Diabetes clinic

Dear Concerned Patient,

Avandia is a medication which has been marketed in Canada since March 2000. It is an insulin sensitizer used in the prevention and treatment of Diabetes Mellitus.

A recent article in the New England Journal of Medicine has caused some concern for people taking Avandia because of the suggestion that the medication could pose some heart risks.

I would first like to reassure any of my patients who are on Avandia that I am aware of the recent article and on the basis of this article I do not suggest that you stop taking this medication. All drugs have risks and benefits. Whenever we prescribe medications we have to weigh the risks against the benefits and determine what is in the best interests of the patient. This drug and the class of medications to which it belongs have been a real breakthrough in the treatment of diabetes. A large research study on type 2 diabetes (the UKPDS) has shown us that diabetes is a progressive disease. All treatments prior to Avandia coming on the market failed because of the progressive deterioration of the pancreas. Avandia was the first drug that showed the potential to slow or possibly stop the deterioration of the function of the pancreas. This was also the first drug of its class in Canada that improved insulin resistance, which is a core defect in type 2 diabetes. Subsequent research has not only confirmed that Avandia slows pancreatic deterioration but also that it is the most effective treatment that we have to prevent diabetes (the DREAM trial).

In major, well controlled studies of Avandia, there has been no associated increase in risks of heart attack. A study done on another member of the same class of medication (Pro-Active Study) using Actos suggested a reduction in cardiac events in people taking the drug. We have always known that this class of medication may pre-dispose the patient to fluid retention and that people with severe heart disease may not be able to tolerate this extra fluid load, possibly developing congestive heart failure. However, we can treat to decrease this risk.

The recent study in the New England Journal of Medicine looks only at certain studies and suggests that there may be a relative risk increase for heart attack in people taking Avandia. We need to put this in perspective and realize that the actual (absolute) risk of heart attack in these studies was very small and the apparent increase in risk may not be of any clinical significance. We need more data and we need to look closely at the studies that are currently being conducted to observe specifically the risks of cardiac events.

For the moment, Avandia is a safe and effective drug. If you have been prescribed this drug, I suggest that you continue to take it. As more information becomes available, please be assured that I will be getting in touch with you and will place a notice on this web site if I think there are significant risks you should be aware of.

J. Robin Conway, MD