The last couple of posts have discussed the corrupting influence in drug company money in American healthcare. Andre Wenker is a reader from France who sent me this note. “In France, Jardiance is considered as having no ATV (Added Therapeutic Value) and its price at the pharmacy, for 30 PVC-Aluminum blister pack(s) of 1 tablet, is €39.1, (approximately) 15 times lower than in the US, reflecting this low value…”
To have such an agency here in the USA would be only “reasonable”, American healthcare consumers would have true advocacy. Disruptions to upstream and downstream economics is the crux. It’s a despicable predicament.
I believe there is already enough data to support the use of Jardiance at the present time for its preventive benefits. For those you follow this thread, that means I disagree with my friend Bill. If The postprandial sugars are not maintained in the 100-130 range, then the next step is to add Ozempic or Mounjaro. as Bill has pointed out, the cost for these medicines is truly excessive
The loyal opposition is at it again: Bill is wrong again in my best guess. The ideal treatment for diabetes after starting with adequate dose metformin, at the present time regardless of whether one is type I or type II diabetic is to use a GLP-1 Such as OZEMPIC or MOUNJARO plus and SGLT-2 like Jardiance or Farxiga. This combination will often prevent the need for insulin, etc.
The incremental value of the GLP-1 drugs and SGLT2 inhibitors is unclear when added to OMT. The cash price of Jardiance is $700 a month and Ozempic is $1100 a month. That is $21,000 a year. If you could get Jardiance for $40 a month as in France that would be an option, but it will take away your pay raise in this country. Again, we use Jardiance as the second drug if metformin is inadequate.
The above is clear enuf for me and in the literature is why I say what I do. RECALL, as Bill and I both say: DM, HBP, high cholesterol, constipation are ALL 90 + % curable and preventable
Bill is mistaken here! The recommendation against the use of Jardiance is misguided and wrong as it is protective for diabetic kidneys and heart in addition to having some beneficial effect on glucose control. Moreover recommending a sulfonylurea which increases insulin production and stimulates the heart, is known to increase cardiac mortality similar to insulin. Control of blood sugar is not the entire issue. This shows how wrong the French can be and there is supposedly very even handed evaluations. H Robert Silverstein MD FACC (cardiologist)
We approach the diagnosis of type 2 diabetes like this. We begin with diet and exercise. Our diet recommendation is carb and sugar restriction coupled with eating real food and intermittent fasting. I agree with your point on sulfonylureas and we don't recommend them.
If a person has the diagnosis of type 2 diabetes, they should be on metformin, period. A protocol containing metformin reduces progression to dialysis 6 fold and hospitalization for heart failure by 70%. Jardiance was not tested against OMT. It was tested against usual care. It is added to metformin in our protocol if the glucose is not well controlled or if there is heart failure or renal insufficiency. As we generate big data, we will learn how much Jardiance helps in the real world. Metformin and Jardiance both provide this protection for cells and organs by switching on the master genetic metabolic survival switch AMPK. If patients fail diet, metformin, and Jardiance, we add self-adjusted basal insulin. Since Jardiance was not tested against OMT, we really do not know how much it adds to that highly effective approach.
the loyal opposition is at it again: Bill is wrong again in my best guess. after an ideally organic in unprocessed low-calorie whole foods diet plus adequate exercise to reduce to the weight called "trim", then begin with metformin. The best combination is an OZEMPIC or MOUNJARO + Jardiance or Farxiga. So doing make clear the need for any other diabetic medication in addition to being remarkably helpful for kidneys and heart in diabetics. H Robert Silverstein, MD, FACC
To have such an agency here in the USA would be only “reasonable”, American healthcare consumers would have true advocacy. Disruptions to upstream and downstream economics is the crux. It’s a despicable predicament.
All we need to do is give the National Academy of Medicine some teeth. They make great recommendations and they are completely ignored.
disagree completely
I believe there is already enough data to support the use of Jardiance at the present time for its preventive benefits. For those you follow this thread, that means I disagree with my friend Bill. If The postprandial sugars are not maintained in the 100-130 range, then the next step is to add Ozempic or Mounjaro. as Bill has pointed out, the cost for these medicines is truly excessive
The loyal opposition is at it again: Bill is wrong again in my best guess. The ideal treatment for diabetes after starting with adequate dose metformin, at the present time regardless of whether one is type I or type II diabetic is to use a GLP-1 Such as OZEMPIC or MOUNJARO plus and SGLT-2 like Jardiance or Farxiga. This combination will often prevent the need for insulin, etc.
The incremental value of the GLP-1 drugs and SGLT2 inhibitors is unclear when added to OMT. The cash price of Jardiance is $700 a month and Ozempic is $1100 a month. That is $21,000 a year. If you could get Jardiance for $40 a month as in France that would be an option, but it will take away your pay raise in this country. Again, we use Jardiance as the second drug if metformin is inadequate.
The above is clear enuf for me and in the literature is why I say what I do. RECALL, as Bill and I both say: DM, HBP, high cholesterol, constipation are ALL 90 + % curable and preventable
Bill is mistaken here! The recommendation against the use of Jardiance is misguided and wrong as it is protective for diabetic kidneys and heart in addition to having some beneficial effect on glucose control. Moreover recommending a sulfonylurea which increases insulin production and stimulates the heart, is known to increase cardiac mortality similar to insulin. Control of blood sugar is not the entire issue. This shows how wrong the French can be and there is supposedly very even handed evaluations. H Robert Silverstein MD FACC (cardiologist)
We approach the diagnosis of type 2 diabetes like this. We begin with diet and exercise. Our diet recommendation is carb and sugar restriction coupled with eating real food and intermittent fasting. I agree with your point on sulfonylureas and we don't recommend them.
If a person has the diagnosis of type 2 diabetes, they should be on metformin, period. A protocol containing metformin reduces progression to dialysis 6 fold and hospitalization for heart failure by 70%. Jardiance was not tested against OMT. It was tested against usual care. It is added to metformin in our protocol if the glucose is not well controlled or if there is heart failure or renal insufficiency. As we generate big data, we will learn how much Jardiance helps in the real world. Metformin and Jardiance both provide this protection for cells and organs by switching on the master genetic metabolic survival switch AMPK. If patients fail diet, metformin, and Jardiance, we add self-adjusted basal insulin. Since Jardiance was not tested against OMT, we really do not know how much it adds to that highly effective approach.
the loyal opposition is at it again: Bill is wrong again in my best guess. after an ideally organic in unprocessed low-calorie whole foods diet plus adequate exercise to reduce to the weight called "trim", then begin with metformin. The best combination is an OZEMPIC or MOUNJARO + Jardiance or Farxiga. So doing make clear the need for any other diabetic medication in addition to being remarkably helpful for kidneys and heart in diabetics. H Robert Silverstein, MD, FACC