Drug Treatment for Liver Disease

A drug traditionally used to treat diabetes could reverse the symptoms of nonalcoholic steatohepatitis — a type of liver disease. Recent research reveals pioglitazone (Actos) effectively reduces fats and inflammation in the liver.

Fifty-five patients with nonalcoholic steatohepatitis and impaired glucose tolerance or type 2 diabetes followed a liver treatment plan for six months. One group of patients followed a low calorie diet and pioglitazone treatment. The other group followed a low calorie diet and took placebo. After six months, both groups showed a reduction in liver inflammation, but those taking pioglitazone had reduced levels of fats in the liver and decreased insulin sensitivity.

“We had a reduction by half in fatty liver and inflammation,” Dr. Cusi said. “This was also associated with improvement in the way the body handles sugar and lipids.”

Nonalcoholic steatohepatitis is difficult to diagnose in the early stage, which means the liver may withstand a great deal of damage before the disease is detected. The disease can cause chronic liver cell death and scarring, or fibrosis. Liver fibrosis can lead to irreversible cirrhosis.

“We think up to one in four patients with NASH [nonalcoholic steatohepatitis] might end up with cirrhosis,” Dr. Cusi said. “Once you develop cirrhosis, half of them [patients] die within five to 10 years.”

A drug option that reverses deterioration of the liver and eventual cirrhosis could have a large impact on the quality of life and lifespan of those living with nonalcoholic steatohepatitis.

“We didn’t expect the improvement to be so impressive,” Dr. Cusi said. “I think the word of caution is this is the first step in the right direction, but much more work needs to be done to look at the long-term efficacy to confirm this in a larger group of patients.”

SOURCE: Ivanhoe interview with Kenneth Cusi, M.D., University of Texas Health Science Center; The New England Journal of Medicine, 2006;355:2297-2307

Physical Activities for Diabetes

Myth “You have to spend a lot of time being active to get any benefit”

Truth The recommended amount of activity is 30 minutes five times a week. But you don’t’ necessarily have to dedicate specific times to this – you can feel the benefits just by being more active in your day-to-day life. Everyday things such as climbing stairs, going shopping, gardening, and housework all count as activity.

Will I still need to take my diabetes medication if I become more active?

Yes, but you may need a lower dose to achieve the same effect. If you are on insulin-stimulating pills, you may be more at risk of a hypoglycemic attack when you become more active, so you may need a reduction in the dose of your pills or a change to a different type of pill. Also, if you are more active, you may find that you lose weight. If you lose more than a few pounds you are likely to need a lower dose of pills or insulin.

I’ve been told I have impaired glucose tolerance. Will being more physically active help me?

Yes, people who have impaired glucose tolerance are more likely to go on to develop Type 2 diabetes. Becoming more active, especially if you also lose weight, will help your natural insulin work as effectively as possible to regulate your blood glucose level. You will always be at risk of developing diabetes, but the more active you are, the longer it may take to develop.

How does being more active help prevent the long-term complications of diabetes?

Regular physical activity helps the insulin you have produced or injected work more efficiently, which in turn contributes toward keeping your blood glucose and your blood pressure in the recommended ranges. These two benefits make the long-term complications of diabetes less likely.

How will being active help my heart?

Regular activity helps lower your blood pressure and your blood cholesterol levels, and consequently, you have less chance of having a heart attack or a stroke. It also makes your heart stronger and more efficient so that it can pump more blood with every heartbeat, and it reduces your risk of having a heart attack from clots forming in your coronary arteries. The more active you are, the less likely you are to have a heart attack, and the greater your chance of surviving a heart attack if you have one.

I’m prone to depression. Will being active help me?

Yes, activity raises your levels of endorphins and serotonin. These brain chemicals influence your mood and sense of well-being and have a strong antidepressant effect. Some types of activity, for example, playing golf or tennis, also entail spending time with other people, and this can help lift your spirits, too.

I don’t’ take pills or insulin yet. Will staying active allow me to continue without medication?

Because of the progressive nature of diabetes, you will probably need pills or insulin eventually, but with an active lifestyle, you may delay the need for medication because regular activity reduces your insulin resistance. Activity can help at any stage. If you already take tablets, increasing your activity levels may help delay the need to start injecting insulin and reduce the dose you need.