General Practitioners Were Neglected
Without any further explanation, the three authors refer preferentially to the algorithm proposed by the German Diabetes Society (Deutsche Diabetes Gesellschaft, DDG). Patients with type 2 diabetes often present with complex symptoms, and most of them are treated by general practitioners. As an experienced GP I do not see any identifiable benefit in the equal status given in the article to the substance dapagliflozin; for this reason, this medication is not mentioned in the third therapeutic stage by the German College of General Practitioners and Family Physicians (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin, DEGAM) and the Drug Commission of the German Medical Association (Arzneimittelkommission der Ärzteschaft, AkdÄ).
The article can also be used for the purpose of collecting CME points. It is of note that the selected authors are exclusively hospital clinicians and that none of the authors from the DEGAM diabetes working group was involved. Dapagliflozin should not be used in patients older than 75. On the other hand, the number of diabetes patients older than 80 is steadily rising. I would have wished for a differentiated reflection on the use of metformin in this age group, and not for quotes from the widely known prescribing information. The authors are likely to be well aware of the fact that in other European countries, the threshold for the glomerular filtration rate is lower. As a GP who is active in continuing medical education I will not recommend this article.
Dr. med. Manfred Lohnstein
Conflict of interest statement
The author is a member of the German College of General Practitioners and Family Physicians (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin, DEGAM).
|1.||Pfeiffer AFH, Klein HH:The treatment of type 2 diabetes. Dtsch Arztebl Int 2014; 111: 69–82 VOLLTEXT|