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Diabetologists stress need for public education on type 2 diabetes; rule out medication as the cause for risks among intensive blood sugar treatment group

Karachi: October 8, 2008 - Eminent endocrinologists and diabetologists Dr Zaman Shaikh, Dr Mashhoor Alam and Dr Razzak Memon have stressed upon the need for educating the public about the risks associated with type 2 diabetes stating that education was central to the successful management of diabetes.

They were speaking at a seminar for young diabetologists and health journalists in Karachi held here on Tuesday to provide an insight to the proceedings of the recently held international moot of American Diabetes Association (ADA) in which they had participated.

Discussion of the senior doctors focused on the findings of ACCORD (Action to Control Cardiovascular Risk in Diabetes) Trial - a large clinical study of adults with established type 2 diabetes who are at especially high risk of cardiovascular disease (CVD). They also discussed two other major clinical trials: Action in Diabetes and Vascular Disease (ADVANCE) and Veteran Affairs Diabetes Trial (VADT).

The doctors highlighted the importance of aggressive treatment of diabetes for the patients stating that the earlier the treatment was started and blood sugar control was attained the better was the outcome of the patients with delaying of all complications and reduction in complications of small blood vessels such as kidney and foot diseases. They said that if the patients were uncontrolled on the previous traditional therapies like metformin and sulfonylurea then instead of up-titration patients can achieve blood sugar control by addition of thiazolidinedione (class of diabetes drugs) like rosiglitazone, which was proven in various studies.

The experts informed the participants that ACCORD, ADVANCE and VADT researchers have extensively analyzed the available data and have not identified any specific cause for the higher death rate among the intensive blood sugar treatment group. Based on analyses done to date, there was no evidence that any medication or combination of medications was responsible for the higher risk. They said that the studies not only contradict the New England Journal of Medicine meta-analysis published last year but clearly explain why the newly-presented outcomes research was more significant.





No prevention for Rotavirus diarrhea except vaccination

Hyderabad: August 19, 2008 - Dr. Salma Shaikh, Chairperson Vaccination and Health Education, Pakistan Paediatric Association (PPA) has warned against the threat of Rotavirus diarrhea in Pakistan stating that 35 per cent of diarrhea in children less than five years of age in the country was caused by this virus.

Speaking at a health awareness programme for housewives organized by the Hyderabad chapter of Pakistan Paediatric Association (PPA) at Sindh Museum on life threatening diseases in children she informed that diarrhea was caused by both bacteria and viruses. Bacterial diarrhea can be prevented by simple measures of drinking clean water, eating safe hygienic food, and washing hands before eating. However there was no prevention for the deadly Rotavirus diarrhea except vaccination of children before the age of six months.

Dr Salma Shaikh informed that Rotavirus was the commonest cause of diarrhea in children worldwide. Almost 25,000 children in Pakistan die of Rotavirus diarrhea each year, which can easily be prevented by oral vaccination available in the market, she added.

Speaking at the forum, Professor M.A. Arif, General Secretary PPA laid stress on the importance of saving children from water borne diseases.

He said almost 200,000 children die every year in Pakistan because of diarrheal diseases, making diarrhea the second commonest cause of death in children less than five years of age. Many more become malnourished due to recurrent episodes of diarrhea and fail to attain normal physical and mental development.

Rosiglitazone's efficacy to provide long term sustained glycaemic control re-endorsed by new studies: Dr Harold Lebovitz

Karachi: September 25, 2008 - Internationally acclaimed endocrinologist Dr Harold Lebovitz, Professor of Medicine, Division of Endocrinology and Metabolism/Diabetes at the State University of New York, Brooklyn provided doctors in Pakistan with an insight to the latest ACCORD, ADVANCE and VADT clinical trials during a real-time video conference held simultaneously in Karachi, Lahore and Islamabad.

The video conference organized by Pakistan Endocrine Society was chaired by Professor Khurram Shahid, President, Pakistan Endocrine Society (PES), Professor Zafarullah Khan, Vice Chancellor, Kind Edward Medical University, Lahore, Professor Najmul Islam, Director, Diabetes, Endocrinology & Metabolism Fellowship Programme, AKU Hospital, Karachi, and Dr Amjad Naseem, Associate Professor of Medicine, Fauji Foundation Hospital, Islamabad. A large number of diabetologists from the three cities attended the symposia.

