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New Drugs For Type 2 Diabetes: Second-line Therapy — Recommendations Report

New Drugs For Type 2 Diabetes: Second-line Therapy — Recommendations Report

PRINT PDF Background CADTH previously completed an Optimal Use Report in 2010 and a subsequent update in 2013 on drug therapies for second- and third-line treatment of type 2 diabetes. Since 2013, several new drugs and a new medication class (sodium-glucose cotransporter-2 [SGLT-2] inhibitors) have been released on the market in Canada. During the same period, CADTH Common Drug Review has provided multiple recommendations in technology assessments of individual drugs for type 2 diabetes. Given the evolving landscape of the treatment of type 2 diabetes, an update of the previous review has been undertaken. This document provides the draft recommendations for second-line drug treatments for type 2 diabetes based on this update. Table 1: Drugs Included in the Clinical Review Drug Class Drugs DPP-4 inhibitor Alogliptin; Alogliptin/metformin Linagliptin; Linagliptin/metformin Saxagliptin; Saxagliptin/metformin Sitagliptin; Sitagliptin/metformin SGLT-2 inhibitor Canagliflozin; Canagliflozin/metformin Dapagliflozin; Dapagliflozin/metformin Empagliflozin; Empagliflozin/metformin Sulfonylurea Chlorpropamide Gliclazide Glimepiride Glyburide Tolbutamide Thiazolidinedione Pioglitazone Rosiglitazone Meglitinide Nateglinide Repaglinide Alpha-glucosidase inhibitor Acarbose GLP-1 analogue Dulaglutide Exenatide Exenatide extended-release Liraglutide Albiglutide Bolus insulin Insulin aspart Insulin glulisine Insulin lispro Insulin, regular Insulin, pork Basal insulin Insulin, NPH Insulin, pork Insulin detemir Insulin glargine Biphasic insulin Insulin regular/insulin, NPH Insulin lispro/lispro protamine Insulin aspart/aspart protamine DPP-4 = dipeptidyl peptidase-4 inhibitor; GLP-1 = glucagon-like peptide-1; NPH = neutral protamine Hagedorn; SGLT-2 = sodium-glucose cotransporter-2. CADTH Continue reading >>

Government Of Canada And Jdrf Invest $7.7m In Type 1 Diabetes Care And Treatments

Government Of Canada And Jdrf Invest $7.7m In Type 1 Diabetes Care And Treatments

Government of Canada and JDRF invest $7.7M in type 1 diabetes care and treatments Government of Canada and JDRF invest $7.7M in type 1 diabetes care and treatments Toronto, ON, May 3, 2018 Sonia Sidhu, Member of Parliament for Brampton South, and Chair of the All-Party Caucus on Diabetes, on behalf of the Honourable Ginette Petitpas Taylor, Minister of Health, highlighted an investment of $7.7M in type 1 diabetes research. This funding will support the clinical trials of ground-breaking therapies in order to accelerate the development of new treatments for people living with type 1 diabetes. There are more than 300,000 Canadians living with type 1 diabetes. People with type 1 diabetes must inject themselves with insulin several times per day to keep their blood glucose levels normal, and despite their best efforts, they can sometimes experience serious complications. There is no cure. JDRF is focused on launching and sustaining innovative research and clinical trials that will result in new treatments to improve the health and quality of life of the over 300,000 Canadians affected by this disease, says Dave Prowten, President and CEO of JDRF Canada. By supporting talented scientists in the field, we are working together and laying the foundation for a future without type 1 diabetes. Dr. Rmi Rabasa-Lhoret, from the Institut de recherches cliniques de Montral, will study how Quebec teens and adults can improve control of their blood glucose levels by participating in an online educational program. He will also create a patient registry to evaluate the effectiveness of wearable devices for preventing complications from dangerously low blood sugar. Dr. Farid Mahmud, from The Hospital for Sick Children in Toronto, will test whether a new drug helps teens with type 1 diabete Continue reading >>

