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Volume 21, Number 3 (September)

Metformin or Thiazolidinediones as First-Line Therapy in Type 2 Diabetes? (pages 7-12)

Silvio E. Inzucchi, M.D.

As physicians seek to attack the root problem of insulin resistance, the insulin secretagogues have fallen out of favor as first-line drug therapy for the typical person with Type 2 diabetes. With their lower risk for hypoglycemia and their ability to reduce insulin resistance, insulin sensitizers thus seem logical successors. The insulin sensitizers of the biguanide and thiazolidinedione classes both offer similar amounts of glycemic reduction and even some similar beneficial effects on cardiovascular risk factorsئacts that can make it difficult to decide which to prescribe. The author makes the case for why metformin currently seems better for use as a first-line therapy in people with Type 2 diabetes when diet and exercise alone cannot control their diabetes.
Drug treatmentMetformin
Drug treatmentThiazolidinediones

Position Statement: Immunization and the Prevention of Influenza and Pneumococcal Disease in People with Diabetes (pages 13-19)

American Diabetes Association

With flu season just around the corner, physicians need to start thinking about vaccinating their high-risk patients, including those with diabetes and the people who come in regular contact with them. Older people with diabetes may also need to be vaccinated against pneumococcal infection. The American Diabetes Association has graciously allowed us to reprint their Position Statement on preventing influenza and pneumococcal disease. The Editor has added his suggestions and comments, gives a heads-up on the return of the tetanusؤiptheria vaccine, and provides a timely list of immunization resources for your use.
Professional guidelines

Clinical Controversies in Diabetes (pages 22-32)

Daniel L. Lorber, M.D.

With the array of drugs available to fight the various comorbidites of diabetes, it can be difficult to decide which to use to treat or prevent problems such as hypertension, dyslipidemia, and nephropathy. The Editor presents recommendations bases on the latest research results to help you determine current best-practice guidelines for your patients.
Complications and comorbiditiesCardiovascular diseaseDyslipidemia
Complications and comorbiditiesCardiovascular diseaseHypertension
Complications and comorbiditiesNephropathy

Peril Seen in Diabetes Drug (pages 33-34)

Daniel L. Lorber, M.D.

Late last spring, headlines warned about the dangers of inappropriate metformin prescriptions. This widely prescribed drug is in fact not appropriate for everyone. The Editor reviews some of the contraindications to metformin use, and when and why you might prudently consider going beyond the package insert.
Drug treatmentMetformin