Questions on What is New in Diabetes Care

Dear Dr. Spence,
What’s new in the world of diabetes care?
Signed,
I.N.Sulin

Dear I.N.Sulin,
Diabetes and diabetes care is in the midst of a "mini-revolution". Within the past year or so, several novel agents have found their way to the market. Unfortunately, at the same time, one drug has already been eliminated from the market while another is potentially on its way out. Pfizer introduced an inhaled insulin earlier this year in hopes of allaying the "fear of needles". Sales were abysmal; I suspect this was in part secondary to physicians reluctance to prescribe a bulky, difficult to use agent with potential adverse lung effects. Either way, they scrapped the drug entirely thus limiting insulin to injection only administration Another popular drug, avandia, has come under close scrutiny by the FDA after preliminary data suggested an increased risk of cardiovascular events. Though not removed from the market, enough controversy surrounds it to limit its use in most cases. Its sister agent, actos, remains a viable option without the inherent cardiovascular risk, though it can cause both weight gain and edema (swelling). Newer medications include both Januvia and Byetta. Januvia can be used in combination with most drugs and seems to do a fair job at lowering blood sugars. It acts directly by inhibiting the destruction of a crucial enzyme that plays a role in glucose metabolism. It decreases production of endogenous (within the body) glucose production among other effects. Byetta, though injectable, may be the most interesting and powerful new weapon in our diabetes armamentarium. Given subcutaneously twice a day, byetta works by decreasing appetite and increasing post-meal satiety (feeling of fullness), and by decreasing the body’s ability to produce excess glucose (much like januvia). These mechanisms translate to lower overall blood sugars, but also the propensity for weight loss, oftentimes quite dramatic. The package insert suggests an average weight loss of 11.2 pounds. I have personally seen patients lose upwards of 60+ pounds; some may be due to lifestyle interventions but I suspect most is directly attributable to the effects of the medication. Current research revolves around the utilization of Byetta depots which may allow patients to administer the injection on a once a week or once monthly basis. They may even provide more profound weight loss than that currently seen with standard byetta regimens. Panhandle Family Care has joined forces with Emerald Coast Research Group to bring diabetes research to our area. We are currently involved in three separate diabetes studies funded by large pharmaceutical companies. These companies enroll eligible volunteers in clinical trials and in return offer free medications, labwork, office visits, testing supplies and education. On occasion, they offer a financial stipend to those enrolled. One such study offers patients free study drug and 300 dollars for their participation in a one month trial. Any patient suffering from diabetic neuropathy (painful burning, numbness or shooting pain the feet) may be eligible. If interested, please contact Kelly Schroeder, the research liaison, at 850-598-3274.

Do you have any medical questions or concerns that you would like addressed? You can contact Dr. Spence by email at panhandledailydose@hotmail.com or by mailing your question to Daily Dose, P.O. Box 6107, Marianna, FL 32446.