Potential New Diabetes Treatment Being Tested In Vancouver

Potential New Diabetes Treatment Being Tested In Vancouver

Potential new diabetes treatment being tested in Vancouver Jan 16, 2018 |For more information, contact Brian Kladko Note to news media:The researchers and a research participant will be available for interviews Tuesday, Jan. 16, from noon to 1 pm at the Diamond Health Care Centre, Vancouver General Hospital, 2775 Laurel St., Room 11177 (11th floor). The University of British Columbia and Vancouver Coastal Health are testing a possible diabetes cure that replaces a persons damaged pancreatic cells with new ones grown in the lab. The replacement cells are grown from embryonic stem cells. Researchers believe that if the new cells mature, multiply, and behave as hoped, recipients would be able to lessen or even eliminate their dependence on self-injected insulin. They might also be spared from having to continually monitor their blood sugar, usually by pricking their fingers several times a day. If these replacement cells restore a persons ability to produce their own insulin when needed, it would prevent dangerous episodes of low blood sugar and lessen the complications resulting from high blood sugar, such as blindness, heart attacks and kidney failure, said Dr. David Thompson, a principal investigator in the clinical trial, a UBC clinical assistant professor of endocrinology and medical director of the Vancouver General Hospital Diabetes Centre. Eventually, it might even free people from a lifetime of constantly checking their blood sugar and injecting themselves, transforming treatment of this disease into a more manageable condition. The trial could involve about 10 or more people in Vancouver with a severe form of type 1 diabetes, in which a persons immune system attacks the pancreas, degrading or eliminating its ability to produce insulin. A UBC-Vancouver Coastal He Continue reading >>

Type 2 Diabetes

Type 2 Diabetes

Type 2 diabetes is one of the fastest growing diseases in Canada with more than 60,000 new cases yearly. Nine out of ten people with diabetes have type 2 diabetes. The good news is that type 2 diabetes can be prevented or postponed by making healthy lifestyle choices. Diabetes is a lifelong condition where either your body does not produce enough insulin, or the body cannot use the insulin it produces. The body needs insulin in order to change the sugar from food into energy. If your body does not have insulin or cannot use it properly, the result is a high blood sugar (glucose) level. There are three main types of diabetes: Type 1, where the body makes little or no insulin. Type 2, where the body makes insulin but cannot use it properly. Gestational diabetes, where the body does not properly use insulin during pregnancy. This type of diabetes usually goes away after the baby is born. At the present, type 1 diabetes cannot be prevented, and people living with type 1 diabetes depend on insulin to stay alive. It is estimated that close to two million Canadian adults have diabetes. One third of these people are unaware that they have the disease. Diabetes is the seventh leading cause of death in Canada and the cost of diabetes is estimated to be up to $9 billion a year. Symptoms of type 2 diabetes The classic symptoms of diabetes (type 1 and type 2) are the following: fatigue; frequent urination; unusual thirst; and unexplained weight loss. In type 1 diabetes, the symptoms usually progress quickly and are often dramatic. In type 2 diabetes, symptoms are slower to progress. However, it is important to note that many people who have type 2 diabetes may have no symptoms. These people may find out they have type 2 diabetes when they go to the doctor for another, unrelated prob Continue reading >>

The Use Of Diabetes Drugs In Canadian Public Drug Plans

The Use Of Diabetes Drugs In Canadian Public Drug Plans

The Use of Diabetes Drugs in Canadian Public Drug Plans - Poster The cost of diabetes treatment has been rapidly increasing in Canada in recent years. While the growing prevalence of the disease is a contributing factor, more expensive treatments have been a major cost driver, especially given the uptake in new, higher-cost drugs. This study analyzes these issues from the perspective of Canadian public drug plans, and provides insight into the actual use of the newer and higher-cost diabetes drugs and their associated cost pressures. Results are presented for all public drug plans participating in NPDUIS : British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland and Labrador, and Health Canadas Non-Insured Health Benefits drug plan. This analysis will support policy decision makers and the health technology assessment community in determining the future impact of diabetes treatments on their plans. 1. While diabetes drugs account for a sizable and growing segment of the pharmaceutical market in Canada, these trends are even more pronounced in the public drug plans. With nearly $1.2 billion in sales, diabetes drugs represented 5.7% of the Canadian drug market in 2014/15. The corresponding share in the NPDUIS public drug plans was 8.4%. This represents a marked increase from the 5.1% share in 2010/11. This bar graph and accompanying table give the diabetes share of pharmaceutical expenditures from fiscal year 2010/11 to 2014/15. The bar graph has two entries for each year. The first gives the share of national retail sales as a percentage of pharmaceutical expenditures, and the second bar gives the share of the NPDUIS public plan costs. National retail sales: 2010/11, 3.8%; 2011/12, 4.2%; 2012/13, 4.7%; 20 Continue reading >>

