The battle against the deadly duo begins

by Jennifer Ong

The textbooks are wrong. It’s more normal to be glucose abnormal if you have cardiovascular disease,” remarks Professor Eberhard Standl at a conference attended by media people, including this writer, recently at the Pudong Shangri-La hotel in Shanghai. His colleagues looked on agreeably. In fact, Professors Rury Holman, DaYi Hu, Robert Josse, and Changyu Pan have also conducted their own respective studies and arrived at the same conclusion.

Dysglycemia is a condition where one possesses above normal glucose levels. A person with dysglycemia may have either prediabetes (higher than normal blood sugar level, but lower than that of a diabetic) or diabetes (particularly type 2). Such is found through various tests, the most effective of which is the Oral Glucose Tolerance Test (OGTT), as recommended by Professor DaYi Hu.

Professor DaYi Hu conducted a China Heart survey recently. Findings show that without the OGTT, about 81 percent of type 2 diabetes patients and 87 percent of prediabetes patients will remain undiagnosed today. More importantly, his study also confirms the conclusions of the recently done Euro Heart Survey, which highlighted the deadly relation between coronary artery disease and diabetes. For many, such reports are a cause for alarm.

The International Diabetes Federation recently estimated that a further seven million people develop diabetes every year. And each year, about 3.8 million deaths are diabetes-related, with the figure far worse in cases of deaths from diabetes that are linked with cardiovascular disease. Truth is, according to reports, 80 percent of people with diabetes die of cardiovascular disease. Moreover, type 2 diabetics are much more likely to suffer from a heart attack or stroke than those who are not diabetic. This is true, regardless of what part of the world one may be in.

The International Diabetes Federation also reports that the five countries with the largest population of diabetics are India with 40.9 million, China with 39.8 million, the United States with 19.2 million, Russia with 9.6 million, and Germany with 7.4 million. Although the Philippines is not in the top 10 list, diabetes ranked ninth among the 10 leading causes of mortality in the country in 2003, accounting for 3.6 percent of total deaths from all causes, according to statistics from the Department of Health. And needless to say, the figures have risen since.

An abnormally high glucose level increases one’s risk to succumb to a fatal cardiovascular event.

The hearty news is, for sometime now, there has been a drastic search for a drug that can effectively combat this situation. Based on the results of numerous studies, acarbose can reportedly fight the duo head-on.

Acarbose is an oral antidiabetes drug that can slow down the digestion of carbohydrates, thereby extending the period during which glucose can be absorbed into the bloodstream. Because of this, acarbose is also said to effectively reduce postprandial hyperglycemia, or prevent blood glucose levels from rapidly increasing after a meal.

Professor Josse asserts, “Glucose level is flattened and improved and reduced by the use of acarbose.”

A highly regarded and awarded professor of medicine from the Departments of Medicine and Nutritional Sciences at the University of Toronto, Canada, Josse is also a member of the STOP-NIDDM (The Study to Prevent Non-Insulin Dependent Diabetes Mellitus) study, which revealed that treatment with acarbose reduces the risk of prediabetes progressing onto type 2 diabetes. More, acarbose was said to reduce the risk of a first cardiovascular event, which can be anything from a myocardial infarction to an angina to a stroke.

Also believing in the power of acarbose is Bayer Schering Pharma who soon developed the acarbose-containing Glucobay. And because they are determined to know more and help more, Bayer also recently sponsored a new study, the Acarbose Cardiovascular Evaluation (ACE) trial, which will begin this year.

The announcement of the ACE trial was actually what brought the five professors together that day. It is co-chaired by Professor Chang Yu Pan, head of the Endocrinology Department of the 301 Hospital in China, and Professor Rury Holman, a professor of diabetes medicine at the Oxford University and director of the Oxford Diabetes Trial Unit.

The study will be done in China, where acarbose has been an approved prediabetes treatment for sometime now. About 7,500 patients from 150 specialist centers in China and Hong Kong will be enrolled for this study. All of them have been diagnosed with cardiovascular disease and prediabetes.

Throughout the study, they will be given standard-of-care cardiovascular therapy, along with an acarbose or matching placebo treatment. Spanning about four years, the trial will make use of the “start low, go slow” titration method, which requires dosage to start at 50mg once daily for about a week before gradually increasing to a maximum of 50mg thrice daily.

With the ACE trial, they hope to confirm if acarbose can delay or prevent new-onset diabetes as well as new cardiovascular disease events in a patient. Since the study will take place for about four years, nothing will be concluded until 2013. Needless to say, the much-anticipated findings are of worldwide relevance.

In 1999, several healthcare professionals from the American Heart Association sent out a heartfelt message when they said that “diabetes is a cardiovascular disease.” But take heart, because now comes a weapon that will hopefully face this dysglycemic-cardiovascular battle head-on.

Source: Philippine Star