According to a new review published online in Annals of Internal Medicine, there are numerous regimes of diabetes medications to treat type 2 diabetes in the US. Many of these patients need to take multiple medications to control their blood sugar levels, but they have side effects - hypoglycemia ( low blood sugar levels) is the the most common serious side effect, others include nausea or diarrhea.
Researchers at Johns Hopkins reviewed 166 studies that examined the efficacy of 6 classes of diabetes drugs. They found that most of the medications lowered blood sugar levels by a similar amount and that combination of 2 drugs improved blood sugar control, but no combination was shown to have significant benefits over another. The study found that metformin, an older drug approved in 1995 in the US, was consistently associated with fewer side effects and is cheaper than most newer drugs. Reserachers suggested metformin is probably the best first-line therapy for type 2 diabetes.
The study noted that 95 of the 166 studies reported drug company support, many of them were not long enough to study the side effects. The study leader said longer-term reserach into their impact on long-term outcome is needed .
Siurce: Comparative Effectiveness and Safety of Medications for Type 2 Diabetes: An Update Including New Drugs and 2-Drug Combinations. Annals of Internal Medicine, First published online on March 14, 2011 ( free f/t article)
Showing posts with label type 2 diabetes. Show all posts
Showing posts with label type 2 diabetes. Show all posts
Wednesday, March 16, 2011
Tuesday, October 05, 2010
Look AHEAD trial - lifestyle intervention for diabetes
Following the Avandia scandal in July 2010, the European Medicines Agency (EMA) on 23 Sept recommended the suspension of the rosiglitazone-containing anti-diabetes medicines Avandia, Avandamet and Avaglim, they will be banned in Europe within the next few months. At the same time, the US government put toughened resrictions on the use of the drug. Critics say these "decisions will virtually eliminate use of the drug around the world".
According to a new study published in the Archives of Internal Medicine, 27 September, lifestyle interventions are recommended to improve glycemic control and risk factors in type 2 diabetes to prevent long-term complications, but the evidence of their efficacy is limited to short-term studies.
The authors said that the Look AHEAD study, a 4-year non-drug approach using intensive lifestyle interventions helped reduce cardiovascular risk factors in type 2 diabetics. The trial randomized 5145 patients with type 2 diabetes to following an intensive lifestyle- intervention program or to receive standard diabetes support and education. The intensive program including a combination of diet modification and physical exercises, with training and group support, was designed to achieve 7% weight loss in the first year and to maintain the weight in subsequent years.
After 4 years, the intensive intervention group maintained a weight loss of 6.15% of their weight compared with 0.88 % in the standard support group. They also experienced greater improvements in fitness, blood sugar, blood pressure, triglycerides and good cholesterol. The standard group had lower levels of bad cholesterol.
The authors said that the result indicated that the intensive intervention group had been exposed to lower cardiovascular disease risk factors during the trial, although it would be too early to say that intensive intervention can prevent heart attacks, there may be long-term benefits from the 4-year period. The study is continuing for several more years.
Should we look beyond Avandia and other drugs for diabetes treatment and invest in more preventive efforts?
Source: Long-term Effects of a Lifestyle Intervention on Weight and Cardiovascular Risk Factors in Individuals With Type 2 Diabetes Mellitus - Four-Year Results of the Look AHEAD Trial. The Look AHEAD Research Group. Arch Intern Med. 2010;170(17):1566-1575. (f/t via Athens)
According to a new study published in the Archives of Internal Medicine, 27 September, lifestyle interventions are recommended to improve glycemic control and risk factors in type 2 diabetes to prevent long-term complications, but the evidence of their efficacy is limited to short-term studies.
The authors said that the Look AHEAD study, a 4-year non-drug approach using intensive lifestyle interventions helped reduce cardiovascular risk factors in type 2 diabetics. The trial randomized 5145 patients with type 2 diabetes to following an intensive lifestyle- intervention program or to receive standard diabetes support and education. The intensive program including a combination of diet modification and physical exercises, with training and group support, was designed to achieve 7% weight loss in the first year and to maintain the weight in subsequent years.
After 4 years, the intensive intervention group maintained a weight loss of 6.15% of their weight compared with 0.88 % in the standard support group. They also experienced greater improvements in fitness, blood sugar, blood pressure, triglycerides and good cholesterol. The standard group had lower levels of bad cholesterol.
The authors said that the result indicated that the intensive intervention group had been exposed to lower cardiovascular disease risk factors during the trial, although it would be too early to say that intensive intervention can prevent heart attacks, there may be long-term benefits from the 4-year period. The study is continuing for several more years.
Should we look beyond Avandia and other drugs for diabetes treatment and invest in more preventive efforts?