Dr Lebovitz in his presentation focused on the findings of ACCORD (Action to Control Cardiovascular Risk in Diabetes) Trial - a large clinical study of adults with established type 2 diabetes who are at especially high risk of cardiovascular disease (CVD). He also discussed two other major clinical trials: Action in Diabetes and Vascular Disease (ADVANCE) and Veteran Affairs Diabetes Trial (VADT) Dr Lebovitz informed the participants that ACCORD researchers have extensively analyzed the available data and have not been able to identify any specific cause for the higher death rate among the intensive blood sugar treatment group. Based on analyses done to date, there was no evidence that any medication or combination of medications was responsible for the higher risk. In addition, although the number of severe hypoglycemic events was greater in the intensive blood sugar strategy group, this does not appear to account for the difference.

Because of the recent concerns with rosiglitazone, one of several medications used in ACCORD, researchers specifically reviewed data to determine whether there was any link between this particular medication and the increased deaths. To date, no link has been found, he informed.

According to ADOPT findings rosiglitazone was proven to provide long term sustained glycaemic control to metformin and sulphonylurea, he further added.

He said that findings from VADT-a large, long-term and independent study into heart attack problems in high-risk diabetes patients showed that while rosiglitazone was used in a majority of patients in the study, it was not associated with increased deaths.

Dr Lebovitz presentation was followed by an interactive session on the ADVANCE study which confirmed a previously identified benefit of the lower blood-sugar strategy for type 2 diabetes patients. He said that diabetes patients can benefit from the combination of metformin and/or SU and rosiglitazone as compared to up-titrations of these traditional OAD to provide sustained glycaemic control to the patients.

To a question about the black box warning and the precautions and contraindications of rosiglitazone, Dr Lebovitz remarked that these were exactly the same as of pioglitazone and it can not be assumed that the latter was safer.
It may be mentioned that the ACCORD, ADVANCE and VADT studies not only contradict the NEJM meta-analysis published last year but clearly explain why the newly-presented outcomes research was more significant.

Studies presented at American Diabetes Association moot confirm Avandia's protection for diabetes patients

Karachi: July 31, 2008 - New data from three different clinical trials-Action in Diabetes and Vascular Disease (ADVANCE); Veteran Affairs Diabetes Trial (VADT); and Action to Control Cardiovascular Risk in Diabetes (ACCORD)-presented at the recently held annual meeting of the American Diabetes Association in San Fransico established that a leading drug indicated for diabetes, Avandia (Rosiglitazone) is not associated with any cardiac risk and confirmed its previously identified benefit of the lower blood-sugar strategy for Type 2 diabetes patients.

Findings from VADT-a large, long-term and independent study into heart attack problems in high-risk diabetes patients-showed that while Rosiglitazone was used in a majority of patients in the study, it was not associated by any means with increased deaths.

It follows the large-scale ACCORD study, which reported that researchers were unable to identify whether the type of drug used increased the risk of death. The study was specifically designed to work out whether control of blood sugar could cut heart disease. Rosiglitazone was not associated with any increased risks.

The ADVANCE study confirmed a previously identified benefit of the lower blood-sugar strategy for Type 2 diabetes patients.

These studies not only contradict the New England Journal of Medicine (NEJM) meta-analysis published last year, but clearly explain why the newly-presented outcomes research was more significant. Some of the doctors attending ADA were of the opinion that the research was more authoritative than the NEJM study because it was the result of clinical studies rather than just a so-called meta-analysis, which is an amalgamation of different researches. These long-term trials were specifically designed for this, in that sense they provided a more robust data set for a physician.

With regard to the safety of Avandia, Thomas E. Mortiz, MS of the Hines VA Hospital, said at the ADA meeting "Rosiglitazone was not doing harm to our patients. If anything, Rosiglitazone had a protective effect." Some of the results actually showed significantly reduced rates of cardiovascular events with Rosiglitazone.