'ADOPT' and 'DREAM' trials and the Indian perspective

Abstract

Two recent landmark studies, the ADOPT and DREAM trials have looked at efficacy of rosiglitazone in the treatment and prevention of type 2 diabetes. The results of the ADOPT study done on recently diagnosed type 2 diabetic subjects suggested that rosiglitazone was more effective in slowing down the progression to monotherapy failure compared to metformin or glyburide. However, rosiglitazone was associated with weight gain, edema, increase in the levels of LDL cholesterol and a reduction in the haematocrit and higher rates of fractures in women. The DREAM study looked at the efficacy of rosiglitazone in the prevention of type 2 diabetes in individuals with pre-diabetes. There was a 62% reduction in risk for developing diabetes with rosiglitazone and this effect was more pronounced in obese and overweight individuals. Liver function was unaffected or improved with rosiglitazone. However, the frequency of non-fatal heart failure was higher in the rosiglitazone, group compared to the placebo, group. The prevalence of type 2 diabetes in India has been steadily increasing over the decades and the prevalence of Impaired Glucose Tolerance (IGT) is also very high. Although the ADPOT and DREAM have widened the horizon for the use of rosiglitazone in both treatment and prevention of type 2 diabetes, the side-effects associated with it points to the need for carefully choosing patients.