The message and the messenger

ResearchBlogging.orgI’m not sure what to make of this. An article in the latest Journal of the American Medical Association (JAMA) reports some potentially good news for type II diabetics. Type II diabetes has been extensively studied (detailed post to follow), and one area of difficulty has been reducing the incidence of macrovascular disease (heart attack and stroke, primarily). Treating blood pressure and cholesterol aggressively in diabetics helps, but controlling blood sugars closely doesn’t seem to help with these particular sequelae of diabetes.

Further complicating the picture was some data released last year about rosigitizone (Avandia), an oral diabetic drug. This showed possible increased cardiac mortality with the use of this medication, although the numbers weren’t too convincing.

So, the new article reports on pioglitizone (Actos), a close relative of Avandia. The data seem to indicate that, versus another type of oral diabetes medication, Actos reduced incidence of death, heart attack, and stroke.

Hmmm. Dr. Steve Nissen, who has always been out front in denouncing potentially dangerous drugs was a lead author on this study. He was also very noisy about the harm of Avandia.

It just seems like an odd coincidence that he should be out front decrying the (possible) harm of one drug, and then be the lead author of a study supporting the use of its main competitor. Nissen has an excellent reputation, so nefarious motives are probably out. But it does show that who says something can be almost as important as what is said.

Nissen, S.E., Nicholls, S.J., Wolski, K., Nesto, R., Kupfer, S., Perez, A., Jure, H., De Larochelliere, R., Staniloae, C.S., Mavromatis, K., Saw, J., Hu, B., Lincoff, A.M., Tuzcu, E.M. (2008). Comparison of Pioglitazone vs Glimepiride on Progression of Coronary Atherosclerosis in Patients With Type 2 Diabetes: The PERISCOPE Randomized Controlled Trial. JAMA: The Journal of the American Medical Association, 299(13), 1561-1573. DOI: 10.1001/jama.299.13.1561