Friday, January 04, 2013


In my reading, I came across this article from China appearing in the Western Journal. There is much work done in China, that appears in Chinese Journal which often carries translation. I go to Beijing every year for the last 15 years and I get to browse through them. This particular article on management of diabetes, is carried in the Diabetes care Journal, Dec 10, 2012 issue. The first author is Dr Jie Hong from the Shanghai Jiao Tong University School of Medicine. The study is ebtitled " Study on the Prognosis and Effects of anti-diabetic Drugs in Type 2 Diabetes Mellitis with Coronary artery Disease SPREAD-DIMCAD study ( trust the Chinese to have a long acronym for a study.
Anyway, the purpose of the study was to compare the effect of two different group of anti-diabetic drugs on CV mortality and morbidity. They enrolled 304 patients who had diabetes for at least 5 years and established coronary artery disease for the last 3 years at least. Half were given Glipizide 30 mg daily for 3 years at least, and the other half Metformin 1.5 gms daily for three years at least. The median follow-up was 5 years. The primary end point was death, non fatal MIs, strokes and myocardial re-vascularisation.
After 5 years of follow-up. there was no difference in mortality, either cardiac or non-cardiac. However, in the composite primary endpoint, there was a relative risk reduction of 46% in the metformin treated group. ( the hazard ratio was 0.54 CI 95% 0.30-0.90 ).
Basically, metformin was much safer then Glipizide ( Diamicron ), has less MACCE after 5 years in diabetics with CAD. This may be due to the fact the Metformin ( an insulin sensitiser ) is a mild anti-inflammatory, and so may be mildly anti-atherogenic. It also seem to lessen platelet adhesion.
Once in a while, we do get a drug that is cheap and good, even in this 21st century where prices of goods are escalating and healthcare cost is climbing steeply.

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