Category Archives: Drugs for Diabetes

DPP-4 Inhibitors Increase Risk of Pancreatitis

…although the risk of getting pancreatitis is pretty small in any case.

DPP-4 inhibitors are sometimes called gliptins. They’re used to treat type 2 diabetes.

From Diabetes Care:

“CONCLUSIONS Treatment with gliptins significantly increased the risk for acute pancreatitis in a combined analysis of three large controlled randomized trials.”

Source: Diabetes Care

Speaking of risk reduction, lower your risk of being prescribed a gliptin by reducing your carbohydrate consumption.

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I Told You So: Low-Carb Diets Help Control Diabetes

Reviewers at London Metropolitan University wondered if carbohydrate restriction was a legitimate approach to controlling diabetes. No surprise to me, they conclude that it is:

“A carbohydrate restricted diet can provide a safe and effective solution for improving diabetes management and should have a place within the diabetic guidelines. The diet was effective in reducing postprandial hyperglycemia and glycaemic variability resulting in low levels of glycaemia without the risk of hypoglycaemia. The ability of the diet to reduce the symptoms of dyslipidemia is of particular importance and when compared to the traditional low fat diet for weight loss, the low carbohydrate diet was comparable and in some instances better. There were significant reductions or cessation of diabetic medication reported throughout the literature alongside a reduction in the psychological aspects of living with a long-term disease. It is possible that the current dietary advice may actually accelerate beta cell exhaustion with elevated blood glucose diminishing the islet cells ability to produce insulin.”

Action Plan. But it’s expensive: $16.95.

low-carb mediterranean diet

Front cover of book

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FDA Says Jardiance Can Claim Cardiovascular Death Prevention 

Jardiance is a diabetes drug in the class called SGLT2 inhibitors.

How do they work? Our kidneys filter glucose (sugar) out of our bloodstream, then reabsorb that glucose back into the bloodstream. SGLT2 inhibitors impair that reabsorption process, allowing some glucose to be excreted in our urine. You could call it a diuretic effect. For example, an SGLT 2 inhibitor called dapagliflozin, at a dose of 10 mg/day, causes the urinary loss of 70 grams of glucose daily.

How drugs like this could prevent cardiovascular disease in type 2 diabetics is a mystery to me.

From MPT:

“The diabetes drug empagliflozin (Jardiance) may be marketed for prevention of cardiovascular death in patients with type 2 diabetes and co-existing cardiovascular disease, the FDA said Friday.

It’s the first such claim ever allowed for a diabetes drug.

Empagliflozin, first approved in 2014, is an inhibitor of the sodium-glucose co-transporter 2 (SGLT2) pathway, reducing blood glucose by causing it to be excreted in urine.Its benefit for cardiovascular risk reduction was demonstrated in the so-called EMPA-REG trial, results of which were reported in 2015.”

Source: Jardiance Wins CV Prevention Indication | Medpage Today

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Benefits of T2D Triple Therapy Hold Up Over Time

“Treating newly diagnosed diabetes patients upfront with metformin/pioglitazone/exenatide therapy appeared to lower blood glucose and reduce hypoglycemic events better than standard sequential therapy, researchers reported here.

After 36 months of treatment, patients who were treated with the combination had a HbA1c of 5.8% compared with an HbA1c of 6.71% if they were treated with metformin, had a sulfonylurea added on and, then had basal insulin added (P<0.0001), according to Muhammed Abdul-Ghani, MD, PhD, at the University of Texas Health Science Center at San Antonio, and colleagues, in a poster presentation at the European Association for the Study of Diabetes.”

Source: EASD: Benefits of T2D Triple Therapy Hold Up Over Time | Medpage Today

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Insulin cost in U.S. doubled between 2002-2013

This is NOT an insulin rig!

This is NOT an insulin rig!

You can’t blame inflation for the cost increase. I’m not sure the link below explains why.

If you’re worried about the cost of insulin, you can take action today to reduce your required dose: lose the excess weight, eat fewer carbohydrates, improve your insulin sensitivity with exercise.

From Reuters:

“The cost of the hormone insulin, one of the most important treatments for diabetes, rose nearly 200 percent between 2002 and 2013, according to a new study.

While other diabetes medications also increased in price, total spending on insulin in 2013 was greater than the combined spending on all those other drugs, researchers report in JAMA.

“The large increase in costs can largely be explained (by) much greater use of newer types of insulin known as analog insulins,” said senior author Philip Clarke, of the University of Melbourne in Australia. “While these drugs can be better for some patients, they are much more costly than the human insulin they replaced.”

Source: Insulin cost in U.S. more than doubles between 2002-2013 | Reuters

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MannKind Corporation Starts New Marketing Campaign for Afrezza (inhaled insulin)

I first wrote about inhaled insulin in 2014. I have yet to run across a patient using it. In fact, I thought it may have been taken off the market for a while. In any case, it’s back:

“MannKind Corporation (Nasdaq:MNKD) (TASE:MNKD) announced it is now distributing MannKind-branded Afrezza® (insulin human) Inhalation Powder directly to major wholesalers and that Afrezza is available by prescription from retail pharmacies nationwide.  The MannKind-branded product is associated with new National Drug Code (NDC) numbers, as noted in the table below. With distribution channels now stocked, the Company announced several key programs to promote access, adoption and adherence to Afrezza therapy.”

Source: MannKind Corporation – Mannkind Assumes Responsibility for Distribution of Afrezza® and Launches Patient Reimbursement and Adherence Support Programs

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Diabetes Drugs: SGLT2 Inhibitor May Improve Kidney Health

I’m not sure I believe this, but here ya go:

“A new class of diabetes drugs can protect kidney health in addition to lowering blood sugar levels, study results suggest.

The findings, published August 18 in the Journal of the American Society of Nephrology, investigated the renal effects of sodium-glucose cotransporter 2 (SGLT2) inhibitors, specifically canagliflozin, which reduce blood sugar by augmenting the excretion of glucose into urine.

“Since glycemic control is only modestly different between canagliflozin and glimepiride, our results suggest that potential kidney protective effects of canagliflozin may be unrelated to glycemic control,” the lead study author, Hiddo Lambers Heerspink, PhD, of the University Medical Center Groningen in the Netherlands, said in a statement.”

Source: New Diabetes Drugs May Also Improve Kidney Health | Medpage Today

PS: Even if these results are reproducible, remember that they may not apply to all drugs in the SGLT2 inhibitor class.

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