Correspondence
Effect of Troglitazone in Type 2 Diabetes Mellitus
N Engl J Med 1998; 339:406August 6, 1998
- Article
To the Editor:
Close inspection of Figure 1 and Figure 2 in the article by Schwartz et al. (March 26 issue)1 suggests that the effects of troglitazone may have been waning when the study ended at 26 weeks, because the values for both glycosylated hemoglobin and fasting serum glucose in the patients given 600 mg of troglitazone daily were slightly higher than earlier. Did any of the patients continue to take troglitazone, and if so, what were its effects?
1 ReferencesDavid M. Gorson, M.D.
Albany Medical Center, Albany, NY 122081
Schwartz S ,Raskin P ,Fonseca V ,Graveline JF . Effect of troglitazone in insulin-treated patients with type II diabetes mellitus. N Engl J Med 1998;338:861-866
Full Text | Web of Science | Medline
To the Editor:
Schwartz et al. found that glycosylated hemoglobin values, serum glucose concentrations during fasting, and insulin requirements all decreased in patients with type 2 diabetes treated with troglitazone for 26 weeks. The authors comment that the 15 percent reduction in glycosylated hemoglobin values in the troglitazone-treated patients can be translated into a 60 percent reduction in the risk of progression of diabetic retinopathy if one extrapolates from the Diabetes Control and Complications Trial in patients with type 1 diabetes. But can results in patients with type 1 diabetes be extrapolated to those with type 2 diabetes?
Moreover, since patients with type 2 diabetes may be taking troglitazone for decades, the long-term benefits of the drug can only be inferred, and they may be limited by weight gain. Whereas the placebo group had a mean weight gain of 1.5 kg, the mean weight gain in the patients receiving 200 mg of troglitazone and in those receiving 600 mg was 1.9 and 3.6 kg, respectively (P<0.001). If this difference increases with time, it may seriously limit the value of the drug.
Matthew H. Rusk, M.D.
Hospital of the University of Pennsylvania, Philadelphia, PA 19104Author/Editor Response
The authors reply:
To the Editor: After completion of the 26-week study, the patients were offered further treatment with troglitazone. The patients who had been taking 200 mg or 600 mg daily continued to take the doses they had taken previously, and the improvement in glycemic control was maintained for up to 17 more months, as indicated by mean glycosylated hemoglobin values and fasting serum glucose concentrations that were similar to those after the first 26 weeks of treatment.1
Although we referred to the findings of the Diabetes Control and Complications Trial, similar results have been reported in studies of patients with type 2 diabetes mellitus. For example, Klein et al. reported that in older patients with diabetes, lower glycosylated hemoglobin values were associated with a decreased risk of microvascular complications, an effect that appeared to be independent of the duration of diabetes.2,3 This is especially relevant to our patients, who had had diabetes for a mean period of 10 years.
The troglitazone-treated patients did gain weight during the study, but among those who continued to take the drug, there was little further weight gain during the follow-up period described above.
3 ReferencesSherwyn L. Schwartz, M.D.
Diabetes and Glandular Diseases Clinic, San Antonio, TX 78229Vivian Fonseca, M.D.
University of Arkansas for Medical Sciences, Little Rock, AR 722051
Fonseca V ,Graveline J ,Nissel J . Long term experience with troglitazone in combination with insulin in type 2 diabetes mellitus. Diabetes 1998;47:Suppl 1:A90-A90 abstract.
Web of Science2
Klein R ,Klein BEK ,Moss SE ,Cruickshanks KJ . The medical management of hyperglycemia over a 10-year period in people with diabetes. Diabetes Care 1996;19:744-750
CrossRef | Web of Science | Medline3
Klein R ,Klein BEK ,Moss SE ,Cruickshanks KJ . Relationship of hyperglycemia to the long-term incidence and progression of diabetic retinopathy. Arch Intern Med 1994;154:2169-2178
CrossRef | Web of Science | Medline
