Filling the role of physician assistants
The recently published position statement on glitazones from the Association of British Clinical Diabetologists1 is to be welcomed. For some time the mismatch between NICE guidance on glitazones (August 2003) and the growing body of evidence supporting their use has been causing controversy.
Since the original NICE guidance there have been licence changes supporting the use of both pioglitazone and rosiglitazone in monotherapy, and the launch of the rosiglitazone/metformin fixed-dose combination product.
There is now published trial evidence confirming positive effects of glitazones on blood pressure, HDL cholesterol and other cardiovascular risk factors2,3,4.
There is also data showing evidence of sustained glycaemic control to 30 months with these agents in combination with metformin.
The new position statement takes all this into account and now recommends glitazones as first-line add-in to metformin in obese patients. Is it now time for GPs to use their clinical judgment and consider a change from traditional prescribing and add glitazones to metformin in patients with insulin resistance syndrome.
Professor Michael Kirby
Director, Hertfordshire Primary Care Research Network Letchworth
1 Higgs et al. Pract Diabetes Int, Sept 2004;21;1-2)
2 Honisett SY et al. Diabetes Care ;26(11)3194
3 Robinson P et al. Diabetologia 2003;46(S2): A291, Abs 839
4 Viberti GC Int J clin Pract 2003 ;57(2)128-134