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Monday, September 18th 2006

Fighting Diabetes

Adult onset diabetes is a terrible disease. Certain populations and areas within this country are suffering a virtual epidemic of it. Now a new drug, already used as a treatment option, might show promise as a preventitive measure.

People at high risk for developing Type 2 diabetes may be able to reduce their risk by as much as 60 percent with a drug already prescribed to treat the rapidly increasing disease, according to a study reported Friday in the online versions of the New England Journal of Medicine and the British medical journal The Lancet.

It isn’t without potential problems.

Still, experts quickly cautioned that the drug, sold as Avandia, should not be viewed as a panacea because it has no effect on obesity, the major risk factor for diabetes, or on obesity’s concurrent risks, such as heart disease, high blood pressure and cancer.

They also said the cost of the drug, between $100 and $150 a month, and its infrequent but potentially serious side-effects must be considered before it is prescribed. Those side-effects include congestive heart failure, which can be fatal, and potentially dangerous fluid buildup in the eyes.

The Drug Doesn’t Address The Underlying Risk Factor

Medrants tries to put the new study into context; how type II diabetics should be treated using evidence based medicine.

I favor attempting lifestyle changes. I also believe that I would recommend treatments that have a high probability of preventing diabetes. Type II Diabetes is a devastating disease. Prevention trumps treatments.

But then I have injected my own value structure. I would rather have my patients take a drug to prevent diabetes than have them develop diabetes. I would love for them to accept lifestyle changes, but remain skeptical about the probability of success.

Type II diabetes is an epidemic down here. But amongst not so affluent populations; $100 – 150 a month isn’t a pretty figure for the possible return. On the other hand these are the same patients where compliance with lifestyle changes is the worst.