Ellen Campbell-Grizzle
Annual worldwide sales of drugs for diabetes are expected to top US$20 billion in 2011 as more people develop the disease. Pharmaceutical companies are churning out new options to treat diabetes and associated illnesses.
Diabetes is linked to obesity which is also reaching epidemic proportions. Pharmaceutical companies expect to produce blockbusters from two novel and closely-related drug classes for Type 2 diabetes that have recently been approved by the U.S. Food and Drug Administration.
Jamaican diabetics would be familiar with insulin for Type 1 diabetes. People with Type 2 diabetes have different medicinal needs. These persons progressively lose their ability to produce or properly use insulin, a hormone made in the pancreas that moves sugar from blood into cells, where it is used as fuel.
Starve cells
A build-up of sugar in the blood not only starves cells of energy but causes serious health complications including blindness, kidney failure, heart attack, strokes and amputations. Older drugs stimulate the pancreas to release insulin or discourage the liver from producing sugar. These newer drugs work differently. They raise the level of GLP-1 (Glucagon-like peptide), which is produced when blood sugar levels in the intestine or stomach are elevated. The hormone stimulates the pancreas to release insulin while restraining the liver from making sugar.
The first GLP-1 analogue reached the market over a year ago. This injectable medicine is used to control blood sugar for adults with Type 1 and Type 2 diabetes. Last week, a dipeptidyl peptidase (DPP) -IV inhibitor, sitagliptin ( Januvia), from Merck and Company, reached the market. Drugs from these classes prolong the effect of gut-derived hormones and are designed to increase insulin secretion in a glucose dependent manner. There are others in the pipeline.
Pros and cons
The new drugs can be added to existing treatment. However, they are relatively expensive when compared to existing drugs, some of which are very inexpensive and are available in generic form. Januvia, of the new Gliptin class, is taken by mouth while the GLP-1 analogues are injectable.
The 'ins and outs' of new drugs are not as well known as older drugs. GLP-1 analogues should not be used if patients cannot tell when their blood sugar is low or if they have slow stomach emptying. Nausea, vomiting, abdominal pain, headache, fatigue and dizziness have been reported. The most common side effects of Januvia include headaches and a stuffy nose. The drugs do not appear to cause weight gain. Unless major toxicities emerge, positive results so far suggest that they will become established as valuable treatment. Make sure that you get full information about these drugs from your pharmacist and do regular blood sugar checks.
Sound advice
You can protect yourself from Type 2 diabetes through diet and exercise. Weight loss and exercise can result in lower blood pressure; lower levels of cholesterol, less sleep disturbances and stave off diabetes. Drugs should be the last resort. Sometimes when people know that there are effective medicines available they do not pursue the required lifestyle change.
The availability of effective medication sometimes sustains a real conundrum. We over-rely on them because achieving the lifestyle change is more difficult. However, these new medicines are expensive and have some side effects. Prevention remains the superior option.
Ellen Campbell Grizzle, president, Caribbean Association of Pharmacists; director, Information & Research, National Council on Drug Abuse; email: yourhealth@gleanerjm.com.
