Type 2 diabetes treatment comparison meta-analysis,d?nyan?n en iyi cfg yapma program?,ocr exam grade boundaries january 2013 - Test Out


However many doctors prescribe lifestyle changes as the first course of action including We have sent Porter’s to Iraq and Afghanistan with our son and his buddies to take care of their minor scrapes and pains.
A number of medicines are used to control blood glucose levels in people with In addition several combination oral edicines are available that contain two diabetes drugs in one tablet. I have absolutely no interest in getting drunk (and I am not entirely sure why others want to) and alcoholic drinks just taste horrible to me. Insulin resistance often goes unnoticed in the initial stages when an individual is described as prediabetic.
ANTES DE LA ENFERMEDAD EN EL CURSO pasta recipes for type 2 diabetes DE LA ENFERMEDADAgente: Insulina.
For patients eating substantial amounts of food, you can use that calculated amount as the total daily dose.
Approximately 40-50% of the total daily insulin dose is to replace insulin overnight, when you are fasting and between meals. This is called background or basal insulin replacement.
The other 50-60% of the total daily insulin dose is for carbohydrate coverage (food) and high blood sugar correction. The bolus dose for food coverage is prescribed as an insulin to carbohydrate ratio.The insulin to carbohydrate ratio represents how many grams of carbohydrate are covered or disposed of by 1 unit of insulin. The bolus dose for high blood sugar correction is defined as how much one unit of rapid-acting insulin will drop the blood sugar. Read some examples and therapeutic principles on how to calculate the carbohydrate coverage dose, high blood sugar correction dose and the total mealtime insulin dose. CHO insulin dose =     Total grams of CHO in the meal ? grams of CHO disposed by 1 unit of insulin (the grams of CHO disposed of by 1 unit of insulin is the bottom number or denominator of the Insulin:CHO ratio).
High blood sugar correction dose =      Difference between actual blood sugar and target blood sugar*? correction factor. This example above assumes that you have a constant response to insulin throughout the day.
Please keep in mind, the estimated insulin regimen is an initial “best guess” and the dose may need to be modified to keep your blood sugar on target. Diabetes mellitus is not one disease, but rather is a heterogeneous group of multifactorial, polygenic syndromes characterized by an elevation of fasting blood glucose that is caused by a relative or absolute deficiency in insulin.
The American Diabetes Association (ADA) recognizes four clinical classifications of diabetes: type 1 diabetes (formerly, insulin dependent diabetes mellitus), type 2 diabetes (formerly, non-insulin dependent diabetes mellitus), gestational diabetes, and diabetes due to other causes (for example, genetic defects or medications). Type 1 diabetics must rely on exogenous insulin injected subcutaneously to control hyperglycemia and ketoacidosis. The goal in treating type 2 diabetes is to maintain blood glucose concentrations within normal limits, and to prevent the development of long-term complications.
Gestational diabetes is defined as carbohydrate intolerance with onset or first recognition during pregnancy. ReferenceInternational Diabetes Federation, Lippincott Illustrated Reviews Pharmacology & Biochemistry, American Diabetes Association, National Diabetes Education Program USA, Mayo Clinic. Thankfulness to my father who shared with me regarding this web site, this website is in fact remarkable. Walking makes your cells more receptive to insulin which leads to better control of blood sugar. Thanks for this excellent review New York Hospital jobs and career resources on Certified Diabetes Educator (RN) Stony Brook University Associate Veterinarian Summary of Job Purpose and Function The primary purpose and function of the Associate Doctor is to ensure the highest quality of veterinary care and Can a yeast infection cause blood to be in urine? Vaginitis may also be due to a yeast infection Interstitial cystitis (chronic pain in the bladder) Some also support treatment of those with diabetes mellitus I guess one last thing that comes to mind is that during an episode it helps a lot to stay away from gluten type foods like grains and cereals.
But if your blood sugar rises more than most people’s you might have diabetes or pre-diabetes a condition that indicates a strong risk for developing diabetes in the future. Services: Part B covers some diabetes Losing weight continuously without any vital reason is certainly nothing good and this is Determinants to calculate the CHADS2 score include the presence of Chronic heart failure Hypertension Age above 75 Diabetes mellitus and earlier Stroke. Our New BMJ website does not support IE6 please upgrade your browser to the latest version or use alternative browsers suggested below. RebuttalGovernment Distoritions in US Health Care SystemMy opponent claims that government interventions have greatly expanded Health Coverage in the US. RebuttalUniversal Health Care and SpendingMy opponent claims that the point about United States government interventions increasing the cost of Health Care is irrelevant and that I failed to refute his argument about preventative medicine:"This part of the debate came about after I demonstrated that the US spends far more on health care than any nation with universal health care.
For Arguments - Con made several assumptions without sourcing or justifying (Pro did too for that matter, but to less of an extent).
Source - Pro, one of con's sources went to a website no longer around (or at least a page no longer around), and others went to blogs that themselves linked to pages no longer around. This debate has been configured to only allow voters who meet the requirements set by the debaters. Get more information about # type 1 diabetes prevention type 2 diabetes food avoid on that post. Copyright © 2015 World Economic News, All trademarks are the property of the respective trademark owners.
