DOCTOR'S VIEW ARCHIVE
Diabetes Update #4 Day 2, Saturday June 11 from the American Diabetes Association National Meeting
Dr. Ruchi Mathur offers perspectives of interest on topics from the American Diabetes Association's 65th Annual Scientific Sessions (held in San Diego, California June 10-14, 2005)
This is Dr. Ruchi Mathur filling you in on some of the topics discussed here on the second day of the American Diabetes Association's annual scientific sessions.
One of my goals in providing state of the art diabetes care is to pick and choose medications that will provide patients with more than one benefit. One example is the class of drugs known as thiazolidinediones (TZDs). Pioglitazone and rosiglitazone are the generic names and Actos and Avandia are the trade names used for the agents currently on the market in the United States. TZDS are known to reduce insulin resistance in patients with type 2 diabetes. They also have been shown to exert a positive effect on cholesterol profiles, and perhaps even reverse thickening of the arteries. The majority of the action of these drugs is through a cellular mechanism called PPAR gamma. However, there is a small component of action through a second mechanism called PPAR alpha. So researchers began to speculate on what would happen if a similar drug was created with more PPAR alpha effects.
This brings us to data released on a new TZD- Muraglitazar. This agent is not yet available on the market, but initial research on this compound is very interesting. In a study presented, approximately 500 patients with type 2 diabetes were given this new compound and were compared to 500 patients given pioglitazone. They were in their 50s on average, with a baseline A1c of 8.1%, LDL of 113mg/dl , triglycerides of 203mg/dl and HDL of 46mg/dl. When reviewed more patients in the muraglitazar group achieved a goal A1c than those in the pioglitazone group, and accordingly, they had a lower fasting insulin and glucose levels.
Here's where this gets interesting. In the Muraglitazar group- there was a 28% drop in triglyceride levels from baseline, compared to 14% in the pioglitazone group. Good cholesterol rose 19% compared to 14% as well. Side effect profiles were similar between groups however; there was a lot more weight gain and more swelling (or edema) in the muraglitazar group (can't seem to have the good without a bit of bad). This weight gain is an important side effect to mention since being overweight is such an issue in type 2 diabetes.
So- what does this mean for you? It means that there are medications coming down the pipeline that offer not only benefit in blood sugar control, but that will also be significant in the treatment of other related areas such as cholesterol abnormalities as seen in type 2 diabetes. This may reduce the number of pills ( and thus the dispensing fees, and copays) for certain patients in the future. More importantly, these medications will not only target blood sugar but also help to control the other factors that increase heart disease in patients with diabetes. Regardless of the interest in these newer agents however, the pros must always be weighed against the cons, since our first goal as physicians is to do no harm. Read and hear the next installment from the conference.
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