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Weight Gaining Effect for Avandia (Rosiglitazone) Might Be Replaced By Newer Antidiabetic Drug: Galvus (Vildagliptin)

The American Diabetes Association estimates that nearly one-third of people who have type 2 diabetes don't even know it. If the condition is left uncontrolled, the consequences can be life-threatening. Nearly 21 million people in the United States have diabetes, according to the American Diabetes Association. About 90 percent to 95 percent of people with diabetes have type 2 diabetes. And the condition is on the rise, fueled largely by the current obesity epidemic.

Your body's primary source of energy is sugar. Sugar comes from breaking down carbohydrate foods. These foods include fruits, milk and yogurt, sweets, rice, pasta, beans, and starchy vegetables such as corn, potato, and green peas. When you have type 2 diabetes your body has a hard time using sugar from these carbohydrate foods for energy.When you have type 2 diabetes, your body has a difficult time using the insulin you produce. This is called insulin resistance. With insulin resistance the cells of your body do not easily recognize your insulin. If the insulin is not recognized, the door will not open and allow sugar to move from the blood into the cell. Sugar remains in the blood leading to higher than normal blood sugars.

Type 2 diabetes is also called non insulin dependent diabetes (previously called “maturity onset diabetes”) typically occurs in overweight, sedentary adults, often with onset around 40 years of age. These patients respond to oral antidiabetic medicines, generally for a few years, and then many of them may require insulin. Data compiled over the last decade or so suggests that the age of onset of type 2 diabetes could often be in the thirties or even the twenties. This is particularly true of diabetes prone populations.

Often type 2 diabetes can be controlled through losing weight, improved nutrition, and exercise alone, but sometimes these are not enough and either oral medications and/or insulin must be used. Treatment often includes:

proper diet
weight control
an appropriate exercise program
proper hygiene
in some cases, insulin replacement therapy (under the direction of a physician)

Untreated or inappropriately-treated diabetes can cause problems with the kidneys, legs, feet, eyes, heart, nerves, and blood flow, which could lead to kidney failure, gangrene, amputation, blindness, or stroke. For these reasons, it is important to be on a strict treatment plan.

Thiazolidinediones – TZD's - Glitazones classes anti-diabetic drug such as Rosiglitazone (Avandia - maximum dose is 8 mg/day) help insulin work better in muscle and fat; they lower insulin resistance and have a small effect on slowing the release of sugar from the liver.But its side effect such as weight gain ,liver abnormalities sometimes outweigh its benefit.

An oral medication in a new class of antidiabetic drugs is able to lower blood sugar (glucose) in type 2 diabetes as well as Avandia (rosiglitazone) does, but without causing weight gain, according to a recent report in the journal Diabetes Care.

The new agent, vildagliptin, also known by the brand name Galvus (made by Novartis), is awaiting regulatory approval in the U.S. and Europe. The new drug class, dipeptidyl peptidase-IV (DPP-IV) inhibitors, improves cell responsiveness to glucose, the authors explain.

Dr. Julio Rosenstock from the Dallas Diabetes and Endocrine Center, and colleagues compared the effectiveness and tolerability of vildagliptin versus rosiglitazone (the generic name for Avandia) in nearly 800 patients with previously untreated type 2 diabetes.

At the beginning of the study, the patients' average hemoglobin A1c level (HbA1c), a measure of long-term glucose control, was 8.7 percent. (Normal HbA1c levels are less than 7 percent). It decreased by 1.1 percent with vildagliptin treatment, with most of the decrease occurring within the first 12 weeks, the investigators report. Patients treated with rosiglitazone had a 1.3 percent decrease in HbA1c, with maximum reduction occurring at week 16.

Patients who were not obese (body mass index below 30) fared better than heavier patients with vildagliptin, the team found.

Vildagliptin treatment was associated with stable body weight during treatment and a significant decrease in the "bad" cholesterol, including triglycerides, LDL, and non-HDL cholesterol, compared with rosiglitazone treatment, the researchers note. Patients taking rosiglitazone experienced a significant average increase in weight of about 3.5 pounds.

Vidlagliptin and rosiglitazone are both effective in reducing blood glucose levels in type 2 diabetes patients who have not received prior anti-diabetic drug treatment, the investigators conclude. Along with being well-tolerated, vildagliptin does not cause weight gain, which is an important consideration in selecting the first drug to treat type 2 diabetes patients.

Type 2 is initially treated by adjustment in diet and exercise, and by weight loss, especially in obese patients. The amount of weight loss which improves the clinical picture is sometimes modest (5–10 lb); this is almost certainly due to currently poorly understood aspects of fat tissue chemical signalling (especially in visceral fat tissue in and around abdominal organs). In many cases, such initial efforts can substantially restore insulin sensitivity.