In an international study of 839 obese patients with Type 2 diabetes, rimonabant produced significant wieght loss, a reduction in waist size and an increase in HDL (”good”) cholesterol levels, but did not lead to any significant change in percentage atheroma volume. There was a small effect on total atheroma volume, but this was not clinically significant. The drug was associated with a high level of psychiatric side effects, as it has done in previous trials, and it has now been withdrawn in the US for this reason.

Weight loss in diabetes remains problematic, but the answer still seems to lie in cutting energy intake, particularly of carbohydrates, and taking more exercise.

Nissen et al. JAMA. 2008;299(13):1547-1560. Published online April 1, 2008 (doi:10.1001/jama.299.13.1547).

A Study published recently in the Journal of the American Medical Association in patients with type 2 diabetes and coronary artery disease, treatment with Actos (pioglitazone) resulted in a significantly lower rate of progression of coronary atherosclerosis compared with glimepiride. The changes were small, however, and the variability of the results wide.

The results have been challenged by other researchers, and although this is interesting, it does not seem to me that this is likely to represent any sort of breakthrough. The studies are continuing though, and may help us understand the mechanisms of heart disease in diabetes rather better.

Nissen et al. JAMA. 2008;299(13):1561-1573. Published online March 31, 2008 (doi:10.1001/jama.299.13.1561).