Diabetes Type 2 Pathophysiology Flow Chart it is poorly absorbed and has no systemic effects.. Some people may refer to this type as insulin-dependent diabetes juvenile diabetes or early-onset diabetes.
I had been an avid runner as a teenager but hadn’t done much in a long time due to shin splints.
Some women are at higher risk of developing Type 2 amazon uk blood glucose monitor diabetes because of a how to take care of juvenile dibetes syndrome that often goes undiagnosed: Polycystic Ovary Syndrome.
In human beings vitamin B12 deficiency leads to pernicious anemia (also called Addisonian anemia) which however is primarily due to a lack of the intrinsic factor which brings about a vitamin B12 deficiency. Between 40% and 50% of that total dose should be administered as basal, with the rest dosed out in nutritional boluses. You should give 50% of that total dose as basal insulin about four hours before patients’ IV insulin is turned off.
This range can vary from 4-30 grams or more of carbohydrate depending on an individual’s sensitivity to insulin. Bear in mind, this may be too much insulin if you are newly diagnosed or still making a lot of insulin on your own. You will need to work out your specific insulin requirements and dose regimen with your medical provider and diabetes team. For example, it is estimated that more than 250 million people worldwide are afflicted with diabetes, and the prevalence is expected to exceed 350 million by the year 2030.
Diabetes is the leading cause of adult blindness and amputation, and a major cause of renal failure, nerve damage, heart attacks, and stroke. The disease is characterized by an absolute deficiency of insulin caused by an autoimmune attack on the ? cells of the pancreas.
The goal in administering insulin to Type 1 diabetics is to maintain blood glucose concentrations as close to normal as possible and to avoid wide swings in glucose levels that may contribute to long-term complications. Insulin may also be delivered by a pump, which allows continuous subcutaneous infusion of insulin 24 hours a day at preset levels and the ability to program doses (a bolus) of insulin as needed at meal times. Weight reduction, exercise, and medical nutrition therapy (dietary modifications) often correct the hyperglycemia of newly diagnosed type 2 diabetes. It is important to maintain adequate glycemic control during pregnancy, because uncontrolled gestational diabetes can lead to fetal macrosomia (abnormally large body) and shoulder dystocia (difficult delivery), as well as neonatal hypoglycemia. A team of inspired pharmacists is working to build a free access pharma publication, we call it Pharma Mirror.
Pharma Mirror has an International Standard Serial Number ISSN 2219-763X of its own and it has been assigned by ISSN Center, Paris.
Cinnamon Blood Sugar Levels Research Okra Cure home Diabetes Special Uncontrolled Diabetes Can Now be Controlled. The best diet to normalize blood lipids is a low carb While they are in a flare the diet they need is truly the opposite of a Cinnamon Blood Sugar Levels Research Okra Cure good diabetic diet.
When hyperglycemia is associated with the presence of ketones in the urine this state demands immediate medical attention. Www Diabetes Diet Org Uk own rice and diabetes type 2 cat diabetes As long as you monitor your blood sugar levels and don’t overdo it with too 1800 calorie diet for diabetics many Blood glucose monitors are used to measure the amount of glucose in blood especially of patients with symptoms or a Most commonly they enable diabetic patients to administer appropriate insulin doses. As doctors prepare to carry out experimental retinal stem cell treatment at Moorfields Eye Hospital in London Umbilical cord blood stem cells FAQs; Is there a diabetes cure? Study C This randomized controlled clinical study enrolled 619 subjects with type 1 diabetes who were treated for 16 weeks with a basal-bolus insulin regimen where insulin lispro Clinical socioeconomic and lifestyle parameters associated with erectile dysfunction among diabetic men. Further examination of the meaning does not need to be brought up in this debate.INTRODUCTIONI'm am happy to be starting this debate which I have been planning to do with jimtimmy. My opponent, however, is making the mistake of looking at intentions and not the actual effects of the programs.
Government DistortionsSo I found myself about to go on about why programs like medicare have vastly expanded the access to healthcare. Con responded by saying that the spending is high because prices have been artificially expanded by the government.Lets assume for a moment that he's right.
Since the europe ages were lowered when there is no logical way for the removal of pre-mature deaths to do that, the data could not be trusted.
I think the deciding factors for me on this debate were the fact that Universal Healthcare doesn't require eliminating Private Healthcare (allowing people to use it if it is so much better) and the fact that the Waiting Lines issue is skewed by people who don't even get in line for Private Health Care due to costs. This debate either has an Elo score requirement or is to be voted on by a select panel of judges. The difference between type 1 and 2 is that people who have type 2 diabetes must inject insulin in order to maintain a safe blood sugar.
Its the same reason I used to save pics Diabetes Type 2 Pathophysiology Flow Chart when I used 4chan years ago and went to u raff u ruse threads to see the same stuff. It doubles as not only the finest video game console but a fabulous Diabetes Type 2 Pathophysiology Flow Chart home entartainment system.
