An analysis of care data from 80909 people has demonstrated that the LDL cholesterol-lowering agent atorvastatin (Lipitor; Pfizer, Tadworth) leads to a 14% reduction in the relative risk of cardiovascular events such as heart attacks and strokes, when compared with simvastatin.
Widespread prescription of simvastatin in place of more potent statins is recommended in the UK to help alleviate financial pressure on the NHS, on the assumption that this will result in similar cardiovascular benefits.
The real-world study mentioned above highlights the potential for poorer cardiovascular outcomes with widespread generic substitution that does not assess people on a case-by-case basis.
Dr Jonathan Morrell, GP and hospital practitioner, commented: ‘This analysis reinforces the existing evidence that not all statins are the same and not all patients are suitable to be switched to generics’. He continued: ‘Each patient should be carefully evaluated before being switched or we may see an increase in CV events among patients who should be on an intensive statin treatment.’
A recent UK audit on switching from atorvastatin to simvastatin also found that 43% of people were unsuitable for the change in medication. This was mainly due to factors such as inadequate cholesterol control, intolerance to simvastatin or a history of simvastatin use that failed to reduce cholesterol to target.
Diabetes treatment modelled on lizard spit available in UK
Exenatide, a first-in-class incretin mimetic used to treat type 2 diabetes, is now available in the UK. Exenatide is based on a chemical found in the saliva of the Gila monster, Heloderma suspectum, a lizard native to North America and Mexico.
The Gila monster only eats three or four times a year and a compound excreted by its saliva glands called exendin-4 may help them digest their food more slowly, an advantageous trait in the control of diabetes.
Exendin-4 has similar properties to glucagon-like peptide-1, which stimulates β-cells in the pancreas to produce insulin in response to raised blood glucose.
Research by Eli Lilly and Company and Amylin Pharmaceuticals led to the development of a synthetic version of exendin-4, exenatide, to treat type 2 diabetes.
Unfortunately, illegal hunting and rapid loss of habitat mean that populations of Heloderma lizards are declining in numbers. The advances in medicine made possible by such discoveries as this one highlight the importance of conserving endangered species.
Insulin detemir limits weight gain
Insulin detemir (Levemir; Novo Nordisk, Crawley) effectively treats diabetes without causing weight gain.
PREDICTIVE, a large-scale, observational study, published in the International Journal of Clinical Practice, examined outcomes with insulin detemir in the clinical setting.
In the European cohort, 20531 people with type 1 and type 2 diabetes from 11 countries were prescribed insulin detemir and followed up after 14 weeks.
Average blood glucose levels decreased, but there was also a noticable improvement in average body weight for both types of diabetes.
This benefit has been reported in every published clinical trial that has compared insulin detemir with other basal insulins. The relative weight benefit has also been shown to increase with increasing BMI.
Professor Russell-Jones of the Department of Diabetes and Endocrinology, Royal Surrey County Hospital, added: ‘Insulin initiation is often associated with considerable weight gain, which is a major problem for people with type 2 diabetes. Studies have shown that even a modest weight reduction can improve the cardiovascular risk profile of these people’.
Website showcases new diabetes success stories
An updated section of the National Diabetes Support Team (NDST) website is showcasing success stories, case studies and innovative work in diabetes.
‘Infopoints’ summarise local work aiming to improve diabetes care in areas such as screening and weight and medicine management.
A simple online form allows anyone to volunteer their own information about relevant work.
NDST Director, Bev Bookless, said: ‘A central part of the NDST’s role is to help diabetes networks share information and Infopoints are providing a great means of doing this. We know there is great work going on in diabetes care all over the country, and we want to hear from people out there’.
For more information, visit http://www.diabetes.nhs.uk/infopoints (accessed 24.05.2007).
Working together to improve diabetes care
Sue Roberts, the Diabetes Tsar, recently published a report about diabetes care in England, entitled Working and planning together for better diabetes care, which highlights the importance of partnership working. She believes that diabetes communities need new approaches to deal with increasing demand.
The report also features case studies, definitions and statistics on the direction of diabetes care in England, along with information on prevalence, costs, partnership working, quality, organising services, engaging people, planning care, commissioning and diabetes networks.
Attempts to achieve remission, or at least a substantial improvement in glycaemic control, should be the initial focus at type 2 diabetes diagnosis.
9 May 2024