Journal Watch: Diabetes

In a New Meta-Analysis, Thiazolidinediones Increase CHF but Not Cardiac Death

General Medicine | Summary and Comment | Subscription Required

The results aren’t inconsistent with previous meta-analyses.

By Bruce Soloway, MD

October 11, 2007

Covering: Lago RM et al. Lancet 2007 Sep 29; 370:1129

Cleland JGF and Atkin SL. Lancet 2007 Sep 29; 370:1103

Montori VM et al. Lancet 2007 Sep 29; 370:1104

Lancet 2007 Sep 29; 370:1101

Thiazolidinediones and Increased MI Risk: A Class Effect?

Cardiology | Summary and Comment | Subscription Required

New meta-analyses support an increased risk for MI with rosiglitazone, but not with pioglitazone.

By JoAnne M. Foody, MD

October 10, 2007

Covering: Lincoff AM et al. JAMA 2007 Sep 12; 298:1180

Singh S et al. JAMA 2007 Sep 12; 298:1189

Routine Use of Perindopril and Indapamide in Type 2 Diabetes

Cardiology | Summary and Comment | Subscription Required

A simple and practical strategy emerges as an ADVANCE in the prevention of vascular events due to hypertension.

By Beat J. Meyer, MD

October 10, 2007

Covering: Patel A et al. for the ADVANCE Collaborative Group. Lancet 2007 Sep 8; 370:829

Optimal Hemoglobin A_1c Targets: Guidance from the ACP

General Medicine | Summary and Comment | Subscription Required

The core recommendation is not new, but the ACP commendably focuses on individualizing goals for glycemic control.

By Richard Saitz, MD, MPH, FACP, FASAM

October 9, 2007

Covering: Qaseem A et al. Ann Intern Med 2007 Sep 18; 147:417

Which Antidiabetic Drugs Are Safest for People with Diabetes and Heart Failure?

General Medicine | Summary and Comment | Subscription Required

In this systematic review, metformin was associated with the best outcomes.

By Keith I. Marton, MD

October 9, 2007

Covering: Eurich DT et al. BMJ 2007 Sep 8; 335:497

Aerobic Exercise and Resistance Training Benefit Glycemic Control

General Medicine | Summary and Comment | Free

Physical activity — especially aerobic exercise and resistance training combined — can significantly lower hemoglobin A_1c levels in patients with type 2 diabetes.

By Richard Saitz, MD, MPH, FACP, FASAM

October 4, 2007

Covering: Sigal RJ et al. Ann Intern Med 2007 Sep 18; 147:357

Screening and Follow-Up for Gestational Diabetes

Women’s Health | Practice Watch | Free

High-risk individuals require both initial screening and repeated testing during and after pregnancy.

By Ann J. Davis, MD

October 4, 2007

Covering: Metzger BE et al. Diabetes Care 2007 Jul 30:251

The Questions Continue About Thiazolidinediones’ Safety

Cardiology | Summary and Comment | Free

A new meta-analysis shows an elevated risk for congestive HF but no increase in cardiovascular death rate with either rosiglitazone or pioglitazone

By Beat J. Meyer, MD

September 28, 2007

Covering: Lago RM et al. Lancet 2007 Sep 29; 370:1129

Cleland JGF and Atkin SL. Lancet 2007 Sep 29; 370:1103

Montori VM et al. Lancet 2007 Sep 29; 370:1104

Lancet 2007 Sep 29; 370:1101

Fitness, Obesity, and Insulin Resistance

Pediatrics and Adolescent Medicine | Summary and Comment | Subscription Required

Exercise decreased insulin resistance despite no changes in fat or lean body mass.

By Alain Joffe, MD, MPH, FAAP

September 26, 2007

Covering: Bell LM et al. J Clin Endocrinol Metab 2007 Aug 14;

Free Full-Text Article

Summary and Comment In a New Meta-Analysis, Thiazolidinediones Increase CHF but Not Cardiac Death The results aren’t inconsistent with previous meta-analyses. The thiazolidinediones (TZDs) rosiglitazone and pioglitazone are known to increase fluid retention and congestive heart failure. Concern about the cardiovascular safety of these drugs has risen since May 2007, when results of a meta-analysis indicated that patients randomized to rosiglitazone had significantly increased risk for myocardial infarction (Journal Watch May 24 2007). In a new meta-analysis, researchers reviewed seven randomized trials involving 20,191 patients with type 2 diabetes or prediabetes who were randomized to a TZD or a comparator drug or placebo for 12 to 48 months and were studied for outcomes including CHF and cardiovascular death. Patients who received a TZD had significantly increased risk for CHF compared with controls (2.3% vs. 1.4%), but their risk for cardiovascular death was not significantly increased. Comment: The authors suggest that increased CHF events with the thiazolidinediones likely resulted from fluid retention superimposed on diastolic dysfunction and that such CHF events may have different prognostic implications than those caused by primary deterioration of myocardial function. The absence of increased cardiovascular mortality in this analysis is consistent with the results of both the aforementioned meta-analysis (in which increased mortality failed to reach statistical significance) and subsequent meta-analyses showing no increased mortality with either rosiglitazone or pioglitazone (Journal Watch Sep 11 2007). Noting the complexity of cardiovascular pathophysiology and the limitations of meta-analyses, editorialists decry the paucity of trials powered to measure “patient-centered” outcomes such as cardiovascular events, the overreliance on surrogate endpoints such as HbA1c, and the premature approval of drugs with multiple poorly understood long-term effects. Clinically, says one editorialist, “the jury is still out for the thiazolidinediones.” — Bruce Soloway, MD Published in Journal Watch General Medicine October 11, 2007 Citation(s): Lago RM et al. Congestive heart failure and cardiovascular death in patients with prediabetes and type 2 diabetes given thiazolidinediones: A meta-analysis of randomised clinical trials. Lancet 2007 Sep 29; 370:1129. Medline abstract (Free) Cleland JGF and Atkin SL. Thiazolidinediones, deadly sins, surrogates, and elephants. Lancet 2007 Sep 29; 370:1103. Medline abstract (Free) Montori VM et al. Patient-important outcomes in diabetes — time for consensus. Lancet 2007 Sep 29; 370:1104. Medline abstract (Free) Ensuring drug safety: Lessons from the thiazolidinediones. Lancet 2007 Sep 29; 370:1101. Medline abstract (Free)