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Duetact combines two medications: pioglitazone and glimepiride, which increase a diabetic’s sensitivity to insulin, while simultaneously causing the pancreas to produce extra insulin. Unfortunately, there is growing evidence linking pioglitazone to a 40% increased risk of bladder cancer.

What is Duetact?

Duetact is a pill used to treat Type-2 Diabetes in people who do not take daily insulin injections. It is a combination of two medications: pioglitazone and glimepiride. In combination, these medications help a diabetic control blood sugar by decreasing insulin-resistance, and causing the pancreas to produce more insulin.

Duetact is manufactured by Takeda Pharmaceuticals, the company responsible for Actos, Actoplus Met, and Actoplus Met XR. The U.S. Food and Drug Administration (FDA) approved Duetact in 2006. It comes in two strengths, with 30-mg of pioglitazone and 2-mg or 4-mg of glimepiride.

Pioglitazone, an anti-diabetic medication sold alone under the brand-name Actos, is a type of drug called a thiazolidinediones (TZD). It reduces the amount of sugar the body can absorb from food, decreases the amount of glucose (sugar) excreted by the liver into the bloodstream, and increases cellular sensitivity to insulin. Unfortunately, this Duetact ingredient has also sparked controversy after it was linked to severe side effects, including cardiovascular problems and bladder cancer.

Glimepiride is a type of anti-diabetic drug in a class called sulfonylureas, which work by stimulating beta cells in the pancreas to secrete extra insulin. Glimepiride also stimulates more activity in intra-cellular insulin receptors, which increases cellular insulin sensitivity, making the body more efficient at using insulin in the bloodstream.

Type-2 Diabetes is a progressive metabolic disorder that occurs when a person has chronic problems with blood sugar control, complicated by insulin-resistance. Normally, whenever you eat food, the liver metabolizes sugars in the food into a substance called glucose, which is dissolved and excreted into the bloodstream. Simultaneously, the pancreas secretes dissolved insulin into the bloodstream. Insulin is a hormone that causes cells in your muscles, fat, and other tissue to start absorbing glucose from the bloodstream, and stop using reserved sources of energy. Over time, these cells can become less sensitive to insulin, or insulin-resistant. When they come in contact with insulin, they are not stimulated effectively, and they do not absorb enough glucose from the bloodstream. This leads to chronic elevated blood sugar levels, with potentially fatal results if it gets out of control. Around 24 million Americans have Type-2 Diabetes, with 25% of cases undiagnosed. For those who have been diagnosed, around 40% inject themselves with extra insulin on a daily basis. Many of those who do not take injections control their blood sugar with a medication, such as Duetact.

Duetact and Bladder Cancer

One condition of FDA approval of new drugs is that the drug manufacturer must conduct post-marketing research to determine whether the drug is causing unexpected side effects. Duetact’s manufacturer, Takeda Pharmaceuticals, is currently conducting a ten-year safety study involving 200,000 people taking a medication containing pioglitazone, such as Actos. When the FDA reviewed data from the five-year mark, they found that diabetics who had taken Actos for at least 12 months were 40% more likely to develop bladder cancer. This prompted the FDA to issue a Drug Safety Communication in June 2011, saying:

“Compared to never being exposed to pioglitazone, a duration of pioglitazone therapy longer than 12 months was associated with a 40% increase in risk . . . Based upon this data, FDA calculated that duration of therapy longer than 12 months was associated with 27.5 excess cases of bladder cancer per 100,000 person-years follow-up, compared to never using pioglitazone.”

Bladder Cancer is a life-threatening Duetact side effect. It is one type of cancer that is most susceptible to toxins, such as workplace toxins, cigarettes, and medications. It begins in the “transitional cells” in the endothelial lining of the bladder. If it is not diagnosed and treated early, it can progress to the muscular wall surround the bladder, and then grow into surrounding tissues, organs, or other parts of the body. Bladder cancer is one of the few types of cancers where scientists have developed novel types of immunotherapy, in which a vaccine (the Bacille Calmette-Guerin vaccine) can be injected directly into the bladder and cause the person’s immune system to attack cancerous cells. Surgical removal of cancerous tissue and chemotherapy are also options.

Duetact Banned in France, Germany

Researchers in France also found a link between pioglitazone and bladder cancer. In a study of 155,000 people taking a medication containing pioglitazone, bladder cancer was 1.2-times more likely. Bladder cancer was 1.4 times more likely in patients who had taken the medication for at least two years. This increased risk was in comparison to 1.3 million people who were not taking a medication containing pioglitazone.

In response, French and German medical authorities decided to suspend sales of medications containing pioglitazone, including Actos, Actoplus Met, Actoplus Met XR, and Duetact.

Duetact Side Effects

Severe Duetact side effects include, but are not limited to:

  • Upper respiratory tract infection
  • Urinary tract infection
  • Bladder cancer
  • Heart attack
  • Bone fractures
  • Stroke
  • Liver problems
  • Fluid retention
  • Weight gain
  • Macular Edema
  • Congestive Heart failure
  • Low red blood cell count (anemia)
  • Low blood sugar (hypoglycemia)