Consider Byetta and Avandia. Both are used to treat diabetes but they work by different mechanisms. Byetta enhances insulin secretion from pancreatic beta cells when glucose is present while Avandia promotes the movement of glucose into skeletal muscle thus decreasing insulin resistance. The question this presents is whether the two therapies would work well together. This question was addressed by group headed by Dr. Ralph DeFronzo from the University of Texas and will appear in the journal: Diabetes.
The clinical trial was designed as a 200 week randomized open label study that involved a number of different centers around the United States. One hundred and thirty seven participants with type 2 diabetes were randomized to receive either Byetta alone, Avandia alone, or Byetta plus Avandia. The group had an average age of 56 years, and A1c level of 7.8%, and a average BMI of 32.5. They were a mix of Caucasian, African American, and Hispanic peoples and included both men and women. All were on metformin and continued their metformin regimen throughout the study.
Just to remind you of what A1c and BMI mean: A1c is a measure of the amount of hemoglobin that is glycosylated in the patient’s blood. If blood sugar is high for long periods of time, the amount of A1c increases and if blood sugar is controlled for long periods of time the amount of A1c decreases. Since it takes about 90 days for red blood cells (which contain the hemoglobin) to turn over, A1c is an average of about 3 months of the patient’s life. The American Diabetes Association is promoting the use of A1c rather than blood sugar levels as the primary determinant of diabetes progression. An A1c below 6.5 has been correlated with a lack of development of complications so this is the magic number to shoot for. BMI stands for body mass index. This is calculated from your height and weight. A BMI of 25 or lower is considered a healthy body weight.
The results indeed demonstrated that combining Byetta and Avandia was advantageous. The A1c level for all 3 groups decreased after 20 weeks but the decrease in the patients who took the combination was better 6.6% as compared to 6.9% and was statistically significant. The Byetta group lost weight while the Avandia group gained weight as expected. The combination group also lost weight showing that weight loss was the predominant effect of the combination. Fasting glucose levels were pretty much the same for all 3 groups. Cholesterol did increase in the combination group as it did in the Avandia group so here it seems that increased cholesterol predominates.
The bottom line is that we now have some scientific measurements to go along with our gut feeling that the combination of Avandia and Byetta would be beneficial. The only down side to combining these drugs appears to be the increased cholesterol. A1c levels and weight are decreased to a greater extent that either of the single drug groups which is a good thing. In fact, the combination group had an A1c of 6.6 – almost in the safe zone. The authors caution that another trial needs to be performed looking at a larger group of people for a longer period of time but for the moment this combination looks good.
If you are interested in reading more about the science of diabetes or are interested in uplifitng and informative articles, recipes, and blogs about diabetes; try A Sweet Life, the magazine for the healthy diabetic. http://asweetlife.org
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