Healthy Skepticism Library item: 9845

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Publication type: news

Laurance J.
Changes in lifestyle hold key to reducing risk of diabetes
The Independent 2007 Apr 27
http://news.independent.co.uk/uk/health_medical/article2488849.ece

Full text:

A drug initially hailed by doctors as giving new hope to people who are at risk of diabetes should not be prescribed to them after all, experts will say today.

The drug, rosiglitazone, sharply reduces the chance of developing diabetes when given to people at high risk, according to the results of an international trial published last year.

But three American professors writing in the British Medical Journal say taking a prescription drug to prevent the condition cannot be justified when lifestyle changes can achieve the same effect.

Professor Victor Montori of the Mayo Clinic in Rochester, New York, and colleagues say the “aggressive marketing of rosiglitazone as a preventive therapy” following last year’s trial is an example of how healthy people are being turned into patients through the medicalisation of everyday life.

Multinational pharmaceutical companies with an interest in promoting new drugs are increasingly identifying “pre-disease states” which require treatment before people fall ill, they say.

Diabetes is one of the biggest potential markets, with almost two million people in the UK affected and a million more predicted to succumb by 2010.

The disease is driven by rising obesity and inactive lifestyles, and experts have warned the numbers could overwhelm the NHS.

Several trials have shown that diabetes can be prevented with drugs. But the results are no better than those achieved through changes to the diet and increases in physical activity that bring modest weight loss. The drugs also have side effects, some of them serious, such as an increased risk of heart failure, bone loss causing fractures, and damage to the retina causing blindness.

Speaking yesterday, Professor Montori said: “Our main concern is the idea that you can turn people into patients very early by getting them to take pills. Diabetes is not a disease you feel you have, it is a disease your doctor tells you that you have. All the drugs do is prevent your blood sugar rising to a level that triggers the diagnosis.”

“You end up with patients taking more drugs who are then at risk of getting side effects and who have to go for more check-ups. You have become a patient where previously you were at risk of becoming one.”

Heart disease, obesity, high cholesterol and high blood pressure were other conditions where drugs were prescribed instead of lifestyle changes.

“It is an issue we should debate as a society – do we want to use tablets and surgery to manage these conditions, or do we want to improve the lifestyle of our citizens? There is a slippery slope from identifying something very clear such as a heart attack, then identifying the risk factors such as high cholesterol and treating those as a disease,” said Professor Montori.

“There is a tendency then to identify obesity as a condition that needs treating and if you keep going you get to a point where being alive and eating is a risk factor. We should be very cautious about the medicalisation of people who feel healthy and then through treatment become patients.”

Rosiglitazone, marketed in the UK as Avandia by Glaxosmithkline, is an established treatment for people with diabetes, but last year’s trial, run in 21 countries and published in The Lancet in September, was aimed at establishing its role in preventing the condition. The results showed that for every 1,000 people at high risk treated with the drug for three years, it would protect 144 who would otherwise have developed the condition.

But most of these people would be unaware of their condition, would not experience any immediate benefit, would require more visits to the doctor, and would have their anxiety levels raised by the diagnosis.

The authors say in the BMJ: “Even under the most optimistic assumptions, patients offered rosiglitazone for prevention will end up taking more pills. Thus neither patients who value preventing diabetes in order to avoid taking drugs, nor a society concerned with cost minimisation, will benefit from early use of rosiglitazone.”

A spokesman for Diabetes UK said rosiglitazone had been shown to be safe and effective. “However, much more research needs to be done to justify the use of this drug in preventing Type 2 diabetes,” he said.