fit!

The Evidence & Efficacy series provides a convenient collection of the most important
controlled clinical trials in particular medical specialties, reviewing the important
pharmacological properties, clinical effi cacy, safety and tolerability of new or established
agents and defi ning their clinical potential or most appropriate place in therapy.
Topics are selected for evaluation/critical appraisal on the basis of a combination of
intrinsic interest, timing (to co-incide with the appearance of early fi ndings of clinical
interest or a new product launch), increasing patterns of use in global markets and a
wealth of evidence requiring objective critical appraisal.

Each book in the Evidence & Effi cacy series contains approximately 30–50 structured
synopses based on landmark studies within the fi eld, accompanied by illustrations of the
key clinical fi ndings/outcome evidence and expert commentaries, extracting the principal
messages relating to clinical and prescribing practice, written by invited key opinion

We hope that the Evidence & Efficacy series will stimulate readers to refl ect on and
update their knowledge and ability to deal with the presentations discussed.

Trial categories will include the following:
• Prophylactic bronchodilation
• Bronchodilation in patients with COPD
• Delivery of bronchodilators in children with mild, moderate and chronic asthma
• Delivery of bronchodilators in adults with mild, moderate and chronic asthma
• Delivery of bronchodilators in children with acute asthma
• Delivery of bronchodilators in adults with acute asthma
• Comparative bronchodilator effi cacy
• Effi cacy of compound bronchodilator therapy
• Meta-analyses for effi cacy, safety and cost-benefi t calculations
Preface v
Abbreviations vi
1. Diabetes prevention 1
The Da Qing IGT and diabetes study 2
Diabetes Prevention Program (DPP) 4
Study TO Prevent Non-Insulin-Dependent Diabetes Mellitus (STOP-NIDDM) 6
XENical in the prevention of Diabetes in Obese Subjects (XENDOS) 8
Diabetes REduction Assessment with ramipril and rosiglitazone Medication 10
Indian Diabetes Prevention Programme (IDPP) 12
Nateglinide And Valsartan in IGT Outcomes Research (NAVIGATOR) 14
National Health And Nutrition Examination Survey (NHANES) 16
Anglo–Danish–Dutch study of Intensive Treatment In peOple with 18
screeN-detected diabetes in primary care (ADDITION)
2. Glucose control 21
Pancreatic extracts in the treatment of diabetes mellitus 22
Diabetes Control and Complications Trial (DCCT) 24
Diabetes Audit and Research in Tayside Scotland/MEdicines MOnitoring unit 26
A Diabetes Outcome Progression Trial (ADOPT) 28
Risk of hypoglycaemia in types 1 and 2 diabetes 30
Survival as a function of HbA1c in people with type 2 diabetes 32
Diabetes therapy Utilization: Researching changes in HbA1c, weight and other 34
factors Through Intervention with exenatide ONce weekly (DURATION)
DPP-4 inhibitors for treatment of type 2 diabetes mellitus 36
3. Glycaemic interventions in CV disease 39
Diabetes mellitus Insulin-Glucose infusion in Acute MI (DIGAMI) 40
Effect of a multifactorial intervention on CV morbidity in type 2 diabetes 42
PROspective pioglitAzone Clinical Trial In macroVascular Events (PROACTIVE) 44
Effect of rosiglitazone on the risk of MI and death from CV causes 46
Action to Control CardiOvascular Risk in Diabetes (ACCORD) 48
United Kingdom Prospective Diabetes Study 10-year follow up (UKPDS 80) 50
Veterans Affairs Diabetes Trial (VADT) 52
Liraglutide Effect and Action in Diabetes (LEAD) programme 54
UKPDS 34 56
4. Hypertension and diabetes 59
Action in Diabetes and Vascular disease: preterAx and diamicroN 60
modified-release Controlled Evaluation (ADVANCE)
5. Dyslipidaemia and diabetes 63
Heart Protection Study (HPS) 64
Atorvastatin in Factorial with omega-3 EE90 RR in Diabetes (AFORRD) 66
6. The metabolic syndrome 69
Role of insulin resistance in human disease 70
The metabolic syndrome: a new worldwide definition 72
7. Obesity and diabetes 75
Weight gain as a risk factor for clinical diabetes in women 76
Weight gain as a risk factor for clinical diabetes in men 78
Effect of surgical management of obesity on health outcomes in diabetes 80
Atkins, Traditional, Ornish, Zone (A TO Z) weight loss study 82
Surgical Treatment And Medications Potentially Eradicate Diabetes Efficiently 84

Meta-analyses for efficacy, safety and cost-benefit calculations
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