RT Book, Section
A1 Bucher, Heiner C.
A1 Cook, Deborah J.
A1 Holbrook, Anne M.
A1 Guyatt, Gordon
A2 Guyatt, Gordon
A2 Rennie, Drummond
A2 Meade, Maureen O.
A2 Cook, Deborah J.
SR Print(0)
ID 1183876702
T1 Surrogate Outcomes
T2 Users' Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice, 3rd ed
YR 2015
FD 2015
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-179071-0
LK jamaevidence.mhmedical.com/content.aspx?aid=1183876702
RD 2024/04/25
AB CLINICAL  SCENARIOYou  are  an  internist  treating  an  overweight  56-year-old  woman  who  was  diagnosed  as  having  type  2  diabetes  mellitus  8  years  ago.  Her  glycosylated  hemoglobin  (HbA1c)  level  has  not  been  well  controlled  (typically  at  8.3%)  during  the  past  12  months,  despite  the  fact  that  she  is  receiving  metformin  therapy  and  you  have  been  providing  her  with  repeated  counseling  regarding  weight  and  exercise.  Her  low-density  lipoprotein  cholesterol  (LDL-C)  and  blood  pressure  (99  mg/dL  and  <135/80  mm  Hg,  respectively)  are  managed  with  statin  therapy  and  an  angiotensin-converting  enzyme  (ACE)  inhibitor  combined  with  a  thiazide  diuretic.  You  are  aware  that  your  patient's  blood  glucose  level  is  too  high,  but  on  the  basis  of  previous  discussions,  you  are  also  aware  that  she  is  reluctant  to  take  more  medications  and  that  she  is  opposed  to  insulin,  which  may  increase  her  struggles  with  her  weight.  Your  patient  is  very  astute,  and  she  has  asked  you  about  the  effect  of  the  medication  on  complications  related  to  diabetes,  including  stroke  and  myocardial  infarction.A  colleague  has  been  talking  to  you  about  exenatide,  a  once-weekly  injectable  glucagon-like  peptide  1  receptor  agonist,  lauding  its  better  control  of  HbA1c  in  patients  with  inadequately  controlled  type  2  diabetes.  He  mentions  the  drug  has  essentially  no  risk  of  hypoglycemia  and  has  beneficial  effects  on  weight  compared  with  dipeptidyl  peptidase-4  (DPP-4)  inhibitors,  sulfonylureas,  thiazolidinediones,  and  insulin.  Wondering  if  your  patient  would  agree  to  an  injectable  drug  in  light  of  the  expected  advantages,  you  are  optimistic  that  if  improved  glucose  control  with  exenatide  is  also  associated  with  a  reduction  in  macrovascular  complications  of  diabetes,  then  shared  decision  making  may  lead  her  to  try  the  drug.  You,  therefore,  conduct  a  literature  search  to  determine  what  evidence  is  available  that  addresses  this  issue.