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Avandia Reduces Risk of Diabetes

October 2, 2006

Taking Avandia (rosiglitazone) may help people at high risk for diabetes to prevent development of the disease, according to a new study.

People at risk for diabetes because of overweight, family history or other reasons, are advised to exercise and adhere to a healthy diet. However, the new study suggests that rosiglitazone may offer additional preventative help, much as cholesterol-lowering drugs are prescribed to people with high cholesterol to reduce heart-attack risk.

The study by the (Diabetes REduction Assessment with ramipril and rosiglitazone Medication) DREAM trial group was recently presented at a meeting in Copenhagen of the European Association for the Study of Diabetes, published online in The Lancet, and summarized in a New York Times article on September 17.

The DREAM trial showed that who high risk for developing diabetes who took rosiglitazone for three years had a two-thirds lower chance of developing diabetes.

Avandia raises cells’ sensitivity to insulin and has been used for over five years in treating people with Type 2 diabetes. The DREAM trial is the first time Avandia has been studied on a large scale to prevent diabetes.

Clinical Trial

The multi-center DREAM trial included about 5,000 participants in 21 countries.

“This is a very large effect, the kind of thing that you don’t expect to see in a clinical trial,” said Hertzel Gerstein, the study’s main author, a professor at McMaster University in Hamilton, Ontario, according to The New York Times. “Ten, even five years ago, we really didn’t know what people could do to reduce their risk of diabetes. Now we are developing an arsenal.”

Dr Gerstein reportedly added that he “would certainly consider using the treatment now” in some patients, although Avandia is not approved for such use in the US.

However, despite the encouraging reports, skepticism about the trial exists among some independent scientists and advocacy groups:

“We’ve looked carefully at the data and it’s just hard to know how many people would benefit and at what cost,” said Cathy Moulton, a care adviser for Diabetes UK, an advocacy group in London, according to The New York Times. “We’re worried that people may think there’s a quick fix, when what is proved to work is lifestyle changes. For the moment, we don’t think we can solve this epidemic with a pill.”

Diabetes Prevention?

Certainly, prescribing drugs to prevent diabetes would be highly lucrative for pharmaceutical manufacturers – statins (prescribed to help lower cholesterol) are a reportedly $40-billion industry.

And there’s good reason to think diabetes prevention – in any form – is a good idea: in addition to an approximately 5% incidence of diabetes worldwide, researchers estimate that another 8% may be prediabetic – that is, they process sugar abnormally and are at high risk for diabetes.

“For the last 20 years, we have been developing a growing number of drugs and interventions that could prevent heart disease,” Dr Gerstein reportedly said. “Now we have entered the era of diabetes prevention. It is very, very important.”

But skepticism about drug prevention for diabetes remains. An accompanying editorial in The Lancet said that “intensive lifestyle changes…should remain the mainstay for the prevention of Type 2 diabetes.”

Governments and healthcare providers worldwide are dealing with what some have termed a “diabetes epidemic”. About 7% of people in the US (20 million people) have diabetes, according to the Centers for Disease Control and Prevention, and about 54 million may have prediabetes (but may not know it).

Based on these data, the authors of the recent study estimated that for every 1,000 prediabetic people treated with rosiglitazone, 144 cases of diabetes – and their associated secondary health risks, such as heart attack and stroke – would be prevented.

Drug Can Prevent Diabetes in Many at High Risk, Study Suggests, The New York Times, September 17, 2006.
Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial. The DREAM (Diabetes REduction Assessment with ramipril and rosiglitazone Medication) Trial Investigators, The Lancet, volume 368, pages 1096-1105, 2006.
Glucose lowering and diabetes prevention: are they the same? Tuomilehto J, Wareham N, The Lancet, volume 368, 2006.

Posted: October 2006