Here's more news of interest:
Wednesday March 25 6:36 PM EST
Dual Therapy Effective For Diabetes
NEW YORK (Reuters) -- Troglitazone, a new oral diabetes drug, can be effectively combined with insulin or with metformin,
another oral diabetes drug, according to two reports published in the March 26th issue of The New England Journal of
Medicine.
In the first paper, Dr. Sherwyn Schwartz, of the Diabetes and Glandular Diseases Clinic in San Antonio, Texas, and colleagues
report that troglitazone improved the control of type 2 diabetes, the form of the disease that occurs in adults, when it was given
daily with at least 30 units of insulin.
Over a 26-week treatment period, 116 patients who took 200 mg of troglitazone and 116 patients who took 600 mg of the
drug had more significant decreases in glucose values than 118 patients who took insulin plus a placebo -- an inactive pill.
Patients who took troglitazone were also able to reduce their dose of insulin.
"Troglitazone was well tolerated," Schwartz's team reports, "and most adverse events were considered to be related to the
underlying diabetes."
"The combined therapy was logical and reversed two abnormalities that patients with this disorder experience," said co-author
Dr. Gerald I. Shulman, a Yale professor of medicine, in a statement issued by the university. "Metformin acted primarily to
decrease the patients' liver glucose production, while troglitazone worked primarily to enhance the ability of patients' muscle to
respond to insulin and take up glucose."
"The future of treatment in our type 2 diabetic patients will likely be combination therapy since no single agent will reverse all of
the abnormalities seen in our diabetic patients," added Shulman, who is also in investigator with the Howard Hughes Medical
Institute at Yale.
In the second study, Dr. Silvio Inzucchi of Yale University in New Haven, Connecticut, and others randomly assigned 29
patients with type 2 diabetes to take either troglitazone or metformin for 3 months. The patients then took both drugs for
another 3 months.
Inzucchi's group found that the two drugs were nearly equally effective at lowering glucose, and combination therapy resulted in
further improvement.
"Combination therapy is logical for patients with noninsulin-dependent (type 2) diabetes mellitus," the researchers explain,
"because they often have poor responses to single-drug therapy."
Troglitazone has been associated with liver injury in a small percentage of cases, according to a letter in the same issue of the
journal. Dr. Paul B. Watkins, of the University of Michigan, and Dr. Randall W. Whitcomb, of Parke-Davis Pharmaceutical
Research, both in Ann Arbor, Michigan, warn that patients receiving this drug should have regular blood tests to detect for liver
abnormalities.
Troglitazone "is useful either alone or in combination with other drugs for glycemic control in patients with type 2 diabetes," Dr.
Hiroo Imura of Kyoto University, Japan, concludes in an accompanying editorial. However, Imura cautions that therapy
"...should be limited to patients who can be evaluated frequently until the incidence and severity of (liver) dysfunction with this
drug become clearer."
According to the American Diabetes Association, about 15 million Americans have diabetes, but over half (8 million) are
believed to be undiagnosed. Type 2 diabetes, also known as "adult onset" diabetes, is the most common type of diabetes, and
is a leading cause of blindness, kidney failure, and amputation. The disease is the fourth leading cause of death in the US.
SOURCE: The New England Journal of Medicine (1998;338:861-866, 867-872, 908-909, 916-917) |
