乌鸦传媒

Although diabetes drugs such as liraglutide and empagliflozin come with a big price tag, clinical trials continue to document their benefits. When weighing the costs against the benefits of these medications, several factors should be taken into consideration including certain benefits that won't be provided by cardiovascular agents alone, says Fernando Ovalle, MD, associate professor in the division of endocrinology, diabetes & metabolism at the University of Alabama at Birmingham and director of UAB's Multidisciplinary Comprehensive Diabetes Clinic.

In this exclusive 乌鸦传媒 video, Ovalle discusses which benefits to consider when prescribing these oral agents. Following is a transcript of his remarks:

I think to some degree that these drugs had it very hard to show a benefit, and I'm actually surprised that they showed a benefit because these patients were already on pretty good intensive therapies with anti-cholesterol agents, statins, anti-hypertensive agents, other anti-diabetic agents, and lifestyle interventions, all these other things were being done. So every time you add something, it gets a little harder.

I would say that if you have somebody on a statin and you're already doing some benefit to that patient, and you add another statin on top of that -- not that I would do this -- but you're probably not going to get a whole lot from the second statin. You're going to get mostly just side effects, and the number needed to treat with several statins will be very high. Because a lot of the risk that you would've perhaps avoided with it have already been taken care of.

So to some degree, this has happened with these strokes is, with many of the diabetes trials, is some of the low-hanging fruit has already been picked by the other therapies, so it's really hard to show further benefit. Still, we have to consider the cost. The problem though is that we don't have good cost-effective analyses out there of the kind that would show the cost per quality of life gained, you know, those kind of studies. Until then, I think we have to put it into context of the patient, the side effects, the physiology of our patients, there are other things that we consider. And I think there is still a use for them despite their relatively, seemingly high cost, the retail value.

There's another point here too is that these drugs, besides reducing these cardiovascular endpoints and giving you some advantage in that, also have other effects that are not taken into account when you look at just that raw number needed to treat. The benefits in terms of microvascular disease reduction -- you know, eye disease, kidney disease, neuropathy, other things -- that is not in that equation, and that's something that other cardiovascular agents do not provide. So, that somehow needs to be taken into consideration when we're making a decision.

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