Diabetes and Heart Medications are a Dangerous Prescription

[Guest guest]

Mixed Meds: A Dangerous Prescription for Heart Patients

By Amanda Gardner

 

HealthDay Reporter

(HealthDay is the new name for HealthScoutNews.)

 

TUESDAY, July 1 (HealthDayNews) -- Patients with diabetes and heart

failure seem to be routinely receiving medications that may aggravate

one condition even if they help (?) the other.

 

 

Specifically, metformin (brand name Glucophage) and a class of

medications called thiazolidinediones -- both of which help (?) control

glucose levels in diabetics (news - web sites) --

 

may cause serious complications in patients with heart failure.

 

 

The findings are detailed in a study in the July 2 issue of the Journal

of the American Medical Association (news - web sites).

 

 

" The number of patients with diabetes has increased dramatically in the

country over the last 10 years and increasingly these medications are

being used as part of their therapy, " says Dr. Sid Smith, director of

the Center for Cardiovascular Science and Medicine at the University of

North Carolina.

 

 

" Because of the observations of fluid retention and weight gain [in the

case of thiazolidinediones], it's very important that they not be used

in patients with known heart failure or, if necessary, that possible

problems be monitored very carefully, " adds Smith, who is a past

president of the American Heart Association (news - web sites).

 

 

 

Part of the problem is that so many patients, especially patients with

diabetes, have other health conditions as well.

 

 

" The typical heart failure patients are patients who have many

concurrent illnesses and complications and can end up on a lot of

different medications, "

says study author Dr. Harlan M. Krumholz, a professor of medicine and

epidemiology and public health at Yale University School of Medicine.

 

 

" As people end up going to a specialist, there's often not a lot of

cross-talk.

 

We need to pay a lot more attention to the integration of our approaches

and taking into account a variety of conditions, " Krumholz says.

 

 

But there's also the issue of whether physicians are paying attention to

U.S.Food and Drug Administration (news - web sites) (FDA) " black box "

warnings on medications. Such warnings are the most serious category of

health side effects.

 

 

" There's a discordance between what the FDA is saying and what's going

on in practice, " Krumholz says.

" We're potentially undermining the entire system. "

 

 

The " black-box " warning for metformin indicates the drug could lead to

lactic acidosis -- or acid in the blood,

 

a potentially life-threatening problem for people with *heart failure*.

 

(moderator's Note: These diabetic drugs list coronary thrombosis as a

likely 'side effect'!)

 

And thiazolidinediones may " cause " fluid retention,

again a serious condition for heart failure patients.

 

 

" Good care of a chronic condition of heart failure entails getting

people into the right balance.

 

And if they're on medications that cause them to " retain

fluid " , it may turn them in the wrong direction and tip them over and

cause themto be hospitalized, " Krumholz says.

 

 

For this study, Krumholz and his colleagues pored through the medical

recordsof Medicare beneficiaries who had been hospitalized with heart

failure and

diabetes from April 1998 to March 1999 and July 2000 to June 2001.

 

 

The earlier sample consisted of 12,505 patients, 7.1 percent of whom

were discharged with a prescription for metformin, 7.2 percent with a

prescription

for a thiazolidinedione, and 13.5 percent with a prescription for one or

the other.

 

 

In the second sample, which consisted of 13,158 patients, 11.2 percent

got metformin, 16.1 percent got a thiazolidinedione, and 24.4 percent

one or theother.

 

 

The study authors did not look at how many people had adverse reactions,

simply how many patients were prescribed the drugs.

 

Moderator's Note: Of course not, who really gives a care ??

 

 

It's not entirely clear why this disconnect is happening, the

researchers say.

Physicians may simply not be aware of the dangers or they may " think "

the benefits outweigh the risks. Or they may have decided that the risks

aren't as high as advertised.

 

" We have a problem when the FDA is saying one thing with respect to the

safety of a medication and clinicians are so frequently " doing "

something else, " Krumholz says.

 

 

 

" We need to determine the best way to treat patients, " he says. " It is a

 

problem when the FDA's black-box warning is not being heeded. Either the

FDAhas overreacted or clinicians are exposing their patients to

unnecessary risk,and we [have] to know which it is. "

 

And it's not just an issue for heart failure patients with diabetes,

although this is a group that warrants more attention.

 

 

 

" It raises the issue about the way that we deliver health care in this

country, " says Dr. Kenneth Hupart, chief of endocrinology, diabetes and

metabolism at Nassau University Medical Center in East Meadow, N.Y.

 

 

 

" Are we either having doctors who are generalists taking care of these

complicated illnesses too much, or are we balkanizing it too much and

having super-specialists taking care of [patients] and sometimes lacking

the broadpicture?

 

We have to reexamine the way we provide health care to people in this

country. We can hypothesize but we can't really know from a study like

this.

 

It invites further studies. "