Diabetes

What's new in diabetes?

Diabetes affects 25.8 million, or 8.3% of the population, in the US

• Of those, 18.8 million are diagnosed; 7 million are undiagnosed
• Among US residents ≥ 65 years, 10.9 million, or 26.9% , had diabetes in 2010
• About 215,000 people <20 years had diabetes (type 1 or type 2) in the US in 2010
• Each year, more than 13,000 young people are diagnosed with type 1 diabetes

New therapies

A 2010 report showed a record 235 medicines in development to treat diabetes, and this number continues to rise.

Since 2010, 7 new drugs have been FDA approved for the treatment of type 2 diabetes mellitus:

• Victoza (liraglutide; Novo Nordisk) is a GLP-1 receptor agonist belonging to the newer class of medications called incretin mimetics that promotes insulin secretion in the presence of elevated blood glucose levels.
• Kombiglyze XR (saxagliptin/metformin HCl extended-release; BMS/ AstraZeneca) combines a DPP-4 inhibitor with extended-release metformin; like incretin mimetics, DPP-4 inhibitors stimulate insulin release in a glucose-dependent manner.
• Tradjenta (lingliptin; Boeringer Ingelheim) is a DPP-4 inhibitor.
• Juvisync (sitagliptin and simvastatin; Merck) combines glucose-lowering action of a DPP-4 inhibitor and cholesterol-lowering action of a statin in a single tablet.
• Bydureon (exenatide synthetic; Amylin) is a GLP-1 receptor agonist.
• Jentadueto (linagliptin plus metformin HCl; Eli Lilly) is a fixed-dose combination of a DPP-4 inhibitor plus metformin.
• Janumet XR (sitagliptin plus metformin HCl extended-release; Merck) combines a DPP-4 inhibitor with extended-release metformin.

Of the new drug classes in development for type 2 diabetes, the sodium glucose cotransporter-2 (SGLT-2) inhibitors are furthest along.

• SGLT-2 inhibitors reduce blood sugar by causing it to be excreted in the urine
• April 2012: first-in-class SGLT-2 inhibitor dapagliflozin neared approval in Europe
• FDA requested additional data before considering dapagliflozin approval in US

While no new therapies for the treatment of type 1 diabetes have been approved within the last few years, much research has focused on an experimental procedure called islet transplantation. It is the hope that islet transplantation, currently in phase III trials, will eliminate the need for daily insulin injections for people with type 1 diabetes.

Updates on diagnosis

Diagnosing diabetic ketoacidosis (DKA), a severe complication that most commonly occurs in people with type 1 diabetes, was recently simplified with the introduction of commercial point-of-care β-hydroxybutyrate measurement devices. Management challenges

• Majority of patients with diabetes do not achieve appropriate glycemic control (defined as glycosylated hemoglobin, or A1C, <7%) with current medications
• Management involves addressing diabetes interventions and complications commonly associated with the disease:
• Microvasculopathies: diabetic retinopathy, diabetic nephropathy, diabetic neuropathy
• Macrovasculopathies: heart disease (CAD and myocardial infarction) and stroke
• Evolving research leads to new considerations for treating patients with diabetes, in addition to those at high risk for diabetes—people with impaired glucose tolerance (known as pre-diabetes) or insulin resistance, which can occur as part of the metabolic syndrome. For example:
• Recent research identified a key gene needed for the free fatty acids found in high-fat food and stored in body fat to induce insulin resistance and lead to abnormally high blood sugar
• A new study suggests that lowering BMI by 5 units can dramatically reduce the risk of type 2 diabetes after 2 and 10 years

Costs

In 2010, global sales of diabetes pharmaceuticals totaled $35 billion. This figure is expected to rise to $48 billion by 2015.