Diabetes drug Actos reduces risk of developing the disease
Taking the diabetes drug Actos every day reduced the chance of developing Type 2 diabetes by two-thirds in people whose obesity, ethnicity, family history and other factors put them at high risk of developing the disease, researchers said Wednesday.
In a study of more than 600 high-risk patients, only 2.1% of those who took Actos, known generically as pioglitazone, progressed to diabetes each year over the three years of the study, compared with 7.6% of those who took a placebo, according to the report in the New England Journal of Medicine.
All of the patients selected for the trial had a condition called prediabetes, in which the body’s ability to control blood sugar levels is already impaired, although not to the level that would constitute diabetes.
“The ability to intervene at a prediabetic state before we become diabetic and become at risk for complications is extremely important,” said Dr. Ralph A. DeFronzo of the University of Texas Health Science Center in San Antonio, lead author of the study.
The study was sponsored by the drug’s maker, Takeda Pharmaceuticals, and conducted by researchers at eight academic centers.
About 27 million Americans are diabetic and about 79 million have prediabetes, according to the most recent statistics from the Centers for Disease Control and Prevention. About 1 in 3 of those who have prediabetes will progress to diabetes without intervention.
Many interventions have been attempted. The diabetes drug metformin reduces progression to diabetes by about 31%. Lifestyle changes and dieting reduce it by about 58%. Rosiglitazone, sold under the brand-name Avandia, has been shown to reduce progression by 62%, but because of cardiac concerns, the Food and Drug Administration has restricted use of the drug to patients who cannot achieve control of blood sugars by any other method.
Actos reduced progression to diabetes by 72%, according to the study.
Only gastric bypass surgery would be more effective than Actos, but it has not been studied in prediabetes.
In the new study, researchers found that fasting glucose levels were significantly lowered, in many cases to normal. Levels of so-called bad (LDL) cholesterol in the blood declined, while levels of good (HDL) cholesterol rose. Blood pressure also dropped, as did the thickness of the walls of the carotid arteries in the neck, generally considered a measure of improved artery health.
“There are so many benefits, not only on the prevention of diabetes, but also the effects on the cardiovascular system,” said Dr. Robert R. Henry of the VA San Diego Healthcare System, a coauthor of the study.
The principal side effects were water retention — which could be managed with diuretic medications — and moderate weight gain, a median of about 9 pounds.
The study “shows that we can prevent, not just treat diabetes,” said Dr. Stuart Weinerman, an endocrinologist at North Shore University Hospital in Manhasset, N.Y., who was not involved in the research. “But it should not be taken as a license that everyone who is at risk should run out and start taking pioglitazone,” he added.
“It’s a single, relatively short-term study with a moderate number of patients.... I would rather use drugs [like metformin] that have been out longer.”