Source: Long-term Effects of a Lifestyle Intervention on Weight and Cardiovascular Risk Factors in Individuals With Type 2 Diabetes Mellitus - Four-Year Results of the Look AHEAD Trial. The Look AHEAD Research Group. Arch Intern Med. 2010;170(17):1566-1575. (f/t via Athens)
Thursday, September 09, 2010
The Avandia scandal
An investigation by the BMJ published this week calls for the withdrawal of the daibetes drug, Avandia, immediately from the market because of the concerns that it may increase the risk of myocardial infarction and the paucity of good evidence to support its use.
Rosiglitazone, also known as Avandia, was GSK's second biggest selling drug, introduced in 1999 and is widely used to lower blood glucose levels in patients with type 2 diabetes. It was approved by the EMA in 2000 despite concerns over its safety.
In 2007, several studies found Avandia having harmful effects and issued serious health warnings. The researchers questioned why Avandia is still available on the market and why physicians would prescribe it to diabetic patients when there are other drugs without these side effects. They called for Avandia to be withdrawn from the market. Since then, the sales of Avandia fell sharply.
The BMJ investigators found that in July, the UK Commission on Human Medicines advised the MHRA to withdraw Avandia as the risks of Rosiglitazone outweigh its benefits. This has raised a lot of questions about the quality of the data used in the studies and the lack of trial results made available to the public. The investigators also ask why the regulators accept such poor evidence on benefit and safety, why patients in the UK and Europe are not make aware of the concerns about this drug and whether the current regulatory body is doing its job properly. They said that doctors are advising that no new patients shoud use this drug, existing diabetic patients should review their options and those at high risk of heart disease should stop taking it.
In the accompanying editorial, the authors said that clinicians had focused on the wrong endpoint and lost sight of the main reason for treating this disease, "which is not to reduce glycaemia but to prevent complications". They went on to say that clinicians need to be "absolutely certain that the long term treatment for type 2 diabetes are not causing the harm they are meant to prevent" and should insist on robust evidence of benefits and harms.
Professor Freemantle noted in the accompanying commentary that the Avandia studies were hindered by inadequate data due to high levels of loss to follow-up. He wrote "In order to learn from our mistakes, we must improve the quality of safety data from clincal trials on all new healthcare interventions, not just antidiabetic drugs" and an overhall in the standards of regulatory trials is needed.
Sources : free f/t
Rosiglitazone: what went wrong? BMJ 2010; 341:c4848 (Published 6 September 2010) Editorial - Licensing drugs for diabetes BMJ 2010; 341:c4805 (Published 6 September 2010)
Commentary: What can we learn from the continuing regulatory focus on the thiazolidinediones?BMJ 2010; 341:c4812 (Published 6 September 2010)
Rosiglitazone, also known as Avandia, was GSK's second biggest selling drug, introduced in 1999 and is widely used to lower blood glucose levels in patients with type 2 diabetes. It was approved by the EMA in 2000 despite concerns over its safety.
In 2007, several studies found Avandia having harmful effects and issued serious health warnings. The researchers questioned why Avandia is still available on the market and why physicians would prescribe it to diabetic patients when there are other drugs without these side effects. They called for Avandia to be withdrawn from the market. Since then, the sales of Avandia fell sharply.
The BMJ investigators found that in July, the UK Commission on Human Medicines advised the MHRA to withdraw Avandia as the risks of Rosiglitazone outweigh its benefits. This has raised a lot of questions about the quality of the data used in the studies and the lack of trial results made available to the public. The investigators also ask why the regulators accept such poor evidence on benefit and safety, why patients in the UK and Europe are not make aware of the concerns about this drug and whether the current regulatory body is doing its job properly. They said that doctors are advising that no new patients shoud use this drug, existing diabetic patients should review their options and those at high risk of heart disease should stop taking it.
In the accompanying editorial, the authors said that clinicians had focused on the wrong endpoint and lost sight of the main reason for treating this disease, "which is not to reduce glycaemia but to prevent complications". They went on to say that clinicians need to be "absolutely certain that the long term treatment for type 2 diabetes are not causing the harm they are meant to prevent" and should insist on robust evidence of benefits and harms.
Professor Freemantle noted in the accompanying commentary that the Avandia studies were hindered by inadequate data due to high levels of loss to follow-up. He wrote "In order to learn from our mistakes, we must improve the quality of safety data from clincal trials on all new healthcare interventions, not just antidiabetic drugs" and an overhall in the standards of regulatory trials is needed.
