One of the problems with starting on metformin or empagliflozin for the reasons you have eloquently stated in this series is to convince one's FP to give the RX. Another problem is that once prescribed either one, it will adversely affect getting insurance, because as soon as the insurance company sees one or more of these meds on the med record, one will be labelled a diabetic. There are problems with being on the edge of the wave - of leading the pack. Until these new concepts of disease prevention are recognised by the medical establishment as a whole, until they are incorporated into "best practice" or Clinical Practice Guidelines, it won't be easy to access and use these meds as you have been describing. What are your thoughts on this?
At this point I am recommending using them when there is established disease or a "risk factor." Jardiance is documented to be helpful in diabetes but it is also helpful in chronic kidney disease and heart failure in non diabetics. I am confident metformin will do the same thing, but no one will do that research because it is generic. It would be a major advance if we just use those drugs when there is a proven benefit. You don't really see that. There is huge variation in practice even when certain meds clearly over superior benefit. We are stuck in the old model because providers make more money that way. If you have one of these conditions, ask for this approach. I do think that these medications will ultimately slow progression of chronic disease generally. Metformin is also proven to be beneficial in slowing progression to diabetes in patients with prediabetes.
It would be helpful if you could cite specific research programs being cut. Both sides are guilty of exaggeration. The right says only the woke DEI programs are being cut. Their PR campaign is helped immensely with DOGE's recent publicity of research grant titles! Conversely the left, claiming thousands will die due to research cuts, needs to be supported with something other than 'anonymous sources'!
"at the same time we are cutting funding for the National Institutes of Health and scientific research in our great university system. Our success in competing with China depends in great measure on our progress in science and technology. Every Amercian has a stake in these decisions and we are on the wrong path."
That is the whole point. America is great because of science and technology. Politicians from both parties supported science and technology but did not interfere in the details. Science is not political. I have some sympathy for more support for science that serves the people but introducing politics beyond that is counterproductive
One of the problems with starting on metformin or empagliflozin for the reasons you have eloquently stated in this series is to convince one's FP to give the RX. Another problem is that once prescribed either one, it will adversely affect getting insurance, because as soon as the insurance company sees one or more of these meds on the med record, one will be labelled a diabetic. There are problems with being on the edge of the wave - of leading the pack. Until these new concepts of disease prevention are recognised by the medical establishment as a whole, until they are incorporated into "best practice" or Clinical Practice Guidelines, it won't be easy to access and use these meds as you have been describing. What are your thoughts on this?
At this point I am recommending using them when there is established disease or a "risk factor." Jardiance is documented to be helpful in diabetes but it is also helpful in chronic kidney disease and heart failure in non diabetics. I am confident metformin will do the same thing, but no one will do that research because it is generic. It would be a major advance if we just use those drugs when there is a proven benefit. You don't really see that. There is huge variation in practice even when certain meds clearly over superior benefit. We are stuck in the old model because providers make more money that way. If you have one of these conditions, ask for this approach. I do think that these medications will ultimately slow progression of chronic disease generally. Metformin is also proven to be beneficial in slowing progression to diabetes in patients with prediabetes.
Thanks for this. Spot on as usual of course.
I need Jardiance for heart failure. Is it true that generics can be approved after this year?
It would be helpful if you could cite specific research programs being cut. Both sides are guilty of exaggeration. The right says only the woke DEI programs are being cut. Their PR campaign is helped immensely with DOGE's recent publicity of research grant titles! Conversely the left, claiming thousands will die due to research cuts, needs to be supported with something other than 'anonymous sources'!
"at the same time we are cutting funding for the National Institutes of Health and scientific research in our great university system. Our success in competing with China depends in great measure on our progress in science and technology. Every Amercian has a stake in these decisions and we are on the wrong path."
It would be helpful to have links at the bottom of the article that direct to the source for his comments.
I will add that NIH is absolutely slashing funding, that has been all over the news. If you haven’t read or seen it, then check your news sources.
That is the whole point. America is great because of science and technology. Politicians from both parties supported science and technology but did not interfere in the details. Science is not political. I have some sympathy for more support for science that serves the people but introducing politics beyond that is counterproductive