Wrong drugs given to most diabetic patients with heart failure

In a recent issue of The Journal of the American Medical Association (JAMA), an article appeared revealing that, although the FDA warns against the practice, doctors are putting many patients with diabetes and heart failure at grave risk by treating them with two anti-hyperglycemic drugs: metformin and thiazolidinediones.

According to the article, although diabetes and heart failure commonly co-exist, the treatment of diabetes in patients with both conditions is complicated because some of the drugs known as "oral insulin sensitizers" are not recommended for treatment of patients with moderate-to-severe heart failure.

Package inserts of metformin, contain a warning that the drug is not recommended for diabetic patients receiving drug treatment for heart failure therapy while thiazolidinediones are not recommended in diabetic patients with symptoms of advanced heart failure.

Yet, according to the research conducted by Frederick A. Masoudi, M.D., MSPH, of the Denver Health Medical Center, Denver, and colleagues, the drugs are commonly prescribed to patients who could be seriously harmed by them.

The study compiled data from nongovernmental acute care hospitals in the United States on patients hospitalized with the primary diagnosis of heart failure and diabetes between April 1998 and March 1999 and between July 2000 and June 2001.

The researchers found that more than half of the patients in the 2000-01 group were discharged with a prescription for the drugs. This was up from 28% in the earlier group.

"In this study of nationally representative samples of hospitalized heart failure patients with diabetes, the use of antihyperglycemic agents not recommended in the package insert in this setting was widespread. This practice nearly doubled between 1998-1999 and 2000-2001, reflecting increasing popularity and familiarity with these agents by prescribing physicians. Use of these drugs in patient populations at particularly high risk for adverse events ... also increased," the authors wrote.

"There is a need for all parties interested in safe diabetes treatment to increase awareness of the recommended approach to diabetes in patients with heart failure," the researchers concluded.

SOURCE: “Metformin and Thiazolidinedione Use in Medicare Patients With Heart Failure,” by Frederick A. Masoudi, M.D., et. al. The Journal of the American Medical Association, July 2, 2003, 2003;290:81-85.