diabetes mellitus
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Source: PLOS ONE
Type 2 Diabetes - How do different therapy combinations affect cardiovascular health?
In a nutshell
This study investigated the effect of 3 different therapy combinations on the occurrence of cardiovascular disease in type 2 diabetes.
Some background
There are a number of types of drugs that can be used to treat diabetes. Metformin (Glucophage) decreases glucose production, and is often the first choice of treatment for type 2 diabetes. Commonly, other drugs are prescribed to be taken alongside metformin. Dipeptidyl peptidase-4 (DPP-4) inhibitors (Januvia, Tradjenta, Galvus) increase insulin release from the pancreas and reduce blood glucose (sugar) levels. Sulfonylureas (Amaryl, Glucotrol, DiaBeta) increase the amount of insulin produced by the pancreas. Pioglitazone (Actos) increases insulin sensitivity (how well the body reacts to insulin).
Diabetes patients in general have a higher risk of cardiovascular complications, and so it is important to determine whether any type of diabetes treatment adds to this risk.
Methods & findings
This study aimed to compare the association of the following drug combinations with cardiovascular disease risk: metformin and DPP-4 inhibitors, metformin and sulfonylureas and metformin and pioglitazone.
There were 349,427 study participants who were followed for an average of 2.1 years. 74,270 were treated with metformin and a DPP-4 inhibitor. 253,563 were treated with metformin and a sulfonylurea. 21,193 participants were treated with metformin and pioglitazone.
Compared to participants treated with metformin and a DPP- 4 inhibitor, participants treated with metformin and a sulfonylurea had a 20% increased cardiovascular risk. Participants treated with metformin and pioglitazone had an 11% reduced cardiovascular risk. However there was a higher risk of heart failure in participants treated with metformin and pioglitazone compared to those treated with metformin and a DPP- 4 inhibitor.
The bottom line
The authors of this study suggested that a DPP - 4 inhbitor should be the first additional drug combined with metformin in type 2 diabetes. The combination of metformin and pioglitazone was also presented as a viable treatment option, but only in those who have a low risk of heart failure.
The fine print
There were a number of limitations to this study. Firstly, the number of participants in each study group was not consistent. Management of participants’ glucose levels was not taken into account. Finally, the study participants were chosen from a national health insurance claims database. Hence, the group of study participants may not accurately reflect the whole community of T2D patients.
Disclaimer:
This information should not be relied upon as a substitute for personal medical advice, diagnosis or treatment. Use the information provided by Medivizor solely at your own risk. Medivizor makes no warranties or representations as to the accuracy of information provided herein. If you have any concerns about your health, please consult a physician.
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I have now been on Metformin, and only Metformin since I was diagnosed in 2009. The dose is 500mg three times a day with food and so far it seem to do it for me, keeping my readings between 5,7 and 6,5 which according to my doctor is good. On the rare occasion when it exceeds 6,5 up to 6,9 I usually know it is due to some food that I definitely should get far away, but as said it on a rare occasion and I am not worried as I know I will be fine on my next test. I was already on my other medications (coumadin - altacet - diltiazem - crestor asapen and vitamin D )before I received my diabetes 2 diagnosis. And lately I have been given Lyrica for my damaged nerves in my feet. Reply
Capps...please add me on fb...American.sandman@ yahoo.com Reply
is it true that fat aroud pancreas is the reason of no 2 diabetes. And if true how can I get rid of that fat withour operation? Reply
....proper nutritional diet and and regular regimen of exercise.....both of these will often lead to a non-medication control of type 2 diabetes. Reply
No it is not true. It will help to control your glucose levels, but once you have been diagnosed with diabetes you have it for the rest of your life. At present there is no cure. Sorry to be so blunt David. Reply
With numbers that low if he follows a good program it is possible that could come off meds & be controlled. But once a diabetic always a diabetic. Just not controlled with meds. Reply
Thanks for your answer, David! Jacques, obesity in general (not necessarily fat around the pancreas) can lead to the development of type 2 diabetes. One way to combat this is through diet and exercise, though many patients will also need medications to help them control their blood glucose levels. Reply
Cappy of Dec 2nd. You are doing good, keep it up. Is the Lycria helping for your feet? Reply
Lyrica seems to be working, I usually take one in the morning and 2 (two) about half hour before going to bed, but I must admit sometimes it actually seem to aggrevate the pain for some time before it suddenly disappears after say about 1 hour. Reply
I have lost about 60 lbs over the last 15 - 18 months. My last a1C test was done in November 2015 and came back at 5.4. Previously my a1C has stayed between 6.1 and 6.4. So it has never been high since getting it under control when I was diagnosed with diabetes in 2006. I pretty much eat whatever I want in moderation. I take 10 mg of Glipizide in the morning and evening and 2000 mg of Metformin with my dinner each evening. I am hoping that as I keep losing my weight that I can eventually drop down the amount of Metformin I take each day. The weight loss I'm hoping will also help the severe pain I have in my lower back. Reply
Congrats on the weight loss. That is the biggest factor in reducing your mefication as your numbers fall. Keep up the goid work! Reply
I have heard that being a diabetic , you burn all your fatty tissue and gain weight because muscle weighs more than fat? Reply
With diabetes, the cells cannot take up glucose from the blood. So although blood glucose levels remain high, the cells are actually starved. This signals the body to start breaking down fat as an energy source, which may lead to the accumulation of break-down byproducts called ketones (and a dangerous complication called diabetic ketoacidosis).
Weight gain among diabetics is usually the result of an unbalanced diet, a sedentary lifestyle, stress, additional medical conditions such as hypothyroidism, or medications such as insulin. Medications used to treat diabetes increase the ability of the cells to take in glucose from the blood, allowing them to store excess energy as fat. Reply
I was told by my Doctor I was going to have to start on medication but I started taking Glucocil from GNC and the next blood test came back o.k. Reply
What is glucocil ? And what makes it better than meds ? Reply
Glucocil is a mixture of supplements which is believed to help maintain glycemic control. However, there is limited evidence of adequate quality as to the actual benefits of Glucocil. It should also be noted that in 2013 Glucocil received a warning from the US Food and Drug Administration (FDA) for portraying the supplement as a treatment drug on their website (Glucocil classifies itself as a natural supplement which fall into a grey area of regulation in the United States). Reply
Gave me pins and needles came off it Reply
I have type 2 diabeties. I was disgnosed 2 years ago i have noted on here that people are regularly tested for their sugar levels. Why is it that in the 2 years i have only had 2 blood tests to check my levels. Should i be having this done regularly? The last one i had was at my own request. What after care should i be recieving? And how often. Reply
Just a comment about your mention of Actos. I realize fully that it is still on the market but with a judgement of over 4.5 billion dollars that was adjudicated against the manufacturer because a number of users developed bladder cancer (their were 10,00 involved in the suit) it seems that one might think twice before taking this drug.
P.S.- I was one of those users and had bladder surgery for cancer three times. Reply
Cath, my dr does a full chem panel twice a year & A1c every 3 mons. While not controlled & every 6 months if controlled. Cholesterol every 6 mons a foot check every 6 mons. Diabetes affects so many systems in the body. It is good to know where your numbets are Reply
Been on Metforminm for one year, side affect? Any comments Reply