Don’t be fooled by the advertisements. They are all propaganda. They serve one purpose. Increase sales for the company that makes the treatment. I am not just talking about the ads with the happy people dancing and singing. I am also talking about the more serious attempts. There is one ad with a large man who has type 2 diabetes and he is trying to warn you about the terrible things that type 2 diabetes can do to you. Many of you have seen the ad and at the end, he asks you to call your doctor so you will be more protected from these serious complications. One the face of it, it is a very good ad, but as usual, it does not tell the whole story. He is promoting semaglutide which is marketed as Ozempic or Wegovy.
Lowering the blood sugar level and promoting weight loss are both important reasons to treat type 2 diabetes, but they are not the main reason. We treat diabetes to reduce the risk of heart attack, stroke, or death. Semaglutide is approved to lower that risk in patients who have known heart disease. Here is the key question. How effectively does it lower that risk and how does that compare to other available treatments.
Consider these results from a study of semaglutide in people with type 2 diabetes and a history of heart disease or chronic kidney disease. Both complications make these patients extremely high risk. The study compared results for patients take real semaglutide vs a fake injection or placebo.
Now compare these results with a study that compares optimal medical therapy (OMT) with usual care in patients with type 2 diabetes and chronic kidney disease. These are also very high-risk patients. Usual care is the treatment most people get for diabetes in the community.
Now just look at the two charts. Semaglutide reduced complications very modestly. OMT reduce complications very dramatically. There is an order of magnitude of difference. The semaglutide chart represents 2 years of follow-up. The OMT chart represents 13 years of experience with these patients. That is a big difference in time but that is actually reassuring to me.
OMT produces these great results by lowering oxidant production and inflammation by treating hypertension with lisinopril or losartan, cholesterol with a statin, and high sugar with metformin. The slide at the top shows how this all ties together. You can get the whole protocol for about $31 a month. Semaglutide, on the other hand, costs over $1100 a month. If you are interested in value-based care, OMT beats semaglutide every time. We have worked with Vestra Health to produce OMT in an American community. Patients seen in their clinic cost half as much. They are in the hospital one fifth as often and in the ER one third as often compared with patients that are seen in the community. That means we are replicating these study results in the community. Data like this is critical when you are deciding which treatment is most effective. OMT is the best treatment for type 2 diabetes.
T2D is erroneously being addressed as a medical problem, it is a lifestyle problem. In the majority of cases, it is reversible in 3 weeks to 3 months with lifestyle changes, as did NYC's Mayor Eric Adams, as documented in his book Healthy At Last. https://www.youtube.com/live/kByNmIucyOc?si=B3ngK_xgztzzk-aX
Other resources:
https://lifestylemedicine.org/
https://www.masteringdiabetes.org/
https://www.pcrm.org/health-topics/diabetes
https://ijdrp.org/index.php/ijdrp
I've been reading and enjoying your articles - but perhaps you could explain in simple terms to us non Americans what exactly OMT is. I kind of have an idea.