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Diabetes Developments - A blog on latest developments in diabetes by David Mendosa

Entries Tagged as 'Medication'

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Choosing a Weight-loss Drug

August 21st, 2012 · 5 Comments

We will soon be able to take the first new diet drug since 1999 when the U.S. Food and Drug Administration approved Xenical, known generically as orlistat. The FDA approved the new drug, Belviq, known generically as lorcaserin hydrochloride, on June 27. The manufacturer, Switzerland’s Arena Pharmaceuticals, hopes to have it on the market here early next year.

But those of us lucky enough to have type 2 diabetes already had our choice of three diabetes drugs that help us manage our blood sugar and happen to help us lose some weight. While people who used these drugs in clinical trials typically didn’t lose quite as much weight as those who used Belviq, the unwanted side effects of the three diabetes drugs tend to be much less serious.

Taking Belviq won’t be a free ride. The FDA approved it for people willing to eat less and exercise more.

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Early Intensive Treatment: Start Strong, Last Long

August 19th, 2012 · 3 Comments

If we hit diabetes hard at first, our bodies will keep on making insulin for a long time.

That’s the gist of study by researchers at the University of Texas Southwestern Medical Center. The full text of the study, which will appear in the July issue of Diabetes Care, is online at “β-Cell Function Preservation After 3.5 Years of Intensive Diabetes Therapy.”

Their research shows that when people who just found out that they have type 2 diabetes take either insulin injections or a combination of three oral medications right away they manage their diabetes better. With either of these two intensive treatments our beta cells keep on making the insulin we need for as long as the researchers studied us, three and a half years.

But the standard guidelines recommend going much slower. They suggest a stepwise approach.

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Posted in: Medication

Who Benefits Most from Bydureon

August 4th, 2012 · 2 Comments

A new medication that those of us who have type 2 diabetes take only once a week can bring our A1C levels way down. It can also help us to lose weight, something that almost everyone who has type 2 diabetes needs to do.
But predicting who will lose weight isn’t easy. Only one thing stood out in the clinical trials.

The new medication is Bydureon, which we have been able to get in our pharmacies for only the past four months. But Amylin Pharmaceuticals, which developed Bydureon, presented a study at the American Diabetes Association’s annual convention earlier this month that shows both glycemic and weight loss control data for people taking Bydureon for the past four years. Those were the people taking the drug in the clinical trials leading up to the U.S. Food and Drug Administration’s approval at the beginning of this year, as I wrote here in “Bydureon Approved Today.”

Bydureon is the latest in a new class of drugs called GLP-1 receptor agonists. Its generic name is exenatide, and it has the same active ingredient as Byetta, which we have been able to get since June 2005 and requires twice-daily shots.

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Who Reverses Diabetes with Bariatric Surgery

July 23rd, 2012 · 4 Comments

People who have diabetes and are severely overweight are deciding more and more often that bariatric surgery is just the thing for them. Although it is expensive and like any surgery it can have complications, the amount of weight that they lose is usually dramatic and their diabetes often completely disappears.

Some people, including a couple of my friends, have had wonderful results from bariatric surgery. But not everybody benefits.

If you are morbidly obese, I’m sure that you have considering bariatric surgery. But how can you tell what the chances are that it will work for you?

A study presented yesterday at the annual meeting of the American Society for Metabolic and Bariatric Surgery can help you decide. Richard A. Perugini, M.D., a bariatric surgeon at the University of Massachusetts Medical Center in Worcester, was the lead study author and presented the findings of his team at the annual meeting. The abstract of the study, “Predictors for Remission of Type 2 Diabetes Mellitus Following Roux En Y Gastric Bypass,” is online.

Graphic of a Roux-en-Y gastric bypass connection
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Metformin Forever

May 30th, 2012 · 16 Comments

Metformin controls the insulin resistance of people who have type 2 diabetes so well that, if possible, all of us should be taking it. That’s what Roderic Crist, M.D., told me at the annual convention of the American Society of Bariatric Physicians in Denver this weekend. Dr. Crist specializes in family medicine in Cape Girardeau, Missouri.

“Not everybody can take every drug,” he added, when I followed up our conversation by calling him at his office after he returned home. “But most of the time people can take metformin if they take it carefully.”

Doctors increasingly prescribe it not only for type 2 diabetes but also for insulin resistance, polycystic ovary syndrome, and non-alcoholic fatty liver disease.

Roughly one-third of Dr. Crist’s patients have diabetes. Well over half, if not two-thirds of the people he sees are insulin resistant.

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Bydureon Approved Today

February 28th, 2012 · No Comments

Today we have the biggest diabetes drug news in 90 years. The U.S. Food and Drug Administration finally approved Bydureon, extended release exenatide.

Now people with type 2 diabetes can take just one shot a week. This single weekly injection will help millions of us manage our diabetes better.

We already know that Bydureon has a significant side effect. Weight loss.

We know that because Bydureon is the extended release version of Byetta, which millions of people have already successfully used to manage their diabetes and reduce their weight. I was one of them.

I used Byetta from February 6, 2006 until December 5, 2007. That’s 22 months.

