Diabetes drug to be limited over heart damage fears

-NewsScotsman.com

05/20/2008- The prescribing of a drug widely used to treat diabetes is to be restricted after warnings which linked it to heart problems.

Drugs experts from NHS Greater Glasgow and Clyde – Scotland's biggest health board – have said only diabetes specialists should be allowed to begin treating a patient with Avandia.

At present, treatment can be initiated by GPs. But growing concern about Avandia, used to treat type-2 diabetes, has prompted prescribing experts to reconsider their position.

The move comes after The Scotsman revealed last month that experts in Glasgow believed there was "no defence" for the continued use of Avandia, also known as rosiglitazone.

While the new guidance does not ban the drug, it is likely to seriously restrict prescribing patterns.

Officials also said patients taking the drug who have certain heart conditions, such as angina, should have their treatment reviewed as soon as possible.

Research published in the New England Journal of Medicine last year suggested Avandia could raise the risk of heart attacks by 43 per cent, and the risk of cardiovascular death by 64 per cent.

In January, the European Medicines Agency said the drug should carry additional warnings.

A review of the whole class of drugs – known as glitazones – concluded the benefits of Avandia outweighed the risks.

The methodology of the research which has raised concerns about the drug has been criticised, and other studies suggest the risks are uncertain.

Members of the Managed Clinical Network for Diabetes in Glasgow have voiced concerns about the continued use of Avandia to the Area Drug and Therapeutics Committee (ADTC).

NHS Greater Glasgow and Clyde said the ADTC met at the end of last month.

A spokeswoman said: "It was agreed rosiglitazone would remain on the Greater Glasgow and Clyde (drug list] with the restriction it is initiated only on the advice of a consultant diabetologist. Subsequent prescriptions can be repeated via the GP.

"Patients who are being prescribed rosiglitazone and suffer an acute coronary syndrome should have their treatment reviewed by a diabetes clinic at the earliest opportunity. Patients who do not have cardiac risks factors should have their treatment reviewed at their next scheduled diabetic clinic visit."

The information is being circulated to GPs to make sure appropriate action is taken.

A spokeswoman for GlaxoSmithKline, which makes Avandia, described rosiglitazone as "an important treatment option for type-2 diabetes".

INSULIN MALFUNCTION IN DIABETICS, the level of sugar in the blood is too high because the body cannot use it properly.

Insulin is a hormone produced by the pancreas to help sugar – or glucose – enter the cells, where it is used as fuel by the body.

In patients with type-2 diabetes, the body can still make some insulin, but not enough, or the insulin produced does not work properly.

Being overweight is a major cause of type-2 diabetes – the most common form of the illness, accounting for between 85 and 95 per cent of people with diabetes. According to the charity Diabetes UK, type-2 diabetes usually appears over the age of 40, though in South Asian and African-Caribbean people it often appears after the age of 25.

However, rising levels of obesity mean type-2 diabetes is increasingly seen in younger people, with children as young as seven now being affected.

There are currently more than 2.3 million people diagnosed with diabetes in the UK. In addition, it is estimated that there are around 500,000 people who have the condition but are unaware of it.