[nfb-talk] Fw: Drug Prevents Type 2 Diabetes in Majority of High-Risk Individuals

Sat Apr 2 13:31:00 UTC 2011

It's awfully early to wax rhapsodic about this; 602 people isn't what I
consider a statistically-significant sample.  Try half a million and I'd be
more apt to believe it.  Moreover, I wonder to what extent socioeconomic,
ethnic and other issues were taken into account.  Medical studies are
notoriously lax when it comes to inclusion of such factors in their
analysis.

Mike

-----Original Message-----
From: nfb-talk-bounces at nfbnet.org [mailto:nfb-talk-bounces at nfbnet.org] On
Behalf Of Ed Meskys
Sent: Saturday, April 02, 2011 6:24 AM
To: sandy meskys; nfb-talk
Subject: [nfb-talk] Fw: Drug Prevents Type 2 Diabetes in Majority of
High-Risk Individuals

----- Original Message ----- 
From: "Louis Gosselin" <gosselin_louis at MYFAIRPOINT.NET>
To: <NHBLIND-TALK at LISTSERV.ICORS.ORG>
Sent: Saturday, April 02, 2011 9:20 AM
Subject: Drug Prevents Type 2 Diabetes in Majority of High-Risk Individuals

Drug Prevents Type 2 Diabetes in Majority of High-Risk Individuals
1-Apr-2011
March 2011 - A pill taken once a day in the morning prevented type 2 
diabetes in
more than 70 percent of individuals whose obesity, ethnicity and other 
markers
put
them at highest risk for the disease, U.S. scientists reported today.
The team also noted a 31 percent decrease in the rate of thickening of the
carotid
artery, the major vessel that supplies blood to the brain. The study, which
enrolled
602 participants through The University of Texas Health Science Center San
Antonio
and seven collaborating centers, is described in the New England Journal of
Medicine
and has direct implications for the care of 79 million Americans who are
pre-diabetic.
"It's a blockbuster study," said senior author Ralph DeFronzo, M.D., 
professor
in
the School of Medicine and chief of the diabetes division at the UT Health
Science
Center San Antonio. "The 72 percent reduction is the largest decrease in the
conversion
rate of pre-diabetes to diabetes that has ever been demonstrated by any
intervention,
be it diet, exercise or medication."
Multiple-year follow-up
Dr. eFronzo led the trial of pioglitazone, which is marketed as Actos by 
Takeda
Pharmaceutical
Co. Ltd. The Japanese company provided an independent investigator grant to 
Dr.
DeFronzo
to conduct the ACT Now study. Some patients were followed for as long as 
four
years;
the average follow-up was 2.4 years.
Pioglitazone is widely used as an insulin sensitizer in patients with type 2
diabetes.
In the ACT Now study, participants were chosen because of their high risk 
for
diabetes,
including obesity, family history and impaired glucose tolerance as 
demonstrated
by a glucose test.
"The drug shows outstanding results," said Robert R. Henry, M.D., president,
medicine
and science, of the American Diabetes Association. "It is the most 
efficacious
method
we have studied to date to delay or prevent the onset of type 2 diabetes." A
study
co-investigator, Dr. Henry is professor of medicine at the University of
California,
San Diego, and chief of the section of endocrinology and diabetes at the VA 
San
Diego
Healthcare System.
Blood vessel damage prevented
Robert Chilton, D.O., FACC, a UT Health Science Center San Antonio 
cardiologist
who
was not involved with the study, said the slowing of carotid artery 
thickness
indicated
that the participants' glucose was well controlled, preventing blood vessel
damage
that leads to heart attacks, strokes and peripheral vascular disease.
Individuals who have diabetes have the same high risk of having a first 
heart
attack
as do non-diabetic people who already had a heart attack, he noted.
"The drug was able to postpone conversion to diabetes in 72 percent of 
people,"
Dr.
Chilton said. "The only thing that could potentially beat that is the free 
pill
no
one seems to be able to take - diet and exercise."
Insulin resistance
Type 2 diabetes involves abnormalities with insulin, a hormone secreted by 
beta
cells
in the pancreas. Insulin helps the body store and use sugar from food, but 
in
type
2 diabetes the body is insulin resistant, that is, it inefficiently responds

to
the
hormone. With time the beta cells in diabetic patients start to die, 
resulting
in
less insulin to handle the demands. Levels of the hormone become 
progressively
lower
and sugar levels are increased progressively, damaging blood vessels and 
organs.
Dr. Henry said the ACT Now study highlights the importance of insulin 
resistance
in the development of type 2 diabetes and how, by treating this resistance, 
the
beta
cell secretion of insulin is preserved for a longer period of time.
Pioglitazone was well tolerated by participants, with weight gain and fluid
retention
observed at the dose used in the study. Dr. DeFronzo said those side effects

can
be mitigated by using a lower dose that works equally well. Pioglitazone
stimulates
appetite while at the same time shifting fat around in the body, taking it 
out
of
muscle, the liver and beta cells and putting it in subcutaneous fat depots 
under
the skin where it is inert and not harmful, he said.
"No drug is perfect," Dr. DeFronzo said. "This particular medication does 
two
things
- improves insulin resistance and improves beta cell function, which are the

two
core defects of diabetes."
Co-authors and centers: Pioglitazone for Prevention of Diabetes in Impaired
Glucose
Tolerance, Ralph A. DeFronzo, M.D.1*, Devjit Tripathy, M.D., Ph.D.1*, Dawn 
C.
Schwenke,
Ph.D., M.S.2,3, MaryAnn Banerji, M.D., F.A.C.P.4, George A. Bray, M.D.5, 
Thomas
A.
Buchanan, M.D.6, Stephen C. Clement, M.D.7, Robert R. Henry, M.D.8, Howard 
N.
Hodis,
M.D.6, Abbas E. Kitabchi, Ph.D., M.D., F.A.C.P., F.A.C.E.9, Wendy J. Mack,
Ph.D.6,
Sunder Mudaliar, M.D.8, Robert E. Ratner, M.D., F.A.C.P.10, Ken Williams,
M.Sc.11,
Frankie B. Stentz, M.S., Ph.D.9, Nicolas Musi, M.D.1, and Peter D. Reaven, 
M.D.2
for the ACT NOW Study
*Both authors contributed equally to the manuscript
Texas Diabetes Institute and University of Texas Health Science Center, San
Antonio,
TX;
Phoenix VA Health Care System, Phoenix, AZ;
W.P. Carey School of Business, Arizona State University, Tempe, AZ;
SUNY Health Science Center at Brooklyn, Brooklyn, NY;
Pennington Biomedical Research Center/LSU, Baton Rouge, LA;
University of Southern California Keck School of Medicine, Los Angeles, CA,
Division of Endocrinology & Metabolism, Georgetown University, Washington, 
DC;
VA San Diego Healthcare System and University of California at San Diego;
University of Tennessee, Division of Endocrinology, Diabetes and Metabolism,
Memphis,
TN;
10 Medstar Research Institute, Hyattsville, MD; 11KenAnCo Biostatistics, San
Antonio,
TX
Source: University of Texas Health Science Center at San Antonio 

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