The bittersweet truth about diabetes

With the central government putting a ban on anti-diabetic drug pioglitazone close to a week ago, medication expenses of diabetics who were on the drug are set to rise. “While a pioglitazone tablet cost Rs4-Rs8, patients who were using the drug will now have to shift to costlier options like gliptin, which cost upto Rs50 per tablet or insulin, each vial of which costs between Rs150-Rs500,” said Dr Siddarth Shah, diabetologist, SL Raheja Hospital in Mahim.

Doctors said that up to 30 lakh people suffer from Type 2 diabetes in the country, the result of a lifestyle that is said to be faulty. Of these 20%  are on standalone or a combination of drugs including pioglitazones.

“We are appealing to patients that they should immediately consult their physicians for alternative lines of treatment. Pioglitazones were excellent insulin sensitizers. However, patients with weak hearts or elderly patients were not given pioglitazone due to side effects like weight gain and congestive heart failure,” said Shah. “In young patients, however, the drug in smaller doses worked well.”

After the ban all drugs containing pioglitazone as an ingredient have gone off the shelf in chemist shops. The central government has banned the drug citing a possible link between pioglitazone and bladder cancer. “The drug has gradually been phased out in France due to a potential risk of bladder cancer. However, even US continues to use the drug, albeit with a black box warning listing the health risks that the drug poses,” said Dr Vijay Pannikar, diabetologist, Lilavati Hospital, Bandra.

Doctors believe that the blanket ban on pioglitazones by the central government is premature. “Instead of imposing an outright ban on the drug, an expert committee ought to have been formed to study the pros and cons of using the drug. More so, the sale of the drug can be regulated by putting it in scheduled category so that it is available on specialised prescription from an endocrinologist or a diabetologist,” said Dr Shashank Joshi, president, Indian Academy of Diabetes.

With the ban on pioglitazones, diabetics may have to shell out more money for diabetes treatment but time-tested alternatives are available, said doctors, allaying fears.

“Metformin, Sulphonyureas and Insulin are time tested alternatives. Moreover, with pharmacy practices in India not up to the mark, pioglitazones were easily available to patients. Diabetics are more prone to develop side effects due to pioglitazones which may have gone unnoticed due to their easy availability,”said Joshi.