Diabetes mellitus type 2 (referred to as diabetes throughout the rest of this article) has the potential to be a devastating disease because it slowly clogs up your network of blood vessels destroying the transportation system that your blood relies entirely uponto nourish and cleanse your cells. For the managers that employ model-builders or for those that must choose between competing systems this book exposes some of the basic methodologies that a manager should expect from a model. Researchers have recently transplanted cells into the pancreas to enable it to produce insulin normally.
Once patients start eating, add the rest in bolus amounts.You should also take into account how well the patient’s glucose was controlled in the ICU on the preceding day. Insulin sensitivity can vary according to the time of day, from person to person, and is affected by physical activity and stress.
Someone who is resistant in the morning, but sensitive at mid-day, will need to adjust the insulin-to-carbohydrate ratio at different meal times.
Insulin resistance is the decreased ability of target tissues, such as liver, adipose tissue, and muscle, to respond properly to normal (or elevated) circulating concentrations of insulin. In the absence of a defect in ?-cell function, non -diabetic, obese individuals can compensate for insulin resistance with elevated levels of insulin. Hypoglycemic agents or insulin therapy may be required to achieve satisfactory plasma glucose levels.
The good news is that scientific studies have proven that control of blood sugar may help delay or even prevent diabetes complications – get started by learning more about the signs and causes of high blood sugar and tips to help prevent its development. Objective The project seeks to raise awareness build capacity and promote large scale screening for gestational diabetes mellitus (GDM) within the public health care service in Cameroon. Overall risk of bias for the primary outcome was low in three reports, unclear in nine, and high in 14. The main reason, my opponent argues, is that Universal Health Care Systems put more focus on Preventative Medicine. First, my opponent claims that Governmet Programs, like Medicare, Medicaid, SCHIP, and TRI-CARE, have been key in expanding coverage to disadvantaged groups. Before I get into that, though, I feel it is necessary to explain why Health Care costs so much in the United States. Diabetes is a very serious condition where the pancreas stops or slows in the production of a serious hormone called insulin.
Actually that's the way it should be: we came from an environment where sugar and fat was rare and precious, so we should grab any we came along. For patients with poor control, consider factoring in another 10% to your total daily dose. Talk to your provider about the best insulin dose for you as this is a general formula and may not meet your individual needs.
The metabolic abnormalities of type 1 diabetes mellitus include hyperglycemia, ketoacidosis, and hyper triacylglycerolemia. They result from a deficiency of insulin and a relative excess of glucagon. Glyburide and metformin may be reasonably safe alternatives to insulin therapy for gestational diabetes. EnjoyIf you enjoyed this post, please consider subscribing to the RSS feed to have future articles delivered to your email inbox or feed reader. If your last diet attempt wasn’t a success diabetes insipidus adalah best pre diabetic diet by Courtney Carter. This is due to a metabolic state of the body called insulin renal diabetes definition vector lilly logo resistance and because the insulin is not Type 2 diabetes is also Cinnamon Blood Sugar Levels Research Okra Cure called non insulin dependant diabetes mellitus (NIDDM) and can be treated with diet only with different types of that any commercially available combination of supplements provides effective control of blood sugar. I love the drink and all the ingredients have possible health helps so I drink it all the time.
This certainly was the INTENT of these groups, but the effects have been quite different.The people who are on these programs actually receive very poor Health care Coverage.
Does that refute what I demonstrated in the first place, that universal health care will reduce spending?


The United States Health Care system is deeply distorted by government programs, regulations, and odd tax laws. Your personal contribution and fundraising efforts support JDRF-funded type 2 diabetes recipes desserts diabetes controlled carbohydrate diet I liked the fact you could fold it up and open up this sturdy cane in a matter if seconds. Vitamin E 7% Vitamin B6 13% Riboflavin 19% (230%)* Niacin 20% (93%)* Magnesium 16% Fiber 22% Zinc 24% Potassium 26% Thiamine 27% (176%)* Iron 30 Have your child follow a good diet emphasizing plenty of vegetables red bull doesnt do much for me but one sip cat diabetes hind leg weakness of one of these guys and im flying When you add a file Family Tree Maker does the work for you. Insulin resistance when the body becomes diabetes obesity conference 2014 resistant to the less common symptoms of type 1 diabetes effects of insulin is primarily what causes diabetes.
Wish that Amazon would label this clearly, or remove the Fire version for purchase until the issue is resolved. Rather, type 2 diabetes develops in insulin-resistant individuals who also show impaired ?-cell function.
However, larger randomized studies are needed to fully assess neonatal outcomes and optimal dosing regimens.
May no one vote without reading and may they be honest in doing so.I will lay out a few short points that I may add to or expand on later. The correct measure is Health Care Spending as a Percentage of GDP, not Health Care Spending per Capita. Internists are 8.5 times more likely to reject Medicaid patients than Private Insurance Patients [1].
When too little of the hormone is present the blood sugar levels begin to rise to dangerous levels.
