The diabetes drug Avandia was back in the news this past week and Mid-South physicians are still answering questions from confused and worried patients.

The issue for patients, physicians and federal regulators is whether the drug, which is prescribed to lower blood sugar, increases a patient’s heart attack risk. “It is not a straight-forward situation,” said Dr. Jay Cohen, a Memphis diabetes specialist.

A study published in the New England Journal of Medicine last month linked Avandia to a 43 percent increased risk of heart attack or heart-related deaths. It prompted the FDA to issue a safety alert warning that Avandia might leave patients at significantly increased risk for heart attack or heart-related deaths.

But investigators reached that conclusion by pooling the results of 42 smaller studies that were designed to answer different questions, weren’t long-term and included relatively few patients, noted Dr. Abbas Kitabchi, another Memphis specialist. “It is difficult to know what to make of the results,” he said. “We are telling patients we aren’t going to take them off” the drug based on the New England Journal study.

Heart failure is a different story, added Dr. Kashif Latif. He is also a Memphis diabetes specialist. “There were always reservations about using these medicines for patients with heart failure,” he said.

On Wednesday, the federal Food and Drug Administration announced it asked manufacturers of both Avandia and Actos, a related drug, to strengthen their warnings about heart failure. The FDA wants both to carry more prominent black-box warnings.

For now, Latif said he believes few physicians are switching patients from Avandia based on the possible heart attack risk highlighted in the New England Journal study. But he and other doctors said if patients are worried, they will prescribe a different medication.

Cohen added, “The biggest risk to patients is having blood sugars that are out of control. It is important for patients to talk to their physician.”

A definitive answer about Avandia and heart attack risks is expected in 2009. That’s when results are due from research currently underway.