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Top Diabetes Stories of 2007

Clinical Studies Raise Red Flags about Avandia. Two large clinical studies, one by the U.S. Food and Drug Administration and the other published in the prestigious New England Journal of Medicine, indicate that people with diabetes who have been taking Avandia to reduce insulin resistance may have an increased risk of heart attack as high as 40%!

To read the official FDA statement click here. To read about and then see a video about this issue click here.

For those who want to read the original NEJM report click here (as medical articles go, this one isn't that complicated). Note the very small numbers of people who suffered heart difficulties. Still, the finding was statistically significant.

Some individuals say not to pay attention to it because the results were "barely statistically significant." While earning my doctorate I remember my statistics professor saying a study is statistically significant or not.

There is no such thing as "barely significant." It's like being "a little bit pregnant. A study has either unearthed a valid new finding or not.

But what does the study about Avandia mean for people with Type 2 Diabetes? Remember, people with diabetes already have a higher risk of heart attack. Could that be factor in the study results. Furthermore,  the people in this study were reported as having poor control of their diabetes. That's a red warning flag itself. So it's quite a leap to conclude that Avandia caused the small increase found in this study.

Should You Panic if You Are on Avandia? No, say Experts. Click here.

What if you are taking Actos, a member of the same family of drugs as Avandia? Here's a quote directly from the NEJM study that, as medical article phraseology goes, is fairly straightforward, but I will decipher it for you in the paragraph after this quote:

"Pioglitazone [generic name for Actos}is a related agent also widely used to treat type 2 diabetes. . . However, unlike rosiglitazone, ^[generic name for Avandia] pioglitazone has been studied in a prospective, randomized trial of cardiovascular outcomes . . .The primary end point, a broad composite that included coronary and peripheral vascular events, showed a trend toward benefit from pioglitazone . . . ^. A secondary end point consisting of myocardial infarction, stroke, and death from any cause showed a significant effect favoring pioglitazone . . . Notably, pioglitazone appears to have more favorable effects on lipids, particularly triglycerides, than does rosiglitazone."

Let me explain what that means: The NEJM study was what is called a meta-analysis, that's a pooling and statistical compilation of data from several related studies. However, a meta-analysis is always considered by scientists to be less convincing than a large prospective trial designed to assess the outcome of interest. So the "red flag" about Avandia is not based on the best evidence.

The best evidence comes from what is called a prospective, randomized trial. In contrast to Avandia, Pioglitazone (PIO) has been studied in such a trial.  It was called called the Prospective Pioglitazone Clinical Trial in Macrovascular Events (PROACTIVE).

As the quote from the NEJM indicates, the "end point," that is the number of people who suffered heart attacks, stroke and death from other causes, favored Actos (and the patients taking it). That and other published data seems to indicate that Actos may have protective effects against a wide range of diabetic complications including death. For instance, PIO appears to have more favorable effects on lipids, particularly triglycerides, than does rosiglitazone. Studies didn't confirm, but do show a trend toward PIO providing some protection against heart attack and stroke and other "coronary and peripheral vascular events." That's why I initially made the deciison to say on Actos.

I say, initially, because unfortunately, one of that drug's side effects began showing up. I started retaining water and the resulting edema could be seen as my stretch socks made dents in my skin.  My endocrinologist missed it even though she took a pulse from my ankle during a brief routine examination. That same day I had an appointment with my internist.  His Physician's Assistant discovered my blouted feet (a harbinger of possible heart problems) and so put me on a stronger diuretic.  I also had an exercise stress test and nuclear scans of my heart that showed a bit of blockage in non-dominant arteries. Not good news but not the end of the world. So I'm off Actos, but on a new heart medication. So it goes.

BTW, a large prospective study on Avandia is being carried on. Unfortunately, the results have not yet been analyzed. However, my own prediction is that when the results from that large prospective study  come in, rather than being a cause of heart attacks, tAdvandia probably also will show a trend toward protection against them. What most of the news reports didn't point out about the meta analysis which raised the red flag on Avandia, is that most of the people taking Avandia in that pooled study had rather poor control of their blood sugar levels. So, it would not be surprising that they had more heart attacks.

