7. Diabetes drug updates

Ban of Pioglitazone: Position statement from Jothydev’s Diabetes Research Center

The popular anti diabetes drug Pioglitazone was banned by Union Health Ministry a few days back due to concerns regarding risk of bladder cancer. We include the position statement from Jothydev’s Diabetes Research Center in this issue. This position statement was originally posted/published in the websites on 1st July 2013.

Fortunately or unfortunately we do not have a single patient on pioglitazone. We completely stopped using pioglitazone 2-3 years back when the initial concerns of cancer of the urinary bladder came up. For the poor patients and in our charity diabetes center we follow the international guidelines : metformin in combination with a sulphonyl urea(glimepiride or glyclazide) and if required low cost human insulins. We make sure that insulin injections are never delayed since late initiation of insulin will result in requirement of very high dosages and also several fold increase in treatment cost and other complications of diabetes.

We however believe that Pioglitazone shouldn't be banned in India all of a sudden, but sold with warning,until new data emerges. The 3 aims in diabetes treatment should be: 1. Customising the treatment and making it affordable for individual subjects 2. Preventing complications like blindness, heart attacks, amputations 3. Using safe, non controversial drugs not banned in any country

Pioglitazone is a very popular and cheap insulin sensitiser with a multitude of benefits which is so unique to the molecule. There are studies to support the efficacy,safety and cost effectiveness and that it actually prevent cancers rather than causing cancer. Metformin is the present day safest and inevitable component of type 2 diabetes therapy. It was made available in UK in 1958; but US FDA approved only in 1994. Years later,now it has become the most popular drug even with capabilities of preventing and treating cancers. Let us hope the pioglitazone controversy will get over very soon.
Meta-analysis: Insulin degludec did not increase risk for recurrent hypoglycemia

Results of a post-hoc meta-analysis of trials comparing insulin degludec with insulin glargine demonstrate that degludec was associated with a 27% lower rate of recurrent hypoglycemia vs. glargine in patients with type 2 diabetes treated with basal-bolus therapy. Additionally, insulin degludec did not increase the risk among those treated with oral medications. In the basal-bolus trial, 38% of patients assigned to insulin degludec and 43% of those assigned to insulin glargine experienced recurrent hypoglycemia, compared with 6.1% of those assigned insulin degludec and 6.6% of those assigned insulin glargine in the four oral therapy trials.

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This newsletter is published for free distribution through the Internet for doctors, patients and public for promoting healthy lifestyles. For enquiries, please contact: Sunitha Jothydev, CAO, Jothydev's Diabetes Centre, Trivandrum - cao@jothydev.net.
Please visit: http://www.jothydev.net
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