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Diabetes

Diabetes Drugs


Date: 22/10/03
 
Imagine a medical condition that opens the door to a wide range of chronic health problems, leaving you vulnerable to cancer, heart disease, high blood pressure, stroke, and kidney failure.

Imagine a medical condition that opens the door to a wide range of chronic health problems, leaving you vulnerable to cancer, heart disease, high blood pressure, stroke, and kidney failure. The condition is type 2 diabetes, and the leading charity Diabetes UK estimates that 1.4 million people in the UK suffer from diabetes - with over three-quarters of these having type 2 diabetes.

Unfortunately, too many doctors respond to patients diagnosed with type 2 diabetes the only way they know how: they medicate. As a result, most sufferers are taking drugs called thiazolidinediones (TZDs) that improve insulin sensitivity. Now a new study shows that this class of drugs may sharply increase the risk of pulmonary oedema and congestive heart failure.

Fortunately, most of these sufferers may be able to successfully address their diabetes without using any drugs at all.

Cardio stress
Investigating the relationship between TZDs and the development of pulmonary oedema (PE) and congestive heart failure (CHF), researchers at the University of Texas Southwestern Medical Centre examined the medical records of six diabetes patients admitted to the hospital suffering from symptoms of PE and CHF. Five of the subjects had been treated with TZD drugs pioglitazone or rosiglitazone.

In all five cases, the threat of heart failure subsided quickly after the discontinuation of the TZD treatment, which had no permanent effect on cardiac function. Based on this small but conclusive trial, the authors of the study state that 'thiazolidinediones can cause pulmonary oedema or exacerbate heart failure.' They also state that TZDs should be avoided by patients with kidney disease or left ventricular dysfunction of the heart.

Obviously, further examination of the relationship between TZDs and heart failure is called for. Until then, this is a study that every pioglitazone and rosiglitazone user needs to be aware of.

Behaviour modified
Most cases of type 2 diabetes are the result of poor diet and insufficient exercising habits that catch up with us as we age. Fortunately, the insulin resistance that triggers type 2 diabetes can often be reversed by modifying the diet and beginning a regular exercise programme.

I've told you in the past about a New England Journal of Medicine study involving more than 3,200 adults (average age was 51) who were diagnosed with pre-diabetic elevated glucose levels. Subjects were divided into three groups: one group received a daily dose of Glucophage (the brand name of metformin); one group received a daily placebo; and one group participated in an intensive programme with a goal of at least 7 percent weight loss through diet adjustment, two and a half hours of moderate exercise each week, and educational sessions to reinforce behaviour modification.

After following these subjects for an average of almost 3 years, the researchers found that Glucophage reduced the incidence of diabetes by about 30 percent versus placebo, but lifestyle changes slashed the incidence rate by more than HALF - a full 58 percent. Plus, patients in the Glucophage group had six times more gastrointestinal side effects than those in the exercise and diet group.

Because type 2 diabetes increases the risk of so many health problems, the last thing a diabetic needs are the potential side effects that come with the use of any synthetic drug. It's clear from everything we know that changes in diet and exercise are the best medicine for most type 2 diabetics.

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