I always enjoy these Fortnights. I agree with John. I feel papers that are poor in terms of evidence and research are still instructive in helping discern the good from the bad. So, continue with these.
The purported increase in NAION has been a big topic in the diabetes and ophthalmology newsletters, giving the impression that it is a clearcut situation. I appreciate the discussion, since, despite its rarity, the phenomenon is somewhat troublesome regarding what to advise potential users of GLP-1's since one feels obligated to at least mention it. The big issue in my mind is whether it has something to do with the well-established phenomenon of worsening diabetic retinopathy in diabetics who have aggressively rapid lowering of chronic hypergycemia. One selection variable that the study doesn't address is whether GLP-1 treatment was chosen more frequently for individuals who have more significant metabolic abnormalities. For many reasons, and this being one of them, my feeling is that, somewhat contrary to the manufacturer's directions, the clinician should advise going low and slow with the dosage, compatible of course with the clinical situation.
Very nice discussion. A couple of thoughts came to mind as I was listening. Weight loss is not guaranteed as some patients seem to be resistant to GLP-1RAs. Significant variance is seen in the long term data from SELECT ... see waterfall plots. I also think we need to be cautious using NNHs given their dependence on baseline risk and duration of exposure. Great point at the end about measurement!
I think the bigger point is not the patients who really need a drug for serious conditions and are making tradeoffs but the many more people who are using drugs like the GLP1s for cosmetic reasons who may have extreme adverse results for possibly no benefit…
I always enjoy these Fortnights. I agree with John. I feel papers that are poor in terms of evidence and research are still instructive in helping discern the good from the bad. So, continue with these.
The purported increase in NAION has been a big topic in the diabetes and ophthalmology newsletters, giving the impression that it is a clearcut situation. I appreciate the discussion, since, despite its rarity, the phenomenon is somewhat troublesome regarding what to advise potential users of GLP-1's since one feels obligated to at least mention it. The big issue in my mind is whether it has something to do with the well-established phenomenon of worsening diabetic retinopathy in diabetics who have aggressively rapid lowering of chronic hypergycemia. One selection variable that the study doesn't address is whether GLP-1 treatment was chosen more frequently for individuals who have more significant metabolic abnormalities. For many reasons, and this being one of them, my feeling is that, somewhat contrary to the manufacturer's directions, the clinician should advise going low and slow with the dosage, compatible of course with the clinical situation.
Very nice discussion. A couple of thoughts came to mind as I was listening. Weight loss is not guaranteed as some patients seem to be resistant to GLP-1RAs. Significant variance is seen in the long term data from SELECT ... see waterfall plots. I also think we need to be cautious using NNHs given their dependence on baseline risk and duration of exposure. Great point at the end about measurement!
I think the bigger point is not the patients who really need a drug for serious conditions and are making tradeoffs but the many more people who are using drugs like the GLP1s for cosmetic reasons who may have extreme adverse results for possibly no benefit…