Kinda’ surprised me as she has a more advanced degree than me and got better grades than me with a job offer right out of school. The metabolic alterations observed in type 2 diabetes are milder than those described for the insulin-dependent form of the disease, in part, because insulin secretion in type 2 diabetes- although not adequate- does restrain ketogenesis and blunts the development of diabetic ketoacidosis.
Con may simply rebut or may include his own points but there will be no new points by him in the last round.ARGUMENTS1. So called "government distortions" are what have made health care more accessible to many Americans.
Neither did Con refute the effect of preventative medicine in nations with universal health care."However, my opponent is incorrect in both of his assertions here.
I do hold against Pro that he should have attacked this more, as there are plenty of studies that show that preventative care is more cost effective than major medical.
Also known as Maturity Onset Diabetes Adult Onset Diabetes and Non Insulin Dependant Diabetes. Type 1 diabetes or often called insulin-dependent diabetes mellitus (IDDM) for short is caused by normal range diabetes type 2 diabetes eye problems bleeding the cells of the pancreas not secreting insulin. Available treatments for diabetes moderate the hyperglycemia, but fail to completely normalize metabolism. Only a minimal number of hypoglycaemias were observed in any treatment arm in trials comparing a DPP-4 inhibitor with metformin as monotherapy or with pioglitazone or a GLP-1 agonist as second line treatment. Lastly, a Surgical Outcomes Study from UVA found that people on Medicaid were 13% MORE likely to die in surgery than people WITHOUT Health Insurance at all, and people on Medicaid were 97% more likely to die than people with Private Insurance [3]. First, it is totally relevant that government distortions have caused US Health Care prices to be so high. The damage that is commonly done includes heart damage, eye damage, nerve damage, and kidney damage. The long standing elevation of blood glucose is associated with the chronic complications of diabetes- premature atherosclerosis, retinopathy, nephropathy, and neuropathy. In most trials comparing a DPP-4 inhibitor with sulfonylureas combined with metformin, the risk for hypoglycaemia was higher in the group treated with a sulfonylurea. These government interventions have brought health care to poor, elderly, veterans and children who otherwise would not have been able to afford it. These studies show that, despite spending hundreds of Billions of dollars on Public Health Programs, it is not even clear that these patients get better coverage than those without any Health Insurance.Furthermore, my opponent did not even answer my main point that high Health Care costs were the result of various Government Interventions, which they are. Incidence of any serious adverse event was lower with DPP-4 inhibitors than with pioglitazone. These government factors, not private Health Care, are too blame for the high cost of Health Care in the United States.The main thing driving the high prices of Health Care in the US is government distortions [2].
This is a key point, as it shows that the private market is not responsible for high Health Care costs.Rationing and Waiting TimesGovernments ration Health Care by limiting individual's use of it.
His entire basis for arguing this is that the United States, without Universal Health Care, has higher prices than countries with Universal Health Care.Therefore, if I can show that Government Distortions, not a lack of Universal Health Care, have caused the US to have such high Health Care prices, I have successfully disproven a major part of my opponent's argument. Diabetes can do damage to you but the faster you notice the type 2 diabetes symptoms, the more healthy you stay.
Incidence of nausea, diarrhoea, and vomiting was higher in patients receiving metformin or a GLP-1 agonist than in those receiving a DPP-4 inhibitor. Basically, the US tax code allows a full exemption for employer provided Health Care, but not individually bought Health Care. Con has not provided any example of health care being rationed by governments with universal healthcare. In my Round 1 and Round 2 posts, I offer substantial evidence showing that Government Distortions have indeed lead to high Health Care prices in the US.This reality effectively rebuts my opponent's entire argument about prices.
Risk for nasopharyngitis, upper respiratory tract infection, or urinary tract infection did not differ between DPP-4 inhibitors and any of the active comparators.Conclusion In patients with type 2 diabetes who do not achieve the glycaemic targets with metformin alone, DPP-4 inhibitors can lower HbA1c, in a similar way to sulfonylureas or pioglitazone, with neutral effects on body weight. In countries without universal health care, namely the United States, the majority of individuals with ailments, whether they know of them or not, have a strong incentive to stay away from check-ups because it will cost them money that they are already struggling to hold onto. And even if these supposed rations exist, he is forgetting about the rations that are inherent in private health care providers as well. As I showed in my last post, Universal Health Care Systems have high waiting times and low supply of medical technologies. As I mentioned earlier, my opponent's entire argument about prices was based on the fact that the US has high Health Care prices. What this means is that employees are NOT paying directly for their own Health Insurance, and, more importantly, this has caused Health Insurance to function as much more than insurance.In a private market, free of this tax distortion, individuals would mostly buy Health Insurance Plans that offer only catastrophic type coverage. So, my opponent is basically arguing that high Health Care prices in the US are caused by a lack of Universal Health Care.
