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Monday, June 05, 2006
Dumaguing: Actos a logical diabetes drug of choice
By Dr. Vic Dumaguing
To Your Health
BREAKFAST sessions in medical conferences, whether local or international, are usually not very popular. For one, it starts at 7:30 a.m. when most of the doctors are still curled up in bed, understandably catching up with sleep, which is luxury item if they are in their place of practice.
But this observation and trend was broken during the lecture of Dr. Piyamitr Sritara on the Production of Cardiovascular Risk in Type 2 Diabetes Mellitus at the Edsa Shangrila during the Philippine Heart Association annual convention May 24-27.
The British-trained cardiologist and researcher, who is one of the leading physicians of the Remathibodi Hospital of the Mahidol University in Bangkok, Thailand started his lecture with Time Magazine's coverage of diabetes as a regional epidemic then segued into heart disease as an Asian epidemic, with a catchy statement "How Asia Got Fat!"
The following slides showed a comparison in the alarming rate of incidence of diabetes in key areas worldwide with Southeast Asia registering the highest jump in the projected incidence by 2025. Citing some salient points of the Asia Pacific Cohort Studies Collaboration which compared incidence of diabetes and cardiovascular/cerebrovascular risk in Asian nations such as China, Korea and Malaysia with patients in Australia and New Zealand, Dr. Sritara noted that the fasting blood sugar level correlated positively with the incidence of heart attacks and stroke. The hazard ratio for myocardial infraction (MI) or heart attack is 2.13 in Asia compared to 1.77 in Australia and New Zealand. As for stroke, the hazards ration of ANZAC is 1.5 compared to the significantly higher 2.5 among Asians. Then, the amiable, always-smiling doctor, in his clear voice, with a charming British-Thai accent, cited the UKPDS (United Kingdom Prospective Diabetes Studies) which showed that intensive treatment of diabetes significantly reduced by 40-60 percent microvascular complications like retinopathy (may lead to blindness), neophropathy (which might required dialysis or renal transplant later) and neuropaty (which may lead to possible amputations).
Unfortunately, the same cannot be said about its macrovascular complications like stroke and heart attacks.
Dr. Sritara then proceeded with the PROACTIVE Study, which enrolls more than 5,000 patients, 35-75 years old with a history of previous stroke, myocardial infraction, peripheral arterial disease (PAD). The participants had glycosylated hemoglobin (HbA1c) more than 7.5 and were followed up for a minimum of 2.5 years. It must be emphasized that 95 percent of the subjects are already on conventional therapy, which included drugs like ACE-inhibitors, beta-blockers, nitrates, ARBs or angiotensin-receptors blockers.
Results showed that the reduction in primary endpoints did not reach statistical significance. There was a very significant reduction in principal secondary endpoints like non-fatal heart attack and stroke. On the metabolic profile, the patient on Pioglitazone (Actos) had a 13.6 percent decrease in their triglycerides, a nine percent increase in their good cholesterol (HDL) and a decrease in their HbAlc. An added bonus, the Actos group of diabetic patients registered an average decrease of their systolic blood pressure by 3mm mercury. And probably, the most encouraging result, on top of its clinical and metabolic benefits, is the 50 percent reduction in progression towards use of insulin injection, to control blood sugar levels.
At this juncture, please allow the author to share with my fellow physicians and dear readers the results of the Complement study, which was presented at the 65th Annual Sessions of the American Diabetes Association.
The multi-center, single-arm, 17-weeks, open-label study enrolled 305 people with type 2 DM taking statins (with or without other lipid-lowering drugs) along with Rosiglitazone alone or in combination with other oral anti-diabetic drug. Patients were then switched from Rosiglitazone to Pioglitazone (Actos) while maintaining their statin with or without other lipid lowering drugs. The results showed that Actos lowered lipids (fat) levels regardless of age or gender of the subjects and whether the patients took fenofibrate (another lipid-lowering drug) in addition to the statin (cholesterol-lowering drug).
Despite the very impressive clinical and metabolic benefits of Actos usage, the drug is not for everyone. The PROACTIVE study showed that adverse effects rate of Actos is 46 compared with 48 of placebo group. Nonetheless, tell your doctor if you have a history of fluid retention or heart failure. Like the other anti-diabetes drugs, with the exception of metformins, Actos use may cause weight gain and if combined with other sugar-lowering agents, may cause hypoglycemia. Actos exerts its molecular effect inside the nucleus of the cell but studies have shown it does not cause malignant neoplasms.
Dr. Sritara pointed out that the edema may due to mobilization of visceral fat to subcutaneous fat. He went further to say that Actos lowers serum SGPTransaminase levels, thus, may be helpful in treatment of NASH (non-alcoholic steatoorheic hepatitis.)
Diabetes has become a reality in our daily lives. Real as it is, don't let its complications set in and spoil your fun, productive years. Actos might just be what you need!
(June 5, 2006 issue)
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