Physician Takes Issue With Fears Over Avandia Risk

Washington, DCThe debate over Avandia and Avandia side effects has galvanized opinion over safety with regard to treatment of Type 2 diabetes—and there has been no shortage of critics banishing Avandia to the virtual gallows. However there are those whom, Avandia risks aside, think the criticism is overdone to the point of fear mongering.

Dr. Matthew Mintz is one such advocate. A practicing physician, Dr. Mintz is both board certified in internal medicine and an Associate Professor of Medicine with an academic medical center. He's also a blogger. And Dr. Mintz has some alternative views to balance those who tend to gang up on Avandia.

"Avandia was the first medicine to show that it could keep patients' diabetes under control," Dr. Mintz writes. "The ADOPT trial showed that Avandia, a thiazolidinedione or TZD, substantially reduced loss of diabetes control compared to both metformin (Avandia 32% better) and sufonlyurea (Avandia 63% better). TZD's work by reducing insulin resistance, and also can improve beta cell dysfunction. Both effects were seen in ADOPT. The recent RECORD trial has now also showed this effect.

"The point is that though the older medications are needed, they are not enough. Newer medications like Avandia have value, most importantly keeping blood sugar under control and preventing the need for insulin"

Stopping Medication A New Avandia Risk?

Dr. Mintz notes that while doctors have increasingly switched their Type 2 diabetes patients from Avandia to Actos (a competitor), the prescribing of TZD medications overall has also declined. More worrisome, however is that many patients simply stopped taking their medication and did not share that decision with their physicians.

"It is not known what ill effects this might have caused. More importantly, those doctors who stopped using the TZD class altogether likely started prescribing more and more insulin… though the exact number from RECORD is not published, based on what was presented at the ADA, I calculate that it takes at most 10 patients treated with Avandia for 5 years to prevent at least one patient from needing insulin. Put another way, for every 10 patients who stopped Avandia, one likely needed to go on insulin."

Among other points, Dr. Mintz takes issue with the publication of the Nissen study by the New England Journal of Medicine (NEJM). According to Mintz, normal protocols surrounding the publication of a study in the NEJM involves a process of peer review. "This process generally takes several months. The New England Journal released the study to the public in just 3 weeks after Nissen submitted it."

The Avandia side effects debate continues.