Sitagliptin, vildagliptin, saxagliptin, and linagliptin are currently approved by the US Food and Drug Administration or the European Medicines Agency, while others are awaiting approval or are in development. Universal health care will save lives.The American Journal of Public Health confirms that around 45,000 people die each year in the United States due to lack of health insurance [2]. This would mean that they would pay individually for Health Care, unless an extreme expense came by. Some complain that the government will supposedly start coming between them and their doctor, while they are completely oblivious to the insurance companies coming between them and their doctor right now.III. Americans have shorter waiting times because they are much less likely to use the health care system due to high costs. However, I have shown that these prices are caused by government distortions and not a lack of Universal Health Care. Their place in the 2009 consensus algorithm was not established because of limited clinical data, high costs, and lower or equivalent effectiveness compared with other agents.1 The National Institute for Health and Clinical Excellence (NICE) clinical guideline for type 2 diabetes suggests adding a DPP-4 inhibitor instead of a sulfonylurea as second line treatment to first line metformin if there is a considerable risk for hypoglycaemia or if a sulfonylurea is contraindicated or not tolerated. This recommendation, however, is based on a small number of trials and a Cochrane systematic review, all published before 2009.3 4 Thus, the potential role of DPP-4 inhibitors among the existing hypoglycaemic drugs needs to be updated and clarified. Even though, as I would see the evidence suggests, universal health is good for the economy, it doesn't even matter. With this system, patients would not overuse things like Dentists, Pediatricians, and other non-emergency type doctors.However, with the domination of Employer-Provided Insurance, patients are removed from their costs. A Health Affairs survey reports that 27% of Canadians and 5% of Americans reported waiting four months or more for elective surgery. Previous systematic reviews of randomised controlled trials have assessed their efficacy and safety.4 5 6 7 8 These included mainly4 5 8 or exclusively6 placebo controlled trials. For if it was bad for the economy, it is still putting a price on human life to say that we would be better without it.
But the same study says 24% of Americans reported that they did not get medical care because of cost.
As prices just reflect the supply and demand of a good or service, shortages arise when there is high demand and low supply for a good or service, but the price is held down.My opponent does not answer this economic issue. Instead, he claims that American shave it worse than those in Universal Health Care systems because, even though Americans have lower waiting times, they have high costs. My opponent never gave any evidence that Universal Health Care systems have more preventative medicine or that preventative medicine reduces prices. The only reason Americans aren't waiting in line is because they can't afford to get in the line. However, as I explained earlier, these prices are the result of Government distortions and artificial restrictions on Medical Supply. However, I made other points regarding why countries with universal health care save lives. I cannot rebut either of these claims because they were never supported in the first place. Universal Health care will help the economyAccording to the US Department of Labor, the average American spends about 3,175 dollars a year on health insurance [3].
And, the problem with this is that patients overuse Medical Services because individuals have no incentive to control their own costs. Universal Health Care and Medical InnovationIn my last post, I offered evidence that Universal Health Care reduced medical innovation and, therefore, did not save lives. Countries with universal health care have lower infant mortality and were ranked as being healthier than the United States. My opponent did offer a theoretical reason why Universal Health Care might increase prevention.
This is known as the tragedy of the commons, where individuals overuse resources because they are removed from the cost. My opponent claims that Universal Health Care does save lives because countries with Universal Health Care have higher life expectencies than the United States, which does not have Universal Health Care.However, this does not show what my opponent thinks it shows.
This is not to mention the fact that, as I showed before, universal health care brings care to tens of thousands of people who otherwise wouldn't have it. Basically, he said that Universal Health Care systems encourage use of preventative check-ups because Health Care is free at the point of delivery. We used the keywords “DPP-4”, “dpp-iv”, “dipeptidyl peptidase 4”, and “dipeptidyl peptidase iv”, combined with relevant MeSH terms and the substance names of both marketed and pre-marketed DPP-4 inhibitors.
Based on the simple mathematics of shared cost, health care would cost the average person less in tax than it would in price. Now, in the US, the system is dominated by government programs and private insurance companies. The United States is the ONLY first world country without Universal Health Care, and the United States also happens to have many more fatal injuries than other countries, which have nothing to do with Health Care.
However, my opponent ignores that Universal Health Care systems do have to deal with much longer waiting times than non Universal Health Care systems. Furthermore, once fatal injuries are taken into account, the US actually has HIGHER life expectancy than other developed countries [4].Universal Health Care and the EconomyMy opponent does not really answer my response from last round. This means that accessing preventative check ups would be challenging in Universal Health Care systems, just like it would be in non Universal Health Care systems. The last search was run on 15 March 2011.We retrieved additional studies by hand searching the abstracts of the 2009 and 2010 annual meetings of the American Diabetes Association, the European Association for the Study of Diabetes, and the American Association of Clinical Endocrinologists. Because, even though the US system is deeply distorted, the price system is still basically allowed to operate.In Universal Health Care Systems, the same tragedy of the commons problem occurs, except it is the government instead of private insurers that is insuring people.
My opponent claimed that Universal Health Care would improve the economy by "putting money in people's pockets".
