Major Study Heralds New Era In Treatment Of Type 2 Diabetes

In addition, canagliflozin, which is a sodium glucose cotransporter-2 (SGLT2) inhibitor, showed potential renal protective effects, delaying progression of albuminuria and reducing the risk of clinically important renal composite outcomes (such as renal death, renal replacement therapy, and 40% reduction of eGFR) by 40% (HR: 0.60; 95% CI: 0.47 to 0.77).

Patients given Invokana were 14 percent less likely to suffer a heart attack, stroke or die from heart disease than those given a placebo, according to the combined data from two studies presented at the American Diabetes Association's annual meeting.

Metformin is now recommended for those with the condition to reduce insulin intake and stabilise weight, but its effects on the heart and blood vessels have been unknown.

Invokana study lead investigator Bruce Neal, from George Institute for Global Health in Sydney, Australia, and colleagues argued that the results of the study showed Invokana has clear benefit compared with current diabetes treatments despite the amputation risks. It found the drug reduced the overall risk of cardiovascular disease by 14% and reduced the risk of heart failure hospitalization by 33%. That is in line with the labelling for the drug in the USA - where Invokana has a black-box warning about amputation - and suggests that "care is warranted in the use of canagliflozin in patients at risk for amputation", according to the trial investigators.

Professor Neal said: "We don't know why there was an increased risk of amputation, and further work is needed in this area".

You can access the study here.

Because these issues are strongly linked to type two diabetes, the drug could make a huge difference to the four million people in the United Kingdom who have the disease.

Coronary heart disease is the biggest killer for people with type 2 diabetes.

The researchers found the risk of heart disease dropped not just for people already deemed to be at cardiovascular, but for all patients. It is neither clear why one of these drugs can raise risk for amputations, which experts said highlights the needs for a test on each of these medicines.

Johnson & Johnson, based in New Brunswick, New Jersey, is conducting another trial to determine if Invokana also offers significant protection for the kidneys, said James List, head of cardiovascular and metabolism at the company's Janssen unit. Current treatments for diabetes only lower the blood glucose level and nothing much, explained Prof.

'Invokana is a relatively new drug and the effects on patients taking the drug for several years are not yet known'.

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