January 24, 2004 (STAR) Diabetes is a complex disease that can be difficult to understand and an even greater challenge to manage. Life-threatening complications such as heart disease and stroke often accompany this disease.

It is estimated that two out of three diabetes patients will eventually succumb to heart disease. Alarmingly, most people who have diabetes are unaware of their increased risk for heart disease and stroke.

People who have diabetes that go undetected and untreated face an increased risk for heart disease because atherosclerosis may occur at an earlier-than-expected age and is more severe in diabetics.

Atherosclerosis is the process where fatty substances, inflammatory cells, cellular waste products and other molecules build up on the inner wall of an artery. This fat build-up can rupture and block blood flow to the heart.

Those who have diabetes-related atherosclerosis in their coronary arteries sometimes suffer from what is called "silent ischemia" or silent heart attack.

Silent, in this case, means without typical pain because neuropathy, or nerve damage, can result from uncontrolled diabetes.

The good news is that the complications of diabetes can be prevented through effective disease management. Traditionally, strategies for the management of type 2 diabetes include diet and exercise followed by monotherapy of anti-diabetic agent.

However, clinical trials such as the landmark United Kingdom Prospective Diabetes Study (UKPDS) showed that these traditional strategies do not effectively manage insulin resistance and beta-cell dysfunction, the underlying causes of type 2 diabetes, and fail to achieve long-term blood sugar (glycemic) control.

Poor management of the underlying causes of diabetes often leads to cardiovascular diseases and other serious complications.

Thiazolidinediones such as rosiglitazone, a class of drugs which reduces insulin resistance, have demonstrated improvements in both insulin sensitivity and beta-cell function, even when combined with either metformin or sulfonylurea.

The positive effects on the range of cardiovascular risk factors suggest that early combination therapy based around thiazolidinedione may also have benefits in reducing the heavy burden of cardiovascular disease in type 2 diabetes.

A study done by Drs. Jane Reusch and Roger Gadsby published in the journal Diabetes Technology and Therapeutics about the benefits of aggressive and early use of thiazolidinedione therapy in type 2 diabetes revealed that the combination therapy of rosiglitazone and metformin or sulfonylurea reduce insulin resistance by 51 percent and 17 percent, respectively, over six months of therapy.

Likewise, there was a 94 percent and 72 percent improvement in beta-cell function over 26 weeks on addition of rosiglitazone to metformin or sulfonylurea, respectively.

With type 2 diabetes slowly becoming a global epidemic, there is a clear and urgent need for a therapy that will effectively manage the disease.

The addition of thiazolidinediones in the doctor’s armamentarium against diabetes will surely benefit more than 300 million people around the world who are suffering from this chronic disease.

Reported by: Sol Jose Vanzi

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