The only difference is that price is the problem in non Universal Health Care systems and waiting times are the problem in Universal Health Care systems. The difference, however, is that in most Universal Health Care systems, the response to overuse of medical services is shortages and rationing, instead of higher costs.Shortages seen in the long waiting times in most Universal Health Care Systems. I pointed out that Universal Health Care is funded by taxation, which offsets this effect.Plus, taxation has additional disincentive effects ("supply-side effects"), like reducing investment and hours worked, that hurt economic growth.
The vast majority of countries below the Unites States on the list do not have universal health care.
I have shown that excessive waiting times do exist in Universal Health Care systems in previous rounds. After removing the duplicate results, two reviewers (TK and PP) independently screened all titles and abstracts and investigated full texts for eligible studies.
Canada, for example, has extremely long waiting times for most serious types of medical services [3].
And, as I showed in my last post, there is a well known growth reducing effect of larger government and higher taxation.Universal Health Care and Medical InnovationMy opponent says that Universal Health Care will not reduce Medical Innovation because Private Insurance will still exist. Another problem with my opponent's argument is that he ignores the fact that high Health Care prices in the US are the result of government distortions not a lack of Universal Health Care. Differences in opinion between the two reviewers were resolved by consensus with a third reviewer (AT). This is not true, as the Public Sector WILL crowd out the Private Sector because the Public Sector is subsidized by the government and not forced to make a profit.
This is relevant, as it shows that high prices are not a necessary barrier to preventative medicine in the absence of Universal Health Care.


One reviewer (TK) conducted the search of conference abstracts, trial registries, and websites of pharmaceutical companies.
This is actually how it works in the US, demand is just artificially high because of government distortions.
This means that people are already paying for Public Insurance through their taxes, so buying Private Insurance would be the equivalent of paying for insurance twice. In other words, a country can have both low waiting times and low prices without Universal Health Care. Eligible trials retrieved from these sources were juxtaposed against the search results from the three electronic databases to identify any unpublished studies.Data extractionWe designed a data extraction form and piloted it on three randomly selected eligible studies. Most of the time, higher demand, without a corresponding increase in supply, means higher prices.
And, as I demonstrated, universal health care is more efficient with it's spending than private health care.
Two reviewers (TK and PP) independently abstracted data, and any discrepancies were resolved by consensus.
A privelege that only the wealthy could attain, because it is too expensive for regular people to pay for Insurance through their taxes and then again for Private Insurance.Universal Health Care in AmericaUniversal Health Care would hurt America.
And if the public sector doesn't take care of it properly, the private sector is still allowed to do it.
However, in most Universal Health Care Systems, prices are kept articially low by price controls. It would fail to control costs, it would reduce medical innovation, and it would lead to long waiting lines for Americans. When I mentioned this before, Con replied that they would not be able to because they would be pushed out of the market. I have shown above and in previous rounds that US prices are the result of government distortions and that this is relevant to this debate.Universal Health Care and Health In my last round, I showed that US life expectancy is only lower than other countries because fatal accidents are more common in America, and that this has nothing to do with Health Care. Our primary outcome was glycaemic efficacy as measured by the change in HbA1c from baseline to end point of the intervention. Furthermore, a Universal Health Care system would violently force people to participate in a system that they may not even support.
My opponent acknowledges this and responds by pointing out that the infant mortality rate is higher in America than it is in other countries.However, this is a deeply flawed argument. Secondary efficacy outcomes included the change from baseline to end point in body weight and the percentage of patients achieving the glycaemic goal of HbA1c <7%. Even if they get Private Insurance, they are forced to pay for the Universal Health Care System through taxation.
Just like Life Expectancy, infant mortality is almost entirely determined by factors that don't relate to Health Care, and, to make matters worse, infant mortality is measured differently accross countries [1].
Safety outcomes extracted included the percentage of patients experiencing at least one hypoglycaemic event, discontinuation rate from any adverse event, occurrence of any serious adverse event, all cause mortality, and incidence of nasopharyngitis, urinary tract infection, upper respiratory infection, nausea, vomiting, and diarrhoea, based on their clinical relevance or relatively high frequency in previous syntheses.4 5 If data for our primary outcome were missing or incomplete, such as sample size and measures of variance, we emailed the corresponding authors or the sponsors (pharmaceutical companies). Of course, whatever board makes the decisions on rationing does not have the information necessary to plan an entire medical system used by millions of people. The solution to the United States's Health Care crisis is to allow individuals to make their own Health Care decisions, free of Government distortions. If it is true this means that universal health care's success can be measured by the fact that those who use it, by a large enough margin to make private insurers disappear, are content with the quality of their healthcare and medical innovation is not a problem.
This means that infant mortality rates say very little to nothing about the quality of Health Care systems.My opponent's next point is that a WHO study found the US to have only the 37th best Health Care system in the world. In case of multiple reports or companion papers of the same study (either published results of an extension period or unpublished results disclosed in trial registries and websites of drug manufacturers) we extracted outcome data separately for each report and subsequently collated all relevant data to maximise yield of information.14Risk of bias assessmentWe used the Cochrane Collaboration’s risk of bias tool15 to assess risk of bias in random sequence generation, allocation concealment, blinding of participants and personnel, incomplete outcome data, and selective reporting. If it is false, it means my point about medical innovation being backed up by the private sector is still well founded.4. I am familiar with this study, as it has been cited favorably by nearly every advocate of Universal Health Care I have encountered. As risk of bias might differ between the primary phase and the extension phase of a study, we assessed this separately for each report.
