Clinical Briefs
By Louis Kuritzky, MD, Clinical Assistant Professor, University of Florida, Gainesville. Dr. Kuritzky is a consultant for GlaxoSmithKline and is on the speaker's bureau of GlaxoSmithKline, 3M, Wyeth-Ayerst, Pfizer, Novartis, Bristol-Myers Squibb, AstraZeneca, Jones Pharma, and Boehringer Ingelheim. Dr. Kuritzky reports no financial relationship to this field of study.
Preventing Diabetes: Long Term Outlook
The Finnish Diabetes Prevention Study (FDPS) demonstrated that a program of diet and exercise was capable of reducing the incidence of diabetes by approximately 60% in persons with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), compared to placebo. These encouraging results were confirmed in a US program with similar design, both trials having at least 3 years follow up. Whether the impact of lifestyle changes persists beyond the initial intervention period was the focus of this publication by Lindstrom, et al.
At the conclusion of the FDPS, subjects who had not progressed from IFG/IGT to diabetes continued to be monitored for a total follow up of 7 years, and were compared with the original control population. At 7 years (mean) follow up, there was still a 36% relative risk reduction in diabetes.
It is not possible to determine how much of the beneficial long-term risk reduction is due to a "carry-over" effect from the original intervention vs adherence to favorable lifestyle continuation post-study. In any case, long-term benefits of exercise, diet, and maintenance of weight are apparent.
Lindstrom J, et al. Lancet. 2006;368:1673-1679
Preventing Osteoporotic Fracture: Which Antiresorptive?
Since the relative demise of hormone replacement therapy as a routine tool for dealing with osteoporosis (OSPS), bisphosphonates-specifically alendronate (ALN), Risedronate (RIS) and Ibandronate (IBN)-have become the mainstay of treatment. Each bisphosphonate has at least one favorable data set, but it is difficult to choose between them in the absence of large head-to-head trials.
A meta-analysis was performed based upon combined trials of bisphosphonates as well as data from the Women's Health Initiative to seek a stronger data set from which to stratify osteoporotic fracture risk reduction with various therapies. Because the trial data for IBN is somewhat limited, analysis was based upon a single large trial (n = 2,946) which included fracture end points.
The most favorable outcomes were seen with ALN (49-55% risk reduction), followed by hormone replacement therapy (25-36% risk reduction), and then RIS (26-27% risk reduction). No conclusion could be reached in reference to IBN, calcitonin, or raloxifene due to insufficient and/ or inconsistent evidence.
Liberman UA, et al Int J Clin Pract. 2006;60(11):1394-1400
Metformin + DPP-4: Safety and Efficacy
Metformin is the most commonly prescribed initial monotherapy for diabetes. Most diabetics will require additional pharmacotherapy to maintain glycemic goals. Dipeptidyl peptidase-4 inhibitors (DPP4) are a new group of pharmacotherapies that capitalize upon several favorable actions of glucagon-like-peptide (GLP): enhancement of glucose-mediated insulin secretion, blockade of glucagon release, and modulation of glucose delivery to the GI tract. Even though endogenous GLP provides these functions, it is a very short-lived agent. DPP4 inhibitors prevent the breakdown of GLP, enhancing its duration of action.
The DPP4 agents fall under a larger classification of "incretins" (pronounced "in-KREE-tin"). Sitagliptin (tradename Januvia) is the first approved agent of this class, although others are pending FDA approval.
This trial randomized patients on metformin who maintained an A1c > 8.0% to sitagliptin 100 mg QD or placebo for 6 months. At the end of the trial, sitagliptin produced a significant 0.65% reduction in A1c, and more patients had achieved their goal A1c with sitagliptin (47%) than with placebo (18%). Sitagliptin was well tolerated. Although the absolute impact of DPP4 inhibitors on A1c is not as prodigious as other classes of agents, it is sufficient to allow many uncontrolled patients to achieve glycemic goals.
Charbonnel B, et al Diabetes Care. 2006;29(12):2638-264
The Finnish Diabetes Prevention Study (FDPS) demonstrated that a program of diet and exercise was capable of reducing the incidence of diabetes by approximately 60% in persons with impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), compared to placebo.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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