Think about this. Medical science has advanced as much as telephone science. Fifty years ago, phone communication was clunky and expensive. There was a long distance fee for calling someone in the next county. Now you can communicate with anyone, anywhere in the world almost instantly and easily for a relatively small monthly fee. And the phone does all kinds of other things. One of the most amazing is GPS navigation. You can use your phone to navigate from your home to a place 4 states away. Over 20 satellites provide your real-time position on a map and you receive voice instructions. The hard science that makes all that happen is fantastic. Medical science has advanced at least that fast but most of us don’t receive the full benefit because it is even more complicated. It is difficult for laymen to understand what to do. The information is so confusing. This site exists to help you overcome that.
Many of use spend a lot of money on treatments that have never been proven to work. We are bombarded with advertisements everyday for this pill to improve your memory and that pill to help you lose weight. Most of them have never been studied in a way that proves that they work. Most of them are a waste of time and money. Because we depend on those medications to solve our healthcare problems, we don’t take inexpensive, proven medications that can make all the difference.
There is a very specific research approach that proves a medical treatment works. It is called a controlled clinical trial. These research efforts begin with two groups of patients. In this landmark study of patients with type 2 diabetes and kidney disease caused by the diabetes, there were two groups of 80 patients. One group just received what is called usual care. They continued to receive care in the community from their usual doctor—the care that most of us still receive. The other group all received the same treatment based on a specified protocol or algorithm. The targets for blood pressure, sugar, and cholesterol control were more aggressive and much more effort was put into achieving them. The blood pressure target was 130/80, total cholesterol 175, and hemoglobin A1c (sugar number) was 6.5. The way those targets were acheived was even more important. Every patient got losartan or lisinopril for high blood pressure, they all received a statin for cholesterol, and they were prescribed metformin for sugar control. These high risk patients all took aspirin. There were consistent diet and exercise recommendations and assistance was available to stop smoking. These protocol treatments lower the targets, but they also interfere with the chemistry that causes heart attack, stroke, and dialysis. The protocol-treated patients achieved lower blood pressure, cholesterol, and sugar numbers. More of them were on the protocol specified medications and they were followed on these treatments for 21 years.
As a result, we have hard proof of what works best in type 2 diabetes. Compared with patients in usual care, patients treated with the aggressive protocol had one fourth as many heart attacks, one fifth as many strokes, and one sixth as many went on to dialysis. By thirteen years, half the usual care patients were dead compared with only 30% of the patients treated with the protocol. The protocol treated patients live 8 years longer and heart attacks were delayed by 8 years. The number of patients hospitalized for congestive heart failure was reduced by 70%.
There is now no question about the best treatment for patients with type 2 diabetes. If you achieve the same targets with the same medications, diet, and exercise, then you should achieve the same level of protection. Best of all, you can take all the medications in the protocol for $31 a month even if you have no insurance. Now you know what you need. Ask your doctor to be sure you are following the protocol and achieving the targets. The usual care that most people are still getting is proven to be much less effective. The stakes couldn’t be higher. Get the best care for yourself!
Bestermann writes excellent information such as given here. He has done an excellent job of giving the exact relevant numbers. The problem with much of randomized controlled studies/RCT = double blind placebo controlled crossover studies is that they are now tainted by researchers who have an agenda to make a point (which will contribute to their being rewarded with future research funding as well as popularity in the professional community). This was widely apparent during the coronavirus pandemic. But it also applies to cardiovascular research. Bestermann's discussion here is ethical and correct and to be believed. Yet there is always progress and that usually comes with a price. For instance the newest aldosterone blocker, Kerendia is better than spironolactone and eplerenone. Combining an Ozempic GLP-1 type medication with a Jardiance SGLT2 type medication gives (both are much more expensive) much better glucose control then metformin as well as vastly reduced risk of heart attack and stroke. Edarbi is a better/more effective and much more expensive ARB than losartan. Chlorthalidone is a better diuretic to lower blood pressure than is hydrochlorothiazide (HCTZ). Much of the price of these new medications is related to governmental requirements for the research which are USUALLY/unnecessarily excessive and incredibly costly to adhere to, thereby affecting the price of the medication when it is released. Bestermann continues to shine thru this fog. H. Robert Silverstein, MD, FACC