The International Monetary Fund urges that the most important thing nations can do in an economic downturn is to strengthen their social safety nets. The problem is that this study is deeply flawed.One problem with this study is that it is very old. Blinding of participants and personnel, incomplete outcome data (because of high rate of discontinuation, type of analysis, or imputation of missing data), and selective reporting were assessed separately for each outcome within each report. Universal Health Care will actually hurt the economy.The main reason is that Universal Health Care requires higher taxes to pay for it.
They say this while well aware that it means raising taxes because they know that it's worth it. We summarised the risk of bias of all six domains to produce an overall risk of bias for every outcome within every different report. Higher taxes actually hurt economic growth by reducing the incentive to work, save, invest, and report income.
This was deemed high in the presence of high bias in any domain, low if all key domains (all domains except random sequence generation and allocation concealment) were of low bias, and unclear in all other cases.
There is a well known growth dampening effect of high taxation, that has been confirmed by numerous academic studies [4].Second, implementing a Universal Health Care system in tough economic times is the worst thing the government could do.
With universal health care, everyone knows that, no matter their financial situation, they can count on having care if they become ill. A priori we planned to perform a sensitivity analysis for every outcome based on its overall risk of bias (excluding reports at high overall risk of bias). The stronger any nation's social safety net is, the less hard any recession is going to hit.4. This could be different among outcomes, hence the subset of studies included in every sensitivity analysis might be different.
Two reviewers (TK and PP) independently assessed the risk of bias, which was subsequently determined through consensus with a third reviewer (AT).Data synthesis and analysisWeighted mean differences between the intervention group (DPP-4 inhibitors) and the active comparator group and 95% confidence intervals were calculated for continuous outcomes with an inverse variance random effects model. Although the US system is far from a free market, it is not Universal and a large private sector does exist. A universal health care system would most likely be funded through the income tax, which is progressive. If a study did not report a standard deviation, this was calculated from the sample size and the standard error or the 95% confidence interval.
Not surprisingly, the US has many more MRI's and CT Scans per capita than countries with Universal Health Care like Canada and the United Kingdom [5].Furthermore, a lions share of the world's medical innovations are coming from the US. If what you say is true, that public sector health care would not provide the necessary treatments to some people, they are still fully capable of buying those treatments from a private provider.ARGUMENTS1. The rich would pay more because they're more able to pay and the price of health care means a lot less to them than it does a homeless man. If it is true this means that universal health care's success can be measured by the fact that those who use it, by a large enough margin to make private insurers disappear"To respond to this point, let me offer a quick hypothetical story. Additionally, for our primary outcome (change in HbA1c) analyses, we calculated 95% prediction intervals to estimate a predicted range for the true treatment effect in any one individual study.16 For dichotomous outcomes we calculated risk ratios and 95% confidence intervals, again using an inverse variance random effects model.
7 of the top 12 Pharmaceutical Companies, as ranked by Forbes Magazine, are located in the United States and 74 of the top 100 Biotech Companies are located in the United States [6] and [7]. Americans Will Be Happier With a Universal Health Care SystemThere are several reasons that a universal health care system would increase the average American's satisfaction with it. Thirdly, even if we are all paying in the same, there is still another inherent success in social safety nets.
Let's say that government forces everyone, by gun, to pay a banana tax so everyone could get free bananas at the grocery store. We used data for intention to treat (all participants randomised) or modified intention to treat (all randomised participants who received intervention and had at least one measurement after baseline) populations when these were available either in a published paper or on websites of pharmaceutical companies and trial registries.
The fact is that Universal Health Care systems simply are not producing nearly as much innovation as the non-Universal US system. It means that no one will need to worry about whether they will be able to afford health care, they know it is taken care of. Any time a human need is made an economic right, it diverts spending from things which are non-necessity, making the market better economized. Now, when everyone goes to the grocery store, there are other private bananas available for people to pay for there, but everyone chooses to take the bananas they were forced to pay for in advance.Because of this, the private banana companies all went out of business, and everyone started taking the "free" government bananas (they were paid by through forced taxation). Additionally, we requested intention to treat or modified intention to treat data for our primary outcome through email contact with the corresponding authors or sponsors if a study reported such an analysis in its methods but not in the results. If the US had a true free market in Health Care, there is no telling how far Medical Innovation would be.ConclusionLet me conclude by saying that I look forward to my opponent's response. CONCLUSIONEvery other industrialized nation besides the United States has adopted universal health care and there's a reason why. Does this prove how good the government bananas are?Or, does it simply show that people will take what they are forced to pay for?I think the answer is fairly simple, and this is why my opponent's argument is wrongheaded.
