Posting this under the heading it deserves: Type 2 diabetes and the largest part of the evidence base Everything below is what sits behind that.
Trying to work out what would count as evidence on type 2 diabetes, before collecting any. This is the part I usually skip and it is the part that makes the rest useful.
If two explanations predict the same observation, observing it does not help. So: what observation would separate them?
Type 2 diabetes: I would want to see the raw numbers rather than the summary before agreeing. Summaries lose exactly the information that would settle this.
Where I part company with post #2, and it is a narrow parting.
Where the honest answer is "nobody knows", giving it plainly is more useful than a confident synthesis of mechanism and anecdote.
That is where I would start, not where I would stop.
Where a condition is well controlled and where it is not are different questions and the published data rarely distinguishes them.
Reporting the observation and leaving the explanation open deliberately.
Type 2 diabetes: the population with the largest evidence base for these compounds. The SURPASS and SUSTAIN programmes established glycaemic benefit. The renal and cardiovascular benefit evidence is separate from the glycaemic benefit evidence.
I am aware this is the third time this month I have made this point.
I had written a reply contradicting post #6 and deleted it. Here is what survived.
Two sentences on type 2 diabetes and then I will stop, because the rest is speculation and the thread is better without mine.
What is documented is narrow. What is inferred from it is broad. The gap between them is where every argument here lives.
On post #9 — agreed on the reasoning, with one qualification.
Multiple comorbidities: a person with diabetes, kidney disease, and cardiovascular disease is outside the studied populations in most trials. Extrapolating to that person requires reasoning from the individual component trials and mechanisms.
I would not lead a decision with this, but I would not ignore it either.
Picking up post #9: that is the part I would want checked first.
On type 2 diabetes: the maintained page in the documentation commons covers the general case with citations and a review date, which is more reliable than any reply here including this one.
My experience of type 2 diabetes contradicts the reply above. I am posting it as a data point rather than as a refutation, because one person's experience is exactly that.
Nothing here is medical advice and clinicians posting in this subcategory say so on their own account rather than because a rule requires it.
This follows post #13 rather than contradicting it.
Registry and observational data covering excluded populations is accumulating and is weaker evidence than a trial and better than nothing.
If the premise is wrong, everything after it is decoration.
Type 2 diabetes is well covered in the tag pages, and the older discussions are better than the recent ones because they were argued out properly. Worth twenty minutes before adding to this one.
Adding the boring version of type 2 diabetes, because the interesting version keeps getting posted and the boring one is usually right.
Check the ordinary explanations, in order, and stop when one of them accounts for what you are seeing. Most of the time the second one does.
Bariatric surgery history: altered anatomy after surgery affects absorption. That matters for oral medications and for reconstituted solutions. Discussing specific medications and doses with a clinician familiar with bariatric surgery is prudent.
On type 2 diabetes, the part that usually goes wrong is that the question is asked as though it has one answer. It has a range, and the width of the range is the interesting bit.
If you can post the two or three numbers you are working from, several people here will check the arithmetic rather than argue about the conclusion.
Two claims get bundled together under type 2 diabetes and they need separating. The descriptive one — this is what was observed — is usually well supported. The causal one — this is why — usually is not.
Almost every disagreement in threads like this one dissolves once you say which of the two you are making.
A condition that affects nutrition or absorption changes the calculus around a treatment that reduces intake, and that interaction is mostly unstudied.
The part I am sure of is shorter than the part I have written.
Where I part company with post #20, and it is a narrow parting.
The practical value of this subcategory is helping somebody frame the question they take to an appointment, and that is worth being explicit about.
If this contradicts something upthread, the upthread version may well be the better one.
Speaking only to type 2 diabetes as I have actually seen it, rather than as it is usually described: the effect is real, it is smaller than the thread suggests, and the variance between people is larger than the effect.
Nothing to add, except that this is the answer I would give if asked.
I disagree with the framing of type 2 diabetes above, and I think it is a substantive disagreement rather than a terminological one. Setting out why, so it can be checked.
The reasoning depends on an assumption that is doing a lot of work and is never stated. If the assumption holds, the conclusion follows. I do not think it holds generally.
I read post #29 twice before replying, because I had assumed the opposite.
Cardiovascular disease: several compounds have cardiovascular outcome trials. SELECT was in people without diabetes; SUSTAIN 6 was in high-risk diabetes. Absolute benefit is largest in high-risk people.
If that is already documented somewhere, ignore me and link it.