Drug helps curb progression to diabetes, says study

PARIS – A drug used to help patients diagnosed with diabetes can also help people who have high-risk precursors for diabetes from progressing to the disease, a study said.

So-called Type 2 diabetes develops when someone cannot produce enough insulin to regulate levels of sugar (glucose) in the blood, or when their body becomes resistant to the insulin that it does produce.

Around five percent of adults worldwide have Type 2 diabetes, and the number is surging, mirroring a rise in obesity unleashed by global changes in dietary habits and exercise.

Those at high risk of progressing to diabetes are individuals with a condition that disrupts their glucose regulation, although many are unlikely to know this because they feel no symptoms.

One condition is called impaired glucose tolerance, and the other is known as impaired fasting glucose.

Canadian researchers explored whether these two precursor conditions could be tackled with a drug that is already used to treat people with Type 2 diabetes.

Rosiglitazone, the lab name for a molecule sold as Avandia by the pharmaceutical company GlaxoSmithKline, is an “insulin sensitiser”: it revives cells’ response to insulin, thus helping to remove glucose from the blood.

The doctors enrolled 5,269 adults in 21 countries who had either of the precursor conditions, and assigned the volunteers to either a daily 8mg dose of rosiglitazone or a placebo over three years.

They also followed this up with regular advice to the volunteers on the need to keep down excess weight, exercise regularly and eat healthily.

At the end of the study, 658 people on the placebo developed diabetes. The number on rosiglitazone was far lower — only 280.

Fourteen people in the rosiglitazone group and two in the placebo group had a non-fatal heart attack.

The authors argue that the higher number of heart attacks in rosiglitazone group is an acceptable cost for the benefit of preventing diabetes, which can cause blindness, severe kidney damage, circulatory problems and in some cases kill.

Rosiglitazone is “a novel preventive approach,” says the paper, whose publication online by The Lancet coincided with a major diabetes congress in Copenhagen.

“Balancing both the benefits and the risks suggests that for every 1,000 people treated with rosiglitazone for three years, about 144 cases of diabetes will be prevented, with an excess of four to five cases of congestive heart failure.”