This article may be worth the free subscription to MedPage Today:
Eight different diabetes drug classes examined in a meta-analysis failed to demonstrate improved cardiovascular or all-cause mortality compared with placebo.
Researchers analyzed 301 randomized clinical trials of patients with type 2 diabetes, and found that, metformin outperformed some other drug classes for its effect on hemoglobin A1c levels, there were no significant differences in mortality -- including when placebo was included as a drug class...
http://www.medpagetoday.com/Endocrinology/Diabetes/59182?xid=fb_o_In other words, you can be on the fanciest, most expensive diabetic drugs, even all 8 classes of them, and lower your A1c very nicely. But that doesn't amount to a hill of beans when it comes to actual health benefit! Sound familiar? Same message with statins and also the newly approved (and researched by Cleveland Clinic) $14,000 a year injectable cholesterol drugs which lower LDL by 70% or more.
When a patient fails to respond to a whole food plant based diet and metformin and is also killing it at the gym (such as my muscle building mixed martial arts patient), I check their C-Peptide levels to see if they have run out of insulin, and if they have, they need basal/bolus insulin on top of their regimen. Sometimes adults can also have type I diabetes come on suddenly (maybe it's from autoimmunity induced by an animal-based diet) and can be detected by antibodies in the blood against islet cells.
http://care.diabetesjournals.org/content/diacare/23/8/1072.full.pdfI'm usually not the one who orders islet cell antibodies because I can usually get the answer by C-Peptide level. Blood sugar super high, and corresponding C-Peptide super low means that body has run out of insulin. One can try to stimulate C-Peptide if the fasting doesn't give the answer by doing post-prandial C-Peptide level a few times after a 50 gram sugar bolus (roughly a 12 ounce 7-up) with the corresponding postprandial glucose.
In the end, lesson is type 2 diabetes - best treated with lifestyle changes! Those meds are uber-expensive, with the SGLT-2 drugs about $300-600 per month and the GLP-1 drugs about $500-$700 / mo. If you're going to spend that kind of money, just save up and spend 10-days at John McDougall MD's program! Or if you're in India, spend $6000 and go to Sharan India in Goa, spend 3 weeks on a WFPB diet no oil, meditation/yoga/cooking class by the beach in Goa. If you're really, really at a loss for what to do, and all else fails, spend some time at True North!
What the medical community wants you to do, is cut you open (or stick a robot in you) and rewire all your intestines and stomach to the size of a fist, so you can't eat, and poop out everything you do eat. The above research is "justification" by surgeons that diabetes is a "surgical disease". No, I'm not kidding!
https://asmbs.org/patients/surgery-for-diabetesMetabolic and bariatric surgery is the most effective treatment for T2DM among individuals who are affected by obesity and may result in remission or improvement in nearly all cases.
No thank you ASMBS!