Sources : free f/t
Rosiglitazone: what went wrong? BMJ 2010; 341:c4848 (Published 6 September 2010) Editorial - Licensing drugs for diabetes BMJ 2010; 341:c4805 (Published 6 September 2010)
Commentary: What can we learn from the continuing regulatory focus on the thiazolidinediones?BMJ 2010; 341:c4812 (Published 6 September 2010)
Monday, December 21, 2009
Tea and coffee drinkers have a lower risk of developing type 2 diabetes
Australian researchers conducted a systematic review and meta-analysis that pooled data from more than 30 studies of the association between tea and coffee consumption and the risk of developing type 2 diabet. About a million of participants were involved.
They found that "high intake of coffee, decaffeinated coffee, and/or tea is associated with a reduction in the risk of new-onset type 2 diabetes" and the compound magnesium and antioxidants in tea and coffee may be involved.
Critics said the studies lacked sufficient data on the effects of these beverages or their components on measures of hyperglycaemia and insulin sensitivity, therefore the mechanisms involved is still unknown. It may not be possible to generalise these findings to other populations because only a small number of particpants were non-white.
Further research into the effect of these beverages on diabetes is warranted, but it is advised that people should not increase their tea or coffee consumption based on these findings.
Source: Huxley R, Man Ying Lee C, Barzi F, et al. "Coffee, Decaffeinated Coffee, and Tea Consumption in Relation to Incident Type 2 Diabetes Mellitus". Arch Intern Med 2009; 169: 2053-2063
They found that "high intake of coffee, decaffeinated coffee, and/or tea is associated with a reduction in the risk of new-onset type 2 diabetes" and the compound magnesium and antioxidants in tea and coffee may be involved.
Critics said the studies lacked sufficient data on the effects of these beverages or their components on measures of hyperglycaemia and insulin sensitivity, therefore the mechanisms involved is still unknown. It may not be possible to generalise these findings to other populations because only a small number of particpants were non-white.
Further research into the effect of these beverages on diabetes is warranted, but it is advised that people should not increase their tea or coffee consumption based on these findings.
Source: Huxley R, Man Ying Lee C, Barzi F, et al. "Coffee, Decaffeinated Coffee, and Tea Consumption in Relation to Incident Type 2 Diabetes Mellitus". Arch Intern Med 2009; 169: 2053-2063
Wednesday, July 30, 2008
Anxiety could double diabetes risk in men
A 10-year study of 5,000 middle-aged Swedish men and women, found that men who suffered stress and sleepless nights were twice as likely to develop type 2 diabetes, the BBC reported.
All participants were asked questions about their lifestyle and had their BMI measured. They also completed a questionnaire to report their ‘psychological distress’. The researchers concluded that self-reported psychological distress was associated with development of type 2 diabetes in men, not in women.
Critics say previous studies have found a link between stress and type 2 diabetes in both men and women. There are also many limitations in the study, further studies are needed.
Source: "Psychological distress and risk of pre-diabetes and type 2 diabetes in a prospective study of Swedish middle-aged men and women". Diabetic Medicine 2008; 25:834-842
All participants were asked questions about their lifestyle and had their BMI measured. They also completed a questionnaire to report their ‘psychological distress’. The researchers concluded that self-reported psychological distress was associated with development of type 2 diabetes in men, not in women.
Critics say previous studies have found a link between stress and type 2 diabetes in both men and women. There are also many limitations in the study, further studies are needed.
Source: "Psychological distress and risk of pre-diabetes and type 2 diabetes in a prospective study of Swedish middle-aged men and women". Diabetic Medicine 2008; 25:834-842
Tuesday, July 29, 2008
45 minutes walk a day can help control diabetes
Newspapers reported a small study of 20 volunteers ( 10 with and 10 without type 2 diabetes)that found walking improved the bodies' ability to store sugar and burn fat, helping to control diabetes.
Each volunteer was given a pedometer and asked to walk an extra 45 minutes each day. After increasing physical activity for 8 weeks, the number of steps had increased to 12,322 a day in the diabetic group, and to 9,187 steps a day in the control group. Researchers found there were no changes in the enzyme ATP use, but lipid metabolism rates increased more in the people with diabetes than in the control group. They concluded that physical activity such as walking can improve cellular metabolism of the diabetes. Further studies would be needed.
Source : "Increased daily walking improves lipid oxidation without changes in mitochondrial function in Type 2 diabetes." Diabetes Care 2008; May 16 [Epub ahead of print]
Each volunteer was given a pedometer and asked to walk an extra 45 minutes each day. After increasing physical activity for 8 weeks, the number of steps had increased to 12,322 a day in the diabetic group, and to 9,187 steps a day in the control group. Researchers found there were no changes in the enzyme ATP use, but lipid metabolism rates increased more in the people with diabetes than in the control group. They concluded that physical activity such as walking can improve cellular metabolism of the diabetes. Further studies would be needed.
