Intended for healthcare professionals


Selecting the right drug treatment for adults with type 2 diabetes

BMJ 2016; 352 doi: (Published 30 March 2016) Cite this as: BMJ 2016;352:i1663
  1. Victor M Montori, professor of medicine
  1. Mayo Clinic, Rochester, MN, USA
  1. montori.victor{at}

We need to turn uninformed choice into random allocation

Clinicians prescribe one or more antihyperglycaemic drugs to prevent and treat symptomatic hyperglycaemia and to lower haemoglobin A1c levels in people with type 2 diabetes. The available agents differ in their efficacy and safety and in how they burden patients in terms of dosing, side effects, and cost. Comparative estimates across these outcomes are generally lacking, limiting the ability of patients and clinicians to make informed decisions.

Reasonably, these estimates may be obtained from data generated in the process of caring for patients. Two observational studies in this issue are based on data acquired during the routine care of people with type 2 diabetes in the United Kingdom. One of the studies, by Hippisley-Cox and Coupland (doi:10.1136/bmj.i1450), compares antihyperglycaemic drugs, particularly gliptins and glitazones, in their ability to control hyperglycaemia, induce hypoglycaemia, and prevent blindness, amputations, and renal failure.1 The other study, by Tuccori and colleagues (doi:10.1136/bmj.i1541), focuses on the association between pioglitazone and bladder cancer.2

These authors took advantage of practice based databases that include most people with type 2 …

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