Nearly 347 million people globally are now plagued by diabetes. While treatment methods for diabetics have gained traction, the optimal treatment strategy (metformin, lifestyle interventions, pioglitazone, among others) remains somewhat ambigious. News this week may offer insight on how to best treat and manage diabetes, a comorbidity that is becoming increasingly common.
Recent news has centered on pioglitazone (Actos, Takeda) and whether the drug should be pulled from the shelves after multiple studies showed that patients administered the drug may have an increased risk of bladder cancer.
France and Germany have already yanked the drug, after news broke that a French analysis of almost 1.49 million diabetics showed that patients taking pioglitazone at higher doses and for longer durations experienced significantly higher incidences of bladder cancer.
The FDA also modified the drug's label to include the risks after a 10-year epidemiological study by the University of Pennsylvania showed that patients exposed to the drug for more than 12 months had a 40 percent increased risk of bladder cancer. Continuing therapy for more than 12 months was associated with a 27.5 excess cases of bladder cancer per 100,000 person-years follow-up.
What are some other options?
A study presented at this year’s American Diabetes Association’s 71st annual scientific sessions in San Diego showed that employing lifestyle interventions can decrease the development of type 2 diabetes by 58 percent; administration of metformin decreased development by 31 percent.
Herman and colleagues conducted a cost-effectiveness analysis to see whether integrating these strategies into practice would help curb diabetes at a reasonable price tag. Herman et al reported 10-year total direct intervention costs for lifestyle intervention to be $1,500 per participant. This equated to about $12,000 per quality-adjusted life years (QALY) gained compared to placebo.
The researchers also found that metformin both saved money and improved health outcomes significantly. Herman et al offered that the drug should be widely distributed in practice and covered for patients at a high-risk for developing diabetes. To put it into context, he said that even other more expensive therapies, such as left ventricular assist devices that carry a lofty price tag of $500,000 to $1.4 million per QALY, are commonly covered in practice.
“Our results show that compared with doing nothing, administering metformin is cost-effective,” Herman concluded.
Lastly, researchers from the University of Cambridge, England, found that integrating a multifactorial intervention strategy to promote intensive management of patients with type 2 diabetes can help improve the incidence of CV events and death, but only slightly. In fact, the reduction was nonsignificant. The incidence of first CV event was 7.2 percent in the intensive treatment arm and 8.5 percent in the routine care group.
What’s on the horizon for diabetes care, management and treatment? Email us with your best management tips and strategies.
Senior writer, Cardiovascular Business