diabetes

What are the facts regarding Maria Sharapova’s use of the diabetes drug meldonium?

The Maria Sharapova saga has thrusted diabetes into the limelight this week. All of sudden, people are talking about the drug meldonium, and questioning what role it has as a diabetes drug.

Well, the fact is that there aren’t too many facts. But here is some concrete information regarding Sharapova’s failed drug test at the Australian Open in January, and what exactly the Russian tennis star’s relationship with diabetes is.

Sharapova had been talking meldonium for 10 years

Sharapova said she was prescribed meldonium (also known as mildronate) by her doctor in 2006. In January, the World Anti-Doping Agency (WADA) added meldonium to the banned list because there was “evidence of its use by athletes with the intention of enhancing performance”.

“For the past 10 years I have been given a medicine called mildronate by my family doctor and a few days ago after I received the ITF (International Tennis Federation) letter I found out that it also has another name of meldonium which I did not know,” Sharapova said at a press conference on Monday.

At this year’s Australian Open tournament, Sharapova failed a drug test. She said she didn’t know that the rules had changed regarding meldonium’s status as a prohibited substance and “made a huge mistake”.

Meldonium is prescribed to treat heart conditions

Meldonium is a Latvian drug. It is not approved for use in Europe, or the U.S., but it is prescribed in Russia to improve exercise tolerance in ischemic heart disease. This is when there is a lack of blood flow to the heart.

Wired.com reports that in the 1970s, the Latvian Institute of Organic Synthesis demonstrated meldonium could treat effects of heart failure, myocardial infarction and atherosclerosis. But meldonium doesn’t just have benefits for the treating of heart conditions.

By increasing oxygen intake, meldonium also enhances stamina and endurance. It is prescribed by some neurological clinics for patients with asthenia – an abnormal lack of energy.

Meldonium is listed as a “metabolic modulator” by the WADA. This is a drug class that can regulate blood sugar in the body and interfere with hormone function. Insulin is also listed in this category.

Sharapova was taking meldonium because of “diabetes indicators”

This is where things get a bit complicated.

Sharapova’s attorney revealed that in 2006, Sharapova had “some immune deficiency, abnormal EKG results, diabetes indicators, low magnesium and asthenia”, according to CNN. Thus, Sharapova was prescribed meldonium.

While we don’t know a lot about those “diabetes indicators”, Sharapova added on Monday that diabetes runs in her family, which is indeed a risk factor for prediabetes, a condition where blood glucose levels are higher than normal, but not high enough to be classed as diabetes.

Sharapova was 18 in 2006. She was in top physical condition. This isn’t to say that young athletes cannot develop prediabetes, but it’s rare that prediabetes develops at such a young age. It is also peculiar that Sharapova would be prescribed meldonium to treat prediabetes for so long.

Forbes’ David Grainger explained: “Even in Russia, though, it (meldonium) is hardly a first-line therapy for treating pre-diabetes, as in the U.S. and much of the rest of the world, clinicians concerned about development of diabetes would reach for metformin (a drug with a similar safety profile to meldonium, and which is above all an equally low-cost option).“

10 years is a very long time to be taking a prediabetes medication, especially for someone as physically active as Sharapova.

Grindeks, the Latvian drug firm who make meldonium, told the Associated Press that a normal course of drug treatment is four to six weeks. They added that “treatment courses can be repeated twice or thrice a year”, but Sharapova’s usage of the drug lasted far beyond those recommendations.

Grindeks added that “physicians can follow and evaluate a patient’s health condition and state whether the patient should use meldonium for a longer period of time”, but this is where the debate begins and ends.

It is not known why Sharapova was prescribed meldonium for 10 years, and without access to her private medical information, it will remain nigh on impossible to be certain as to why she was still taking meldonium.

Meldonium has been banned for increasing athletic endurance

One thing that’s for sure, though, is that meldonium is now classed as a performance-enhancing drug.

A 2015 study published in Drug Testing and Analysis found that meldonium “demonstrates an increase in endurance performance of athletes, improved rehabilitation after exercise, protection against stress, and enhanced activations of central nervous system functions.”

Grindeks noted that meldonium can improve the “work capacity of healthy people who are overloaded physically or mentally or who are in a rehabilitation period”, but does not believe that the drug would enhance athletes’ performance in competition.

Sharapova said she received email notifications in late 2015 informing her of the planned meldonium ban in January, but did not read it at the time.

She has been suspended from participating in tennis tournaments from March 12, and could face a four-year ban if she is found guilty of deliberate use of prohibited medication, according to the Kommersant newspaper.

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