To me that finding is just further confimration on the importance of controlling blood sugar. You can do that in three ways: By taking prescribed diabetic medications, by being careful about what you eat, and by increasing physical activity. By far, the most benefit comes from watching what you eat.

While I believe in modern medicine, my own deeply held belief is that we can't depend on drugs alone to protect us from heart attacks and strokes. In my opinion, moderate, carbohydrate intake with an emphasis on low glycemic foods and frequent moderate exercise, provides more benefits than all the oral meds combined. For more information on a plan to achieve control of high blood sugar whether you are on meds or not see DiabetesManager.

Most Important Diabetes Stories from 2006

1. People with diabetes are more at risk of developing what is known as NAFLD or Non-Alcoholic Fatty Liver Disease. The good news is that are old friend the diabetic drug Metformin works to protect us against NAFLD: For a summary of the study go to http://www.blackwell-synergy.com/doi/abs/10.1111/j.1572-0241.2005.41583.x

2. People with diabetes often have high levels of fat in their bloodstreams. Fish oil capsules have been shown to have some effect in reducing fat in one's bloodstream: http://paktribune.com/news/index.php?id=128162

3. Diabetes.com has some good, easy-to-use recipes for breakfast, lunch, and dinner. Available at: http://www.diabetes.com/ip010008.html

4. Pregnant? You may be at risk of gestational diabetes. Find out what to do about it here: http://www.fortwayne.com/mld/newssentinel/13422284.htm

Older News

1. Study shows breast feeding babies may reduce occurence of Type 2 diabetes:http://www.forbes.com/lifestyle/health/feeds/hscout/2005/11/22/hscout529291.html

2. Good advice on controlling diabetes from another source. Sound similar to what I have been advocating? Sure does: http://pittsburghlive.com/x/tribune-review/trib/newssummary/s_397250.html

3. Study show less than half of us who have diabetes DON'T use aspirin to prevent a heart attack. I do. You should too. Read all about it here;: http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/11-21-2005/0004220459&EDATE=

5. Intriguing Study. Can Radio Frequency waves in bar code readers affect your insulin? Yes, in a worst case situation, FDA finds a rise in temperature of the insulin: http://www.rfidjournal.com/article/articleview/1961/1/1/

6. Two Warnings: Don't combine ibuprofen and naproxen with aspirin AND People with Diabetes may have higher risk of colon cancer. Have you been tested for colon cancer? See your doctor. http://www.wtnh.com/Global/story.asp?S=4052340&nav=3YeX

Updated 10/30/05

1. Here's an example of news article on islet cell transplants that lacks context and promises too much. I'll explain why in the inaugural issue of my newsletter, but IMHO Islet cell transplants are certainly not ready for prime time for most of us. (True, some Type 1's have benefited from the treatments but they have to now take immunosuppresant drugs. Is the tradeoff worth it? Maybe). http://www.thepittsburghchannel.com/health/5190668/detail.html

2. Here's an example of junk science published in a prestigious medical journal. Do you know what a "straw dog" argument is? These "scientists" set up a "straw dog" control experiment to make their real experiment look better even though it confirmed the obvious, the fact that eating a food program low in carbs results in lower blood sugars. http://www.diabeteshealth.com/read,2002,4350.html

Updated 10/25/05

1. People newly diagnosed with Diabetes get Depression counseling, at least in Scotland. Why not here? http://news.scotsman.com/edinburgh.cfm?id=2143122005

2. Hopes for a new drug that would treat diabetes and high cholesterol at the same time take a beating: http://health.dailynewscentral.com/content/view/0001800/42/

3. Good news for people with type 1 diabetes. They have an improved prognosis regarding end-stage renal disease. It appears that the incidence of end-stage renal disease is lower than previously estimated: http://www.newswise.com/articles/view/515127/

Updated 10/10/05

1. Consumer Reports Rates Blood Glucose Meters. Is Yours On Their List? http://www.kfor.com/Global/story.asp?S=3920446&nav=6uy6

2. Mayo Clinic Reports that Neuropathy May Begin Earlier than Previously Believed. Are You at Increased Risk? http://www.newswise.com/articles/view/515000/

3. New Review of Studies Indicates Metformin Should Be First Line of Defense for All People with Type 2 Diabetes. Are You Taking Metformin? http://www.emaxhealth.com/23/3352.html