Reports From The Field-Diabetes
Reports From The Field-Diabetes
Exercise extends life for type 2 diabetes patients
Men with type 2 diabetes who do not exercise regularly are two times more likely to die than those with type 2 diabetes who are fit, according to a recent study in the Annals of Internal Medicine.
Researchers studied 1,263 men with type 2 diabetes who received a thorough medical examination between 1970 and 1993 who did not take insulin injections to control their diabetes. Study participants completed a medical history, questions about health and exercise habits, a physical examination, blood tests, electrocardiography, and a maximal exercise test. Researchers classified study participants as "low fit" or "fit" based on their performance on the maximal exercise test. The 20% of the men who had the lowest fitness scores were classified "low fit" and all other participants were classified as "fit."
Researchers used the national death index, a database that lists all deaths in the United States, to see which men had died by Dec. 31, 1994. Researchers identified 180 deaths among study participants for the period ending Dec. 31, 1994. After accounting for other risk factors, such as smoking and age, men in the low-fit group were two times more likely to have died than men who were in the fit group.
The study supports the idea that patients with type 2 diabetes should participate in regular exercise and improve their physical fitness. However, researchers note that only a study that randomly assigns participants to exercise or not exercise could prove this finding.
[See: Wei M, Gibbons LW, Kampert JB, et al. Low cardiorespiratory fitness and physical inactivity as predictors of mortality in men with type 2 diabetes. Ann Intern Med 2000; 132:605-611.]
Combination therapy controls diabetes better
Study finds single agents don't control all causes
Most antidiabetic agents target only one of the underlying causes of diabetes. A new study suggests that a combination therapy using the drugs metformin hydrochloride and rosiglitazone maleate appears to maintain optimal glycemic control in patients with type 2 diabetes and offers better outcomes for patients whose diabetes is poorly controlled by metformin alone.
Researchers conducted a randomized, double-blind, placebo-controlled trial in 36 outpatient centers in the United States. The study included 348 patients between ages 40 and 80 with a mean fasting plasma glucose level of 12.0 mmol/L, a mean glycosylated hemoglobin level of 8.8%, and a mean body mass index of 30.1 kg/m2.
Patients were randomly assigned to one of the following three groups:
• 116 patients received 2.5 g/d metformin plus placebo.
• 119 patients received 2.5 g/d metformin plus 4 mg/d of rosiglitazone.
• 113 patients received 2.5 g/d of metformin plus 8 mg/d of rosiglitazone.
Glycosylated hemoglobin levels, fasting plasma glucose levels, insulin sensitivity, and B-cell function improved significantly with metformin-rosiglitazone therapy in a dose-dependent manner.
Findings include the following:
• Glycosylated hemoglobin levels decreased by 1.0% in the 4 mg/d metformin group and by 1.2% in the 8 mg/d metformin group. Levels decreased by less than .001% in the placebo group.
• Fasting plasma glucose levels decreased by 2.2% mmol/L in the 4 mg/d metformin group and by 2.9% in the 8 mg/d metformin group. Levels decreased by less than .001% in the placebo group.
• Of patients in the 8 mg/d group, 28.1% achieved a glycosylated hemoglobin level of less than 7%.
Researchers concluded that combination therapy with once-daily metformin and rosiglitazone improves glycemic control, insulin sensitivity, and B-cell function more effectively than treatment with metformin alone.
[See: Fonseca V, Rosenstock J, Patwardhan R, Salzman A. Effect of metformin and rosiglitazone combination therapy in patients with type 2 diabetes mellitus. JAMA 2000; 283:1,695-1,702.]
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