Cardiovascular outcome trials of glucose-lowering strategies in type 2 diabetes

摘要

I read Rury Holman and colleagues' paper1 about glucose-lowering strategies in type 2 diabetes with interest. Up to 2014, no double-blind randomised clinical trial of type 2 diabetes has ever shown the efficacy of hypoglycaemic drugs-so-called antidiabetics (including metformin, insulin, and DPP4-inhibitors)-when clinically relevant outcome measures are used, especially cardiovascular.2 In the absence'of solid evidence for a benefit, the benefit-risk balance of those drugs is uncertain, even unfavourable. Some believe thatthis inability to show benefit stems from the insufficient duration of the studies in question. Yet, diabetology has long-lasting trials: UGDP and UKPDS lasted about 10 years each, whereas drugs such as ACE inhibitors and statins have shown some effects in trials shorter than 5 years' duration.