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Episode 61: Type 2 Diabetes – how sweet it isn’t – Part VII

In the 61st episode, the seventh podcast in our thesis on type-2 diabetes, we get off the topic of glucose and talk about STENO and blood pressure treatments. We decide the bottom line is control of blood pressure with low doses of thiazides and ACE inhibitors with no tolerance for side effects. Mike’s blood pressure goes up with some of James’ suggestions but high doses of reserpine, methyldopa and clonidine calm him down.

Show Notes


N Engl J Med 2008;358:580-91

2) Blood pressure trials UKPDS 38

BMJ 1998;317:703-13

HOT Trial

Lancet 1998;351:1755-62

Do ACEI/ARBs uniquely protect the kidney – No?

Lancet 2005;366:2026-33


JAMA 2002;288:2981-97

Low doses of ACEI – most of the BP effect is from low doses

Cochrane Library


Lancet 2000;355:253-59

Episode 60: Type 2 Diabetes – how sweet it isn’t – Part VI

In episode 60, the sixth podcast in our saga on type-2 diabetes, we talk about what to do when metformin is not enough and get to the evidence surrounding other blood glucose lowering treatments. We fumble around in a pretty much evidence-free zone. James develops a bad case of hypoglycemia during the podcast because he hasn’t eaten since the start of the diabetes section of these podcasts; Mike comes to his aid by prescribing a low dose of a chocolate bar and eats the rest of it himself.

Show Notes

1) UKPDS (recent results)

NEJM 2008;359:1577-89

Table of results

2) Fluoxetine, orlistat, sibutramine for weight loss in type-2 diabetics

Arch Intern Med 2004;164:1395–404

3) Acarbose for impaired glucose tolerance

JAMA 2003;290:486-94

4) Glitazones meta-analyses

JAMA 2007;298:1180-8

JAMA 2007;298:1189-95

Table of results

5) Risks of an elevated A1c

Link to table

6) Long acting insulin analogues – no advantage

CMAJ 2009;180:385-97

Episode 59: Type 2 Diabetes – how sweet it isn’t – Part V

In episode 59, the fifth podcast in our diatribe on type-2 diabetes, we finally get to the evidence surrounding specific treatments. The importance of lifestyle is discussed and then the rest of the time is spent talking about the who, what, why, where, and when’s of metformin. James asks lots of rhetorical questions and Mike tries to answer them in a grandiloquent way.

Show Notes

1) UKPDS (original trial)

Lancet 1998;352:854-65

2) UKPDS (recent results)

NEJM 2008;359:1577-89

3) Metformin’s contraindications should be contraindicated

CMAJ 2005;173:502-4

Episode 58: Type 2 Diabetes – how sweet it isn’t – Part IV

In episode 58, the fourth in our installment of podcasts on diabetes, we briefly talk about the evidence surrounding intensive glucose lowering (ACCORD, ADVANCE, VADT and UKPDS trials) – podcasts #9 and #38 did this in more detail. At the end of the podcast, Mike identifies many of James’ flaws, but does it with compassion and kindness; at least he says he does.

Show Notes

1) Does tight glycemic control burden patients with complex treatment programs, hypoglycemia, weight gain, and costs and offers uncertain benefits in return?

Ann Int Med 2009;150:803-8

2) ACCORD and ADVANCE studies

Click here for a synopsis of the results

N Engl J Med 2008 358:2545-2559

N Engl J Med 2008 358:2560-2572

Also listen to Episode 9: News Flash: Aggressive Blood Sugar Control Not All Sweet

3) VADT trial N Engl J Med 2009;360:129-39

Also listen to Episode 38: New trials you need to know about

4) Glucose lowering meta-analysis – do the results support the conclusions?

Lancet 2009; 373:1765-72

5) UKPDS data

BMJ 2000;320:1720-3

6)UKPDS – 10 year update (recent results)

NEJM 2008;359:1577-89

Episode 57: Type 2 Diabetes – how sweet it isn’t – Part III

In episode 57, we continue yet again with the topic of type 2 diabetes. In this podcast, we talk about monitoring HbA1C, self-monitoring of blood glucose and, diabetes education in general. We hear Jillian Popel suggest not only is self-monitoring of glucose not really useful when it comes to overall glucose control, it in fact might be harmful. We also discuss what we think diabetes education should really focus upon. Finally, after 56 episodes, Mike and James actually agree on an issue, but it was just that all complaints about any of the content in the podcasts should be sent directly to Jillian.

Show Notes

1) Self-monitoring of blood glucose ESMON

BMJ 2008;336:1174-7


BMJ 2008;336:1177-80

2) Calculating cardiovascular risk for type 2 diabetics

UKPDS risk engine

3) Diabetes education – Cochrane reviews

Individual patient education for people with type 2 diabetes mellitus

Group based training for self-management strategies in people with type 2 diabetes mellitus

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