Letter from the Editor #733

This week there is a lot of press on the use of insulin right after metformin and the increased risk of death in patients on this combination. Upon reading the entire article you see, however, that it is a retrospective review and unfortunately there is little if any data on how the choices are made. With the addition of the GLP-1 mimetics, DPP-4 inhibitors and SGLT2-I’s to our medicine armada, is there really a need for insulin right after metformin or do our old habits just die hard? It gets ever harder to look for true correlations with this study when we look at the use of Rapid Insulin Analogs versus the old Human N and R insulins. If we take the data in Item #1 and look at the increase use of human insulin it appears that maybe we need to tease out the non-rapid insulin patients in that cardiovascular study and see if using human insulin has a different effect than using the analogs

Steve and Andrew are at the ADA Scientific sessions in San Francisco. When we were there in 2008 we took a great picture of escalator from the exhibit hall that embarrassed quite a few attendees. We checked with the Convention Center and the steps are working. Watch out for the hidden camera……

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Dave Joffe, Editor-in-chief