When I started my twice-daily injections of Byetta my A1C was already pretty good, 6.2. But I was able to reduce my level to 5.3 before I stopped taking it.

That alone would have been enough to make me happy. But what Byetta did to my weight changed my life. The day that I started taking it I weighed 312 pounds and my waist was 58 inches. Twenty-two months later my weight was down to 168 pounds. Unfortunately, I can’t find what my waist measurement was at that time.

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No Diabetes Supplement like Noni

January 13th, 2012 · 6 Comments

When the captain of the skiff who took me snorkeling off South Water Caye, an island of Belize in the Caribbean Sea on Thanksgiving Day, told me about the benefits to people with diabetes of a local fruit, I listened. While I was theoretically on vacation, I always think about my diabetes and how I can help other people who have this disease.

The captain, Ismael Usher, said that his grandmother had diabetes and managed it by drinking the juice of the noni tree. After we got back to the island, he picked a noni fruit from a tree there and gave it to me.

I Study the Fruit of the Noni Tree after Snorkeling
Noni was new to me, so I ate it. It didn’t taste good. But I expected that after trying several other traditional remedies, like bitter melon and gymnema sylvestra.

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Posted in: Medication

Diabetes Without Drugs

October 11th, 2011 · 5 Comments

All drugs have side effects, some worse than others. Yet one of the cornerstones of diabetes management along with diet, weight control, and exercise, is to take insulin or one of the many diabetes medications that our doctors routinely prescribe.

People with type 1 diabetes have no choice. They have to take insulin. But the great majority of us have type 2 and mostly take one or two or even three different pills for our condition.

Some of these pills are clearly safer than others. For example, none of us take Rezulin any more, now that it killed at least 63 people. That was a dozen years ago so I wouldn’t be surprised if you forgot about Rezulin or never heard of it, but half a million of us were using it when the U.S. Food and Drug Administration recalled it.

Six years later Avandia became even bigger than Rezulin, earning GlaxoSmithKline $2.5 billion that year. Not so many of us take Avandia now that studies show that it raises the risk of heart attack by 43 percent.

Recently, yet another diabetes drug, Actos, seems to be life-threatening. Already banned in parts of Europe because it may cause bladder cancer, the FDA says that doctors should be cautious when telling us to take Actos. “The benefits of blood sugar control with pioglitazone,” it says, “should be weighed against the unknown risks for cancer recurrence.”

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Medicine Once a Month

August 12th, 2011 · No Comments

How would you like to manage your diabetes by taking your medicine just once a month?

You can’t do that yet. But that prospect is on the horizon.

While I seldom write about news that we can’t use at the moment, I think that this is such big news that many of you will want to know about it right now.

Only once before (if my memory serves me) have I ever written about a diabetes medicine that the U.S. Food and Drug Administration had not yet approved. That was in 2002 when I wrote about something then called Exendin-4 in my article “The Monster Drug.”

That monster drug, renamed exenatide — made from the venom of Gila monsters — became Byetta after the FDA approved it in 2005 as the first of a new class of drugs, GLP-1 agonists. Byetta became a monstrously successful medication for people with diabetes, including this writer. Full disclosure: I own some shares of stock in Amylin Inc., the company that developed Byetta.

When people take Byetta they inject it before breakfast and before dinner. That twice-a-day coverage isn’t quite as convenient as the second GLP-1 agonist, Victoza.

But when and if the FDA approves an extended release form of Byetta called Bydureon, taking it just once a week will be even more convenient.

Today’s news is about an even longer lasting form of exenatide. This is the biggest news announced at the 71st Scientific Sessions of the American Diabetes Association.

The ADA’s annual meeting is always the biggest diabetes gathering in the world. This year more than 17,500 people, including 14,000 scientists, physicians, and other health care professionals — plus a few regular people and some journalists like me — are meeting in San Diego, California, from June 24 to June 28.

The amount of information presented is staggering. I am making my way through more than 2,000 abstracts and more than 1,600 posters. But they seem to save the biggest news for what they call “Late-Breaking Posters,” some 131 in all. These posters got posted today.

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Posted in: Medication

Comparing Type II Diabetes Pills: Metformin and the Insulin Secretagogues

May 17th, 2011 · 2 Comments

When people with type 2 diabetes could take a pill instead of insulin to help us control our diabetes, smiles must have appeared on many faces. The pill was tolbutamide, and in the mid-1950s it became the first of the sulfonylurea class of drugs.

But that was more than half a century ago. Meanwhile, we now have choices of pills we can use. In fact, we now have nine other classes of oral diabetes medication plus several combinations.

The sulfonylureas force the beta cells in the pancreas to pump out the insulin that our body makes there. That’s why we call these drugs insulin secretagogues. For years many of us have been concerned that they will eventually burn out whatever beta cells we have left.

About a dozen years ago I voiced this suspicion to Edward S. Horton, who was then the director of clinical research at the Joslin Diabetes Center in Boston. In reply he told me that we have no evidence for this belief.

“You are not whipping the beta cells to death,” he said. “There is evidence that the beta cells do fail gradually over time. But there is no evidence that drugs hasten the process. I know that it is a popular conception that people have, but it is not true.”

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Posted in: Medication