The percentage of Americans using oral diabetes pills to treat the disease increased by more than a quarter over a ten year period, according to an article from HealthNewsDigest.com.

In 1997, approximately 60% of Americans reported using pills to control their diabetes. By 2007, that number had jumped to 77%, an increase of 17 percentage points and nearly 28%, according to data from the Agency for Healthcare Research and Quality. At the same time, the percentage of diabetics using insulin dropped dramatically from 38% to 24% over that time period.

The data also showed a shift in the types of medications people with Type 2 diabetes are using. People using sulfonylureas, which stimulate the pancreas to produce extra insulin, fell from 51% to 40%. The percentage of those taking biguanides, which curb the liver’s excess glucose production, rose from 21% to 55%. Lastly, people taking Thiazolidinediones, which increase the body’s sensitivity to insulin, rose from 5% to 25%.

Source: http://diabetesnewshound.com/type2/classes-of-type-2-meds/

Type 2 diabetes patients who underwent bariatric surgery appear to require significantly less medication and incur considerably lower health costs, says a report published in this month’s issue of Archives of Surgery , a JAMA/Archives journal. Bariatric surgery is a surgical procedure on the stomach and/or intestines to help extremely obese people lose weight – it is an option for patients with a BMI ( body mass index) above 40.
,br>The authors write, as background information in their report:

The rapidly growing epidemics of obesity and diabetes threaten to overburden the world’s health care systems. From an epidemiological standpoint, once these diseases develop they are rarely reversed. Dietary, pharmaceutical and behavior treatments for obesity are associated with high failure rates, and medical management of diabetes is also often unsuccessful. Despite many efforts to improve the control of glucose levels in diabetes, including clinical guidelines and patient and provider education, less than half of all patients with type 2 diabetes mellitus achieve the American Diabetes Association recommendation of a hemoglobin A1C level of less than 7 percent.”

The authors note that bariatric surgery use, that results in long-term weight loss, significantly better lifestyle and lower death risk, has tripled during the last five years.

Martin A. Makary, M.D., M.P.H., and team at the Johns Hopkins Bloomberg School of Public Health and The Johns Hopkins University School of Medicine, Baltimore, examined data on 2,235 U.S. adults (average age 48.4) with type 2 diabetes who had undergone bariatric surgery between the years 2002 and the end of 2005 (four year period). Claims data was used to measure pre- and post-surgery diabetes medication use, as well as health care costs per year.

The study revealed that of the 2,235 patients:85.8% (1,918) were taking at least one diabetes drug before surgery (average 4.4 medications per patient).6 months after surgery, 74.7% (1,669) of patients had stopped taking their diabetes medications altogether.Of the 1,847 patients with available data one year after surgery, 80.6% (1,489) had eliminated medications; after two years, 906 of 1,072 (84.5 percent) had done so. This reduction was detected in all classes of diabetes medications. The researchers wrote:

We observed that independence from diabetes medication was almost immediate within the initial months after surgery and did not correlate with the gradual weight loss expected. This supports the theory that the resolution of diabetes is not due to weight loss alone but is also mediated by gastric hormones, with the three most implicated being peptide YY, glucagonlike peptide and pancreatic polypeptide. As a known mediator of insulin regulation, glucagonlike peptide levels have been noted to increase immediately after bariatric surgery and may explain why surgeons have noted complete resolution of diabetes in some cases within days after surgery.

Health care costs:In the two years before surgery health care costs averaged $6,376 annuallyThe median/midpoint cost of surgery and hospitalization was $29,959Total yearly health care costs rose by $616 (9.7%) in the year after the bariatric surgeryTotal yearly health care costs dropped by $2,179 (34.2%) in year two after surgeryTotal yearly health care costs dropped by $4,498 (70.5%) in year three after surgeryThe scientists concluded:

Based on these data, we have identified several important implications for health care delivery and public policy. Foremost, eligible obese patients should be properly informed of the risks and benefits of bariatric surgery compared with non-surgical health management. Health care providers should consider discussing bariatric surgery in the treatment of obese patients with type 2 diabetes. Health insurers, private and public, should pay for bariatric surgery for appropriate candidates, recognizing a potential annualized cost savings in addition to the benefit to health. Arch Surg
Published August. 2010;145[8]:726-731.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

Source: http://www.medicalnewstoday.com/articles/197866.php

Rosiglitazone (Avandia) and pioglitazone (ACTOS) are in a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and fat and also reduce glucose production in the liver. The first drug in this group, troglitazone (Rezulin), was removed from the market because it caused serious liver problems in a small number of people. So far rosiglitazone and pioglitazone have not shown the same problems, but users are still monitored closely for liver problems as a precaution. Both drugs appear to increase the risk for heart failure in some individuals, and there is debate about whether rosiglitazone may contribute to an increased risk for heart attacks. Both drugs are effective at reducing A1C and generally have few side effects.