In our meta-analyses we used data from the group randomised to the approved DPP-4 inhibitor dose (100 mg daily for sitagliptin and vildagliptin and 5 mg daily for saxagliptin and linagliptin). I will also say that I have tried my best to source my arguments adequatley, but I do hope my opponent does not use incorrect or inadequate sourcing as a "cop-out" on some of my arguments. Doctors will be free to take care of their patients as they want, their available treatments will not be limited by an insurance company and they will not have to deal with the moral disgrace of turning anyone down because they couldn't afford it. The fact that people will enroll free public insurance that they are forced to pay for through mandatory taxation does not prove that this Public Health Insurance is superior to Private Health Insurance in any way.On another note, I have in previous rounds that Universal Health Care systems do impede medical innovation and that Universal Health Care systems are not very efficient. In the absence of a group receiving the approved doses we analysed the group receiving the highest dose.In our main analysis for each outcome we used the report with the longest duration of follow-up (extension) for each study. Lastly, Americans will be more satisfied because the majority of Americans endorse a universal health care system. The best economic and medical associations endorse universal health care and there's a reason.Because it works.
Universal Health Care and the EconomyMy opponent claims that Universal Health Care will help the economy.
Because it works a lot better than what we have now.NOT letting sick people die or live in suffering is a moral and practical thing for society, for the economy, for our daily lives. I2 values of 30-60% and over 75% represent moderate and considerable heterogeneity, respectively.17 We decided a priori to explore potential causes of heterogeneity by performing a sensitivity analysis for every outcome, excluding reports at high overall risk of bias. Instead, he simply pointed out that it would be more equitable.In previous rounds, I explained how Universal Health Care does not reduce costs and, more importantly to this point, must be funded by new taxation. In this analysis, in case of multiple reports of the same study we used the report with the lowest overall risk of bias and the longest duration of follow-up. We performed additional sensitivity analyses for the primary outcome, excluding unpublished reports or using only the reports from the main (not extension) phase of studies. The robustness of the results was also tested by repeating the main analysis with an inverse variance fixed effect model.
Universal Health Care, through the higher taxation necessary to fund it, will actually harm the economy.ConclusionI have successfully disproven the notion that a Universal Health Care system is beneficial to the population. I have shown that there is no reason to believe that Universal Health Care will reduce prices, and I have shown that Universal Health Care will lead to long waiting times.
From the search of the three major electronic databases we identified 23 eligible reports, 15 of which were primary studies19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 and eight34 35 36 37 38 39 40 41 were extensions of seven primary studies.20 22 24 26 28 31 32 Six additional eligible completed trials were retrieved through the search of other sources.
A total of 27 reports (15 published primary studies, eight published extensions, three unpublished extensions, and one conference abstract) with 7136 patients randomised to a DPP-4 inhibitor and 6745 patients randomised to another hypoglycaemic drug were included in the systematic review and meta-analyses.
Of these, 12 reports19 20 21 22 23 24 34 35 36 41 43 44 compared a DPP-4 inhibitor with metformin as monotherapy. A DPP-4 inhibitor combined with metformin was compared with metformin combined with a sulfonylurea, pioglitazone, and a GLP-1 agonist in nine,25 26 27 28 29 33 37 38 45 four,30 31 39 42 and three reports,30 32 40 respectively. We did not identify any eligible trial comparing a DPP-4 inhibitor with insulin combined with metformin.Fig 1 Flow diagram of study selection processStudy characteristicsTable 1 summarises the characteristics of the included studies?. All studies were parallel and included an active control group in a double blind design, except for the study by Pratley et al32 40 (open label design), the study by Forst et al29 (in which patients were randomised to receive double blind linagliptin (1, 5, and 10 mg) or placebo or open label glimepiride), and the study by Handayani et al42 (no blinding mentioned). Nine reports (six primary studies and three extensions) were published in 2010, while three (one primary study and two extensions) were published in 2011.
The duration of intervention was equal to or longer than one year (52 weeks) in 12 studies (including their extension periods).
Random sequence generation and allocation concealment were described adequately in 1619 20 24 25 26 29 30 31 32 33 34 35 37 39 40 41 and 1024 25 29 30 31 32 33 39 40 41 of the 27 eligible reports, respectively. Overall risk of bias for the primary outcome was low in three,25 30 38 unclear in nine,19 20 21 22 23 27 31 33 39 and high in 14 reports24 26 28 29 32 34 35 36 37 40 41 43 44 45 (mainly because of inadequate handling of outcome data (per protocol analysis) or attrition bias resulting from high discontinuation rate). We did not assess risk of bias for the study of Handayani et al42 because it was available only as an abstract. Seven trials (n=3237) comparing a DPP-4 inhibitor with metformin monotherapy and 10 trials (n=8912) that compared DPP-4 inhibitors with other hypoglycaemic drugs combined with metformin contributed to this analysis. Figure 3 shows the risk ratio for achieving an HbA1c of less than 7%?.Fig 2 Weighted mean difference in change in HbA1c (%) from baseline.
Inverse variance random effects meta-analysis comparing DPP-4 inhibitors and other hypoglycaemic drugsFig 3 Risk ratio for achieving HbA1c <7%.



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