Benefit Of Actos For Teens With Type 1 Diabetes Unclear

Adding the diabetes drug Actos to insulin does not improve blood sugar control and may cause weight gain in adolescents who have type 1 diabetes who show signs of insulin resistance. In theory, increasing the insulin dosage to overcome insulin resistance should be enough to improve blood sugar control in adolescent type 1 diabetics, note Dr. Jill Hamilton, from the Hospital of Sick Children in Toronto, and colleagues. However, this often does not occur, and there is a need for "adjunctive therapies to complement the action of insulin."

Actos (also known as pioglitazone) works by increasing the body’s sensitivity to insulin, to better control patients’ blood sugar. It is used alone or in combination with other drugs if needed.

While Actos can improve metabolic control in subjects with type 2 diabetes, the benefits of adjunctive Actos therapy in adolescents with type 1 diabetes have not been studied.

In the current study, 35 teens with type 1 diabetes took Actos or placebo in addition to standard insulin therapy for 6 months. All of them had suboptimal metabolic control on insulin alone.

Participation in the trial was associated with significant improvement in metabolic control, the authors report.

However, Actos was no better than placebo in improving control as determined by favorable changes in hemoglobin A1C (an indicator of blood sugar) as well as the required insulin dose. Moreover, Actos was associated with weight gain.

The current findings contrast with a recent study involving adults with type 1 diabetes, the researchers admit. In that study, adding Avandia (rosiglitazone) did help patients cut back on the required insulin dose. Moreover, on subgroup analysis, use of Avandia produced a greater reduction in hemoglobin A1C. Hamilton’s team thinks these differences may relate to the fact that patients in the current study were leaner than those in the adult study.

The Journal of Pediatrics, December 2006.

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