As part of the pancreatic cancer litigation that has been taking up a lot of my time, I've spent a lot of my time lately thinking about diabetes in general. Diabetics know all too well the merry-go-round they can end up on as doctors switch them from one medication to another in search of perfect control of their blood sugar levels.
That's the only reason any of my clients ended up on Januvia, Victoza, Byetta or the like. No one truly needed one of those three drugs in the same way that, say, a person having a stroke needs a blood clot buster or a person at risk for heart attacks needs aspirin. Rather, those drugs just seemed to be the best fit for the patient; our concern in the litigation is that the drug manufacturers never warned patients about the true risk of the drugs, i.e., the increased risk of pancreatic cancer.
But maybe we've all been thinking about diabetes itself in the wrong way. A new study in the British Medical Journal, "Comparative effectiveness of exercise and drug interventions on mortality outcomes: metaepidemiological study," reported widely (including by Philadelphia Magazine) found that, in patients with heart disease and diabetes, exercise did just as well as medication in extending patients' lives. Similarly, despite all kinds of hype, it remains unproven that moderate fluctuations in glucose / blood sugar levels - or even sustained moderate elevations - cause much long-term damage in the end.
In short, there's no magical number that patients need to reach to avoid long-term harm, even death. Outside of severe cases, diabetes management is more about a happy, productive lifestyle than it is about extending life or preventing diseases.
Which brings into sharp focus the true horror of the pancreatic litigation: most people really, truly don't need these drugs to be healthy. They need better support for diet and exercise routines, and the use of these drugs on the whole shortens their lives, rather than extending them.