Can Actos Really Prevent Type 2 Diabetes?

Diagnosing diabetes is simple. If the blood sugar is found to be elevated you are diabetic. Increasing or decreasing the cut off level between normal and diabetic will dramatically change the number of people diagnosed with diabetes. In 1997 the American Diabetes Association lowered the criterion of diabetes (type 2) to a fasting blood sugar above 126 mg/dl instead of 140 mg/dl. Suddenly 1.7 million Americans became “diabetic” under the new definition.

In the latest issue (March 24, 2011) of the New England Journal of Medicine research was published stating that Actos (pioglitazone), a popular medication used to treat type 2 diabetes, could substantially reduce the percentage of people at high risk for developing diabetes who progress to actual diabetes. 600 people with a form of pre-diabetes known as impaired fasting blood sugar (fasting blood sugar levels between 95 and 125), were divided into one group given placebo and the other group given Actos. After 2.5 years Actos reduced the incidence of developing type 2 diabetes by 72% compared to placebo. Initially, I was very impressed with these results.

Actos is the sister drug to Avandia and Rezulin. All of these drugs show similar ability to reduce blood sugar in diabetics. Rezulin and Avandia fell into disfavor due to the potential for side effects. Actos is considered safer.

It seems almost a little too obvious that if diabetes is defined as elevated blood sugar that if the test medication reduces blood sugar, diabetes can be “prevented”. Since Actos lowers blood sugar, the conclusion that Actos reduces the progression of pre-diabetes to actual diabetes seems inevitable. A substance that does not already lower blood sugar which prevented elevated blood sugar from developing would be far more impressive.

Side-effects of taking Actos need to be considered, as well. In this research study (New England J of Medicine 364; 12, 2011) the group taking Actos gained an average of about 9 pounds. That doesn’t include the 3% of test subjects who dropped out of the study because they gained too much weight. Edema (puffy ankles) was also more common in those taking Actos. We know that weight gain, particularly in pre-diabetics, is not a good thing. What are we hoping to accomplish by using Actos to prevent diabetes when at the same time, we make people chunkier and puffier?

To be fair, the family of medications known as “glitazones” which contain Actos, Avandia and Rezulin, have some intriguing properties. Years ago, the Triad Study, showed that women with gestational diabetes who received Rezulin, did not go on to develop type 2 diabetes nearly as often, even years after stopping this medication. This does seem like a true preventive benefit.

I am dubious about using Actos to prevent diabetes at this time. My patients, I suspect, will agree with that decision. I don’t think I would survive very long in practice, if my patients gain 10 or more pounds as I try to “prevent” their progression to diabetes.

This information is for educational purposes only and is not intended as medical advise or treatment. Always consult with your physician when deciding whether to use a prescription drug.

Gary Pepper, M.D.


Common Liver Disease Responds to Vitamin E

Vitamin E May Be of Help in Common Liver Disease:

Over the years the medicinal qualities of vitamin E have been both praised and criticized. For decades there has been a debate whether this vitamin could prevent cancer or heart disease. Large studies have pretty much determined that cancer and heart disease don’t respond to vitamin E supplementation. For that reason many physicians believe that vitamin E treatment is worthless for any purpose. This assumption is incorrect. For example, a recent study in the New England of Medicine has shown vitamin E to be of great use in the treatment of a common liver disease resulting from fat accumulation in the liver (steatosis).

The liver normally store some fat but in excess it can lead to inflammation of the liver, a condition called steatohepatitis. In up to 15% of those with steatohepatitis, cirrhosis and liver failure can result. Steatohepatitis itself is relatively common. In my endocrinology practice several patients per day show evidence of this liver disease, manifested as abnormalities on routine liver blood tests. Patients most likely to show characteristic abnormalities on liver blood tests are those with high cholesterol (particularly if taking the cholesterol lowering medications known as statins), diabetes, and obesity. If the blood tests are particularly abnormal an ultrasound of the liver is usually obtained to be sure nothing else is occurring, such as liver cancer or cirrhosis. Simple steatosis itself is generally easy to diagnose on the ultrasound.

A recent study in the New England Journal of Medicine (Volume 362, No. 18) demonstrates that vitamin E is beneficial for treating steatohepatitis. 247 subjects with evidence of steatohepatitis not due to alcohol use or diabetes were given various treatments. The group getting 800 IU vitamin E per day showed a 43% improvement in measures of steatohepatitis. Also examined as a possible treatment for steatohepatitis was Actos (pioglitazone), a popular diabetes drug. Although the results with Actos were promising they weren’t as good as the results with Vitamin E.

As always, the researchers conclude that further studies will be needed to confirm this benefit. Before using vitamin E in your own program be sure to check with your physician first. Vitamin E can act like a blood thinner, so its use in people who have bleeding abnormalities or on drugs that influence blood clotting, is of particular concern.

This article is for educational purposes only and is not intended as medical advice. The disclaimer for applies to this and all my posts.

Gary Pepper, M.D., Editor-in-Chief,