Calling tuberculosis a social disease—an excuse for complacency?

Abstract

www.thelancet.com Vol 384 September 20, 2014 1095 estimated that more than 90% of people started on such treatment will not benefi t. A 1% reduction in HbA1c would add only about 10 months of quality-adjusted life for a 45 year old and 6 weeks for a 75 year old. But such gains would be completely eliminated by any treatment deemed, by the patient, to reduce the quality of life by more than 3%, a fi gure below that generally cited for injectable drugs. On this basis, even a drug for diabetes that improves cardiovascular outcomes might be a poor choice for many patients. These measures of likely health gains matter because such treatments, although potentially providing benefit in aggregate outcomes, are being used for individual benefit. The patient should be the one who makes choices about treatment once they are fully informed of potential benefi ts, burdens, and harms. When these factors are closely balanced, and when patients vary in the weight they give to different factors, good quality information that is clearly communicated becomes particularly important. Data about glucose lowering falls far short of what licensing and regulatory bodies, clinicians, and patients need from new drugs for diabetes.