Type 2 diabetes is the focus of a study that says a prediabetes and a patient with the same condition receiving rosiglitazone or pioglitazone is more liable to have CHF or congestive heart failure. However, it said further that the risk for CVD or cardiovascular death is not increased.
The importance of this I believe is in making treatment decisions based on the results that are most relevant to the patient. The outcome we are talking about here are the vascular complications and the quality and quantity of life instead of just focusing simply on sugar glucose control.
A team at Lahey Clinic Centre led by Dr. Richard Nesto analyzed seven trials involving 20,191 patients of drug related CHF in patients with prediabetes and type 2 diabetes who had been given rosiglitazone or pioglitazone. They measured the development of CHF and CVD in these patients.
The researchers found 72% increase in CHF but this was noted among different backgrounds of patients: those with prediabetes, those with no cardiovascular disease with type 2 diabetes, those with the same conditions for both, and those with documented CHF and type2 diabetes.
The scientists said the CHF risk was wide-ranging among the groups. This should guide the doctors in selecting appropriate patients when describing these drugs. So despite the fact that these drugs lower the glucose, they should not be prescribed for those who have heart failure.
They should also be prescribed for glycemic control with care for those who do not have heart failure but with cardiovascular disease. For those without cardiovascular disease and type 2 patients who have lower risk for CHF, the use of the drugs should still be considered against the benefits and risks of the other medications.
Let’s hope they succeed in this endeavor as it will make life so much easier for the diabetics. Let’s also hope that they take time in putting this in the market and wait for all the bugs to be ironed out before releasing this product to the public.
The researchers admitted that they didn’t have enough follow-up to determine the link between the drugs and the CDF and CVD. They also need more data to differentiate the effects between the two drugs and to determine whether CHF is a harmful effect or an endpoint.
The jury is still out but the researchers are continuing their search for better and newer drugs. They are hoping for new ones that will help control the blood glucose. An example is Troglitazone which is a relatively new oral hypoglycemic agent. This is supposed to decrease not only the fasting blood glucose but also the one taken after meals.
Troglitazone is also known to improve the glucose tolerance and to increase insulin sensitivity. So far it has results that are encouraging for type 2 diabetes patients. This drug belongs to the class of drugs known as thiazolidinediones.
So you see despite some bumps in the road as shown in the study that patients taking rosiglitazone or pioglitazone are more liable to have CHF or congestive heart failure, there’s still hope for the future. Despite the barriers that need to be overcome, the promise of a cure is on the horizon.
By: Roger Guzman, M.D. About the Author:
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Brief Biography: Dr. Guzman worked for the Atlantic Health Corporation and was consultant to St. Joseph’s Hospital, Sussex Mental Health Clinic, and St. Stephen Mental Health Clinic for many years. He was Director of Forensic Psychiatry at Centracare for ten years and published numerous articles in the Journal of the American College of Forensic Psychiatry and other medical magazines.
Copyright © October 6, 2008 Roger Guzman, M.D. (Type 2 Diabetes Alert) All Rights Reserved. You may copy and publish this article as long as the text, the author’s name, the active links and this notice remain the same.