Source : "Increased daily walking improves lipid oxidation without changes in mitochondrial function in Type 2 diabetes." Diabetes Care 2008; May 16 [Epub ahead of print]
Tuesday, April 08, 2008
Tai chi can help diabetics control their sugar levels
Two small separate studies found a 12-week programme if tai chi exercixes help diabetics control sugar levels, reports the BBC.
The first study, by a Taiwanese team, included 30 people with diabetes who took part in a weekly 3 hour- sessions of tai chi. The study found that blood sugar levels dropped "significantly" and the level of cells and chemical involved in the body’s immune response have increased significantly in the diabetics.
The second study by the University of Queensland, based on just 11 participants, produced similar results. Critics argued that any form of exercise would improve individuals' health, fitness and energy levels and that the clinical significance of the findings is unclear.
Source: "Regular Tai Chi Chuan exercise improves T cell helper function of patients with type 2 diabetes mellitus with an increase in T-bet transcription factor and IL-12 production" British J Sports Medicine; 2008: Online First
The first study, by a Taiwanese team, included 30 people with diabetes who took part in a weekly 3 hour- sessions of tai chi. The study found that blood sugar levels dropped "significantly" and the level of cells and chemical involved in the body’s immune response have increased significantly in the diabetics.
The second study by the University of Queensland, based on just 11 participants, produced similar results. Critics argued that any form of exercise would improve individuals' health, fitness and energy levels and that the clinical significance of the findings is unclear.
Source: "Regular Tai Chi Chuan exercise improves T cell helper function of patients with type 2 diabetes mellitus with an increase in T-bet transcription factor and IL-12 production" British J Sports Medicine; 2008: Online First
Monday, January 28, 2008
Coffee is bad for diabetics
A small study of 10 patients with type 2 diabetes and who drank at least two cups of coffee daily found that daily consumption of caffeine increases their sugar levels by 8% and can exaggerate the rise in glucose after each meal. Higher sugar levels are bad for diabetics, complications may develop if the sugar levels are not controlled.
Source:"Caffeine Increases Ambulatory Glucose and Postprandial Responses in Coffee Drinkers With Type 2 Diabetes" Diabetes Care 31:221-222, 2008
Source:"Caffeine Increases Ambulatory Glucose and Postprandial Responses in Coffee Drinkers With Type 2 Diabetes" Diabetes Care 31:221-222, 2008
Friday, July 27, 2007
Diabetes drugs double heart failure risk
More than 1.5 million prescriptions for rosiglitazone (Avandia) and pioglitazone (Actos) were issued in England alone last year, but experts warn these 2 commonly used diabetes drugs could double the risk of heart failure, even for those who have never suffered the condition, in a new study in the journal Diabetes Care.
The two drugs are prescribed to millions of patients to treat type 2 diabetes and approved by NICE for use on the NHS. Experts call for a re-evaluation of the benefits and risks of both drugs in view of the concerns on cardiovascular safety.
Drug agencies urge patients not to panic over research findings and should contact their doctors if concerned. Read more ...
The two drugs are prescribed to millions of patients to treat type 2 diabetes and approved by NICE for use on the NHS. Experts call for a re-evaluation of the benefits and risks of both drugs in view of the concerns on cardiovascular safety.
Drug agencies urge patients not to panic over research findings and should contact their doctors if concerned. Read more ...
Wednesday, July 11, 2007
Selenium supplements may increase diabetes risk
US researchers expected to find selenium improves gluocose metabolism as suggseted by animal studies, but in a new randomized, double-blinded and placebo-controlled study of 1202 patients who were taking part in a clinical trial to assess the effect of selenium supplementation on skin cancer, the researchers were surprised to find that the incidence of type 2 diabetes was significantly higher in the selenium group than in the placebo group.
They concluded that long term use of selenium supplements may increase the risk of developing type 2 diabetes. More significantly, the higher the blood level of selenium, the greater the risk for developing the disease.
This is an important finding for public health because selenium supplements (30 - 200 mg) are used by people throughout the US and the western world. Read more...
The findings will be published in the August issue of Annals of Internal Medicine: 21 August 2007, vol 147, issue4. "Effects of Long-Term Selenium Supplementation on the Incidence of Type 2 Diabetes: A Randomized Trial"
They concluded that long term use of selenium supplements may increase the risk of developing type 2 diabetes. More significantly, the higher the blood level of selenium, the greater the risk for developing the disease.
This is an important finding for public health because selenium supplements (30 - 200 mg) are used by people throughout the US and the western world. Read more...
The findings will be published in the August issue of Annals of Internal Medicine: 21 August 2007, vol 147, issue4. "Effects of Long-Term Selenium Supplementation on the Incidence of Type 2 Diabetes: A Randomized Trial"
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