| مستخلص: |
Fisman et al. report an observational analysis in an unselected, patient population of type 2 diabetic patients with coronary artery disease. They suggest that there may be increased mortality in patients treated by combined therapy with sulphonylurea and metformin. However, such observational studies of the risk of therapies are notoriously difficult if not impossible to interpret, since the therapies used inevitably reflect severity of disease. This is particularly the case in type 2 diabetes, that is a progressive disease that can often be treated initially by diet, but subsequently requires one and then combined oral hypoglycaemic agents [1]. Therefore, patients receiving combined therapy have, on average, had diabetes for a longer duration than those taking one therapy or diet alone. In accord with this, Fisman et al. reported the patients treated by diet alone had mean fasting glucose 158 mg/dl, with sulphonylurea 185 mg/dl, with metformin 192 mg/dl and with combined therapy 219 mg/dl. Thus inspite of addition of single or combined oral hypoglycaemic agents, there was step-wise greater hyperglycaemia. [ABSTRACT FROM AUTHOR] |
