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Medications for type 2 diabetes: how will we be treating patients in 50 years?

ABSTRACT: The past 50 years have seen the development of many new options for treating and preventing type 2 diabetes. Despite this success, the individual and societal burden of the disease continues unabated. Thus, the next 50 years will be critical if we are going to quell the major non-communicable disease of our time. The knowledge we will gain in the next few years from clinical studies will inform treatment guidelines with regard to which agents to use in whom and whether more aggressive approaches can slow the development of hyperglycaemia in those at high risk. Beyond that, we anticipate identification of novel targets and techniques for therapeutic intervention. These advances will lead to more personalised approaches to treatment. Most importantly, we will need to focus our political and economic efforts on enhancing and implementing public health approaches aimed at prevention of diabetes and its co-morbidities. This is one of a series of commentaries under the banner '50 years forward', giving personal opinions on future perspectives in diabetes, to celebrate the 50th anniversary of Diabetologia (1965-2015).

SUBMITTER: Kahn SE

PROVIDER: S-EPMC4499484 | biostudies-literature | 2015 Aug

REPOSITORIES: biostudies-literature

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Medications for type 2 diabetes: how will we be treating patients in 50 years?

Kahn Steven E SE Buse John B JB

Diabetologia 20150314 8

The past 50 years have seen the development of many new options for treating and preventing type 2 diabetes. Despite this success, the individual and societal burden of the disease continues unabated. Thus, the next 50 years will be critical if we are going to quell the major non-communicable disease of our time. The knowledge we will gain in the next few years from clinical studies will inform treatment guidelines with regard to which agents to use in whom and whether more aggressive approaches ...[more]

PMID: 25773402

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Project description:BackgroundThe role of locking plate in lateral malleolar fracture fixation for the elderly remains unclear. The aim of our study is to compare radiological and functional outcomes in older patients (> 50 years) with AO/OTA 44B lateral malleolar fractures after locking plate (PLP) or one-third non-locking tubular plate (TP) lateral fixation.MethodsWe retrospectively reviewed the medical records of 72 patients (PLP group, 34 patients; TP group, 38 patients; mean age, 61.9 ± 7.6 years; range, 51-80 years; follow-up, 1 year). Patients with open fractures, syndesmosis injuries, and a previous ankle trauma or surgery were excluded. Demographic data, union rate, complications, radiographic outcomes, visual analog scale (VAS) scores, and foot and ankle outcome scores (FAOSs) between the groups were recorded and compared. We also investigated the association of clinical features with pain and function. Statistically, the Fisher's exact test was used for categorical variables and the Mann-Whitney U test for the continuous variables. The final model for the multiple regression analysis was used to predict factors related to functional outcomes.ResultsThere were no significant between-group differences in demographic data, complication rates, immediately postoperative distal fibula lengths, ankle osteoarthritis (OA) grades, talar tilt angles (TTAs) ≥ 2°, or reduction accuracy. All fractures achieved union. The PLP group had significantly lower rates of distal screw loosening, fibula shortening > 2 mm, OA grade progression, and TTAs ≥ 2°, and better FAOSs and VAS scores than was the case for the TP group after 1 year of follow-up (all p < 0.05). The severity of OA, TTA ≥ 2°, and distal screw loosening were positively associated with VAS scores, and negatively associated with FAOSs.ConclusionsWhen treating AO/OTA 44B fractures in patients over 50 years of age, PLPs provided better VAS scores, FAOSs, and radiological outcomes, including less fibula shortening > 2 mm, less osteoarthritic (OA) ankle progression, less implant removal rate, and fewer TTAs ≥ 2° than was the case for TPs after a 1-year follow-up.Level of evidenceTherapeutic level III.

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Medications for type 2 diabetes: how will we be treating patients in 50 years?

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Medications for type 2 diabetes: how will we be treating patients in 50 years?

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