ADA: 'Polypill' Could Cut Diabetes-Related MIs in Half

WASHINGTON, June 11 ? If medications for four optimal therapeutic goals of diabetes could be combined into a single pill, the risk of diabetes related heart attacks could be cut in half over the next 30 years.

According to Robert A. Rizza, M.D., chairman of endocrinology at the Mayo Clinic in Rochester, Minn., such an approach would cost only about per patient a year, and the system would save up to for each patient for every year treated.

The hypothetical "polypill" described by Dr. Rizza at the American Diabetes Association meeting here would contain 1,000 mg of Glucophage (metformin), 75 mg of aspirin, 40 mg of a generic statin such as Pravachol (pravastatin), and 10 mg of a generic angiotensin-converting enzyme (ACE) inhibitor.

The pill is hypothetical, but the treatment is not, Dr. Rizza said: Kaiser Permanente includes a combination of the agents as part of its diabetes treatment protocol.

He based his projections on a series of mathematical models developed in collaboration with Archimedes Systems, Inc., of Waltham, Mass. The Archimedes model has been shown to be remarkably accurate at predicting clinical responses to therapies in randomized controlled trials, matching actual results with projections virtually data-point by data-point in validation studies testing the model against real world trials.

Because a cure for diabetes is not a reality, and optimal care?following all ADA guidelines to the letter?is a goal far from being realized, clinicians who care for patients with diabetes must be willing to settle for what he called "committed care."

"If 80% of patients with diabetes could achieve the ADA's recommended goals?and I truly think this is achievable," he said, "it would require that our nation begins to appropriately pay for the treatment of diabetes rather than pay for the treatment of diabetes complications alone."

The components of committed care include the following goals:

• Hemoglobin A1C levels of less than 7%.
• Blood pressure of less than 130/80 mm Hg.
• Use of a statin to achieve LDL of less than 100 mg/dL, and HDL of 40 mg/dL or more for men, and 50 mg/dL for women, with triglycerides of less than 150 mg/dL.
• 75 mg aspirin daily.

This plan foregoes the optimal care goals of no smoking and body mass index less than 25 kg/m², Dr. Rizza noted.

Committed care, which could be achieved with the hypothetical polypill or a real-life combination of all of the agents, even if instituted in only 80% of eligible patients, would still result in a 50% reduction in myocardial infarction over the next 30 years, a 4% reduction in renal failure, a 33% reduction in blindness or eye surgery, and a 35% drop in total serious diabetes complications, according to the mathematical model, Dr. Rizza said.

"Committed care results in five million fewer heart attacks, 600,000 fewer strokes, 1.2 million fewer episodes of renal failure, 1.2 million fewer episodes of eye disease and surgery, and 1.8 million fewer deaths, and this results in 11 million fewer serious diabetes complications," he said.

The savings would amount to more than billion in total medical costs, he added.

Dr. Rizza said the country needs to invest heavily in diabetes research aimed at finding a cure, at a level commensurate with the risk that diabetes represents to the health of the population, the health care system, and the economy.

In addition "we must establish and provide the financial support to sustain systems of care that ensure every person with diabetes receives the best possible care every day," he added. "To do anything less is foolish. To continue to pay for complications while refusing to pay for prevention is folly."

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