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To get more information about Actos: ACTOS MEDICATION.

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Rosiglitazone (Avandia) and pioglitazone (ACTOS) are in a group of drugs called thiazolidinediones. These drugs help insulin work better in the muscle and fat and also reduce glucose production in the liver. The first drug in this group, troglitazone (Rezulin), was removed from the market because it caused serious liver problems in a small number of people. So far rosiglitazone and pioglitazone have not shown the same problems, but users are still monitored closely for liver problems as a precaution. Both drugs appear to increase the risk for heart failure in some individuals, and there is debate about whether rosiglitazone may contribute to an increased risk for heart attacks. Both drugs are effective at reducing A1C and generally have few side effects.

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GlaxoSmithKline, the maker of Avandia (rosiglitazone), a drug used to treat type 2 diabetes, has agreed to add the new warning to the existing black box warning on the drug’s label, according to U.S. Food and Drug Administration officials.

“We are announcing an update to the existing box warning on Avandia,” Dr. Janet Woodcock, acting director of the FDA’s Center for Drug Evaluation and Research, said during a midday teleconference. “A black box is the strongest form of warning, and we are adding another warning to that black box.”

Despite the revised warning label, the FDA said it isn’t seeking to have the drug withdrawn from the market, because the evidence for the increased heart-attack risk is not conclusive.

“We are keeping Avandia on the market, because we have concluded there isn’t enough evidence to indicate that the risk of heart attack is higher for Avandia than other type 2 diabetes treatments,” Woodcock said.

Woodcock said the FDA has asked GlaxoSmithKline to conduct a long-term study comparing Avandia with other type 2 diabetes drugs. The trial will most likely start in a year, and full results won’t be available until 2014.

Dr. Steven Nissen, chairman of the Cleveland Clinic’s department of cardiovascular medicine, first raised concerns about Avandia and heart-attack risk in a study published earlier this year. He said he welcomed “the addition of a black box warning for the risk of heart attack from Avandia,” but would have preferred a warning “written with greater clarity,” like the one used by Health Canada, the FDA’s counterpart in Canada.

The Canadian labels says Avandia is not to be used as the sole medication for type 2 diabetes except for patients who can not take another drug — metformin — that also lowers blood sugar. The label also states that Avandia is not to be used by any patient with heart failure.

“This is a much clearer statement than the FDA statement,” Nissen said.

Nissen said he was also bothered by the proposed trial that ends in 2014. “It really doesn’t solve the problem of what to do in the meantime,” he said. “I hope the appearance of a black box warning will be enough to keep people from being harmed.”

The new FDA-mandated labeling change follows recommendations made by the FDA’s Endocrine and Metabolic Advisory Committee and Drug Safety and Risk Management Advisory Committee. In July, the committees recommended keeping Avandia on the market, pending a review of additional data. The committees also said the drug’s label should carry a warning of the potential for increased risk of heart attacks.

Controversy over Avandia started in May, when a study by Nissen and colleague Kathy Wolski, published in the New England Journal of Medicine, found a 43 percent increased risk of heart attack among patients taking the drug. Nissen said he uncovered the risk after poring over data from 42 studies of Avandia.

Both the FDA and GlaxoSmithKline continue to say that the evidence for the risk of heart attack with Avandia is inconclusive.

“Avandia remains a safe and effective medicine for most patients with type 2 diabetes when used appropriately,” Dr. Ronald Krall, GlaxoSmithKline’s chief medical officer, said in a prepared statement. “Given the severity of this disease and the importance of Avandia in helping patients manage their diabetes, we will continue to work with the FDA to conduct more studies about the safety and benefits of our medicine.”

The new warning states: “A meta-analysis of 42 clinical studies (mean duration 6 months; 14,237 total patients), most of which compared Avandia to placebo, showed Avandia to be associated with an increased risk of myocardial ischemic events such as angina or myocardial infarction. Three other studies (mean duration 41 months; 14,067 patients), comparing Avandia to some other approved oral anti-diabetic agents or placebo, have not confirmed or excluded this risk. In their entirety, the available data on the risk of myocardial ischemia are inconclusive.”

The FDA is advising people with type 2 diabetes who have heart disease or are at risk of a heart attack to discuss their use of Avandia with their doctor to evaluate treatment options. The agency is also advising doctors to monitor patients who have cardiac risk and are taking the drug.

In August, Avandia’s warning label was changed, to state that the drug and others in its class may worsen heart failure — a condition in which the heart does not adequately pump blood — in some patients. The association between Avandia and increased risk for heart failure has been known since 1999, when the drug was first approved.

Woodcock noted that Avandia and the other oral anti-diabetes drugs, called thiazolidinediones, have not been shown to prevent cardiovascular risk as a byproduct of reducing blood sugar.

In light of this, the FDA is asking all manufacturers of approved oral anti-diabetes drugs to include a statement on their label saying that there is no data that the drugs have the ability to protect the heart.

HealthDay

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