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研究人员周五报道，已经进行的最大规模的预防试验发现，一种广泛用于治疗糖尿病的药物可以延缓或预防60％以上糖尿病前期发展至糖尿病。

超过4100万的美国人存在血糖异常——称为糖尿病前期——这意味着他们可能很快发展为糖尿病，这些人是服用罗格列酮（商品名文迪雅，葛兰素史克制药）的最佳人群。

饮食控制和运动是目前仅有的预防2型糖尿病的措施。

为期3年的研究发现，罗格列酮可增加充血性心力衰竭的发生，尽管发生此情况的绝对病例数较少，内科医生处理得当，但这仍然是罗格列酮的一个重要副作用。

与进行严格的调整饮食和加强运动相比，服用罗格列酮每月的花费高达170美元。但是专家指出，很少有医生或患者愿意花费必需的时间和精力去执行严格的饮食和运动计划。

该研究结果是本周五在丹麦哥本哈根举行的欧洲糖尿病研究协会会议上公布的，研究结果将发表在新一期《柳叶刀》杂志上。

罗格列酮研究结果似乎让人振奋，但是有专家认为很难确定该药对延缓糖尿病发生到底有多大作用，因为该研究的志愿受试者也定期接受了健康饮食和生活方式的建议。

未参与该研究的波士顿加斯林糖尿病中心医学主任Martin Abrahamson博士说，“我们知道，仅生活方式的改变就可以减少发展至糖尿病的风险约58％。”

美国大约有1800万2型糖尿病患者。这个数字持续快速增长，美国疾病控制和预防中心宣称糖尿病是一种流行病。世界范围内共有2亿2000万糖尿病患者，大多数患者晚期都会发生心脏病，肾病，失明或神经损害，还常常需要截肢。

与1型糖尿病患者胰腺停止分泌胰岛素不同，2型糖尿病的发生是由于胰腺部分丧失分泌胰岛素的能力，伴有体细胞利用胰岛素代谢血糖以供细胞利用的能力部分或全部丧失。

罗格列酮可以增加细胞对胰岛素的敏感性。

早期关于糖尿病治疗的研究表明，罗格列酮和另外一种药物雷米普利可能阻止发展为糖尿病。雷米普利（商品名Altace，King Pharmaceuticals公司和惠氏制药）可以增加胰岛素分泌。

当前这项由加拿大麦克马斯特大学Hertzel Gerstein 博士领导的研究，共纳入来自21个国家的5269名糖尿病前期受试者。

Gerstein指出，接受罗格列酮治疗的2365人中10.6％发展为糖尿病，与之相比，给予安慰剂的2634人中25％发展为糖尿病。罗格列酮组有14人发生充血性心力衰竭，而安慰剂组仅2人发生充血性心力衰竭。

该研究的第二部分关注雷米普利，研究发现尽管雷米普利可以将受试者的血糖降至正常水平，但它并不能延缓进展为糖尿病。

Drug may slow development of diabetes
By Thomas H. Maugh II
Los Angeles Times
A drug widely used to treat type 2 diabetes delayed or prevented progression of prediabetes to diabetes by more than 60 percent in the largest prevention trial ever conducted, researchers reported Friday ..

More than 41 million Americans have blood-glucose abnormalities — known as prediabetes — that indicate they may soon develop diabetes, making them good candidates for rosiglitazone, sold by GlaxoSmithKline under the brand name Avandia.

Diet and exercise are the only current treatment for preventing progression to type 2 diabetes.

One important side effect of the drug during the three-year study was an increase in congestive heart failure, although the absolute number of cases was low and physicians managed it successfully.

The results with rosiglitazone, which costs up to $170 a month, are comparable to those achieved with intensive programs to modify diet and increase exercise, but experts noted few physicians or patients are willing to invest the time and effort necessary to implement such a program.

The results of the study were presented Friday in Copenhagen, Denmark, at a meeting of the European Association for the Study of Diabetes. The results will be published in the new issue of the journal Lancet.

The rosiglitazone results at first glance seem impressive, but some experts said it is difficult to determine how much impact the drug had, because study volunteers also were regularly counseled about healthful diets and lifestyles.

"We know that lifestyle changes alone can reduce the risk of developing diabetes by up to 58 percent," said Dr. Martin Abrahamson, medical director of the Joslin Diabetes Center in Boston, who had no ties to the study.

In the United States, an estimated 18 million people have type 2 diabetes. The number has been growing so rapidly that the Centers for Disease Control and Prevention has declared diabetes an epidemic. Worldwide, 220 million people have diabetes, most of whom later develop heart disease, kidney disease, blindness or nerve damage, often leading to limb amputation.

Unlike type 1 diabetes, in which the pancreas stops producing insulin, type 2 diabetes occurs when the pancreas loses part of its ability to produce insulin and the body's cells lose part or all of their ability to use insulin to take glucose from blood for use by cells.

Rosiglitazone increases the sensitivity of cells to insulin.

Earlier studies on treating diabetes had suggested rosiglitazone and a second drug, ramipril, might also halt progression to diabetes. Ramipril, sold by King Pharmaceuticals and Wyeth under the brand name Altace, increases production of insulin.

The current study, led by Dr. Hertzel Gerstein, of McMaster University in Canada, enrolled 5,269 people with prediabetes in 21 countries.

Gerstein reported that 10.6 percent of the 2,365 people who received rosiglitazone progressed to diabetes, compared with 25 percent of the 2,634 given a placebo. Fourteen of those receiving the drug developed congestive heart failure, compared with two receiving placebo.

The second part of the study looking at ramipril found the drug produced no delay in progression to diabetes, even though it reduced the subject's blood-sugar levels to normal.

Material from The Associated Press is included in this report.

http://seattletimes.nwsource.com/html/nationworld/2003261251_diabetes16.html

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