Type 2 Diabetes

Type 2 Diabetes

Print Diagnosis To diagnose type 2 diabetes, you'll be given a: Glycated hemoglobin (A1C) test. This blood test indicates your average blood sugar level for the past two to three months. It measures the percentage of blood sugar attached to hemoglobin, the oxygen-carrying protein in red blood cells. The higher your blood sugar levels, the more hemoglobin you'll have with sugar attached. An A1C level of 6.5 percent or higher on two separate tests indicates you have diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. Normal levels are below 5.7 percent. If the A1C test isn't available, or if you have certain conditions — such as if you're pregnant or have an uncommon form of hemoglobin (known as a hemoglobin variant) — that can make the A1C test inaccurate, your doctor may use the following tests to diagnose diabetes: Random blood sugar test. A blood sample will be taken at a random time. Blood sugar values are expressed in milligrams per deciliter (mg/dL) or millimoles per liter (mmol/L). Regardless of when you last ate, a random blood sugar level of 200 mg/dL (11.1 mmol/L) or higher suggests diabetes, especially when coupled with any of the signs and symptoms of diabetes, such as frequent urination and extreme thirst. Fasting blood sugar test. A blood sample will be taken after an overnight fast. A fasting blood sugar level less than 100 mg/dL (5.6 mmol/L) is normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is considered prediabetes. If it's 126 mg/dL (7 mmol/L) or higher on two separate tests, you have diabetes. Oral glucose tolerance test. For this test, you fast overnight, and the fasting blood sugar level is measured. Then you drink a sugary liquid, and blood s Continue reading >>

Canadas Gift To The World: A Cure For Diabetes Mellitus

Canadas Gift To The World: A Cure For Diabetes Mellitus

A look at the past, the present, and the promising future of treating diabetes By Sunitha Chari, Biology and Life Science co-editor Think of some of your favourite foods: pizza, pasta, breador perhaps you have a sweet tooth and enjoy desserts and chocolates. Ever wondered why these foods are so appealing? The answer is sugar, particularly glucose , which acts as our cells fuel. It circulates through our bodies as blood sugar and is taken up by our cells to produce energy or stored for later use. Insulin is a hormone produced by the pancreas that regulates glucoses entry into the cells. Without insulin, glucose remains in the blood, resulting in high blood glucose levels (hyperglycemia). Excess glucose is expelled in the urine, but, over time, high blood glucose levels can give rise to a chronic condition known as diabetes . If untreated, diabetes can cause serious health complications including cardiovascular disease , blindness ( diabetic retinopathy ), kidney failure ( diabetic nephropathy ), and neurological damage ( diabetic neuropathy ), and can even lead to lower-limb amputations. There are two main types of diabetes. Type 1, or juvenile-onset diabetes , is an autoimmune disorder that destroys the insulin-secreting beta cells in the islets of Langerhans of the pancreas. It affects a minority of the diabetic patient population, but is the focus of most research, since in the absence of insulin produced by the body, patients rely on daily insulin injections, and managing the symptoms requires careful monitoring of blood glucose levels. Type 2, or adult-onset diabetes , is a more common condition caused when there is either insufficient insulin production or when the cells of the body are unable to use the insulin produced by the pancreas. In its early stages, type Continue reading >>

First-in-class Type 2 Diabetes Medication Approved In Canada

First-in-class Type 2 Diabetes Medication Approved In Canada

First-in-class type 2 diabetes medication approved in Canada INVOKANA offers a new approach to treatment TORONTO, May 26, 2014 /CNW/ - Janssen Inc. announced today that Health Canada has approved INVOKANA (canagliflozin), an oral, once-daily prescription treatment used to lower blood glucose (sugar) levels in adults with type 2 diabetes.1 INVOKANA belongs to a new class of medications called sodium glucose co-transporter 2 (SGLT2) inhibitors that offers a novel approach to treating diabetes by increasing the loss of glucose in the urine. Of the three million Canadians living with diabetes, 90 per cent have been diagnosed with type 2 diabetes.2 Despite the numerous treatment options available, approximately 50 per cent of patients don't reach the level of glucose control recommended by their doctor.3 "Living with diabetes can be extremely frustrating and discouraging," said Mississauga resident, Jatinder Bawa, who has lived with type 2 diabetes for 10 years. "While I have made some lifestyle changes to control my condition, there were times when I wasn't well-managed and it was hard to always stay motivated without seeing some signs of improvement." INVOKANA: A New Way of Treating Diabetes As glucose is filtered from the blood in the kidneys it is reabsorbed into the bloodstream. SGLT2 is an important transporter responsible for this reabsorption. INVOKANA selectively inhibits SGLT2 and as a result, promotes the loss of glucose in the urine, lowering blood sugar levels in adults with type 2 diabetes. "In clinical trials, INVOKANA had a great impact on patients by improving glycemic control, while reducing body weight and systolic blood pressure," said Dr. Ronald Goldenberg, endocrinologist, LMC Diabetes & Endocrinology. "INVOKANA was also associated with a low incidence Continue reading >>

Treatments & Medications

Treatments & Medications

Look for special events, expos, programs and services close to home or a mouse-click away. People with diabetes can expect to live active, independent and vital lives if they make a lifelong commitment to careful diabetes management. Education: Diabetes education is an important first step. All people with diabetes need to be informed about their condition. Physical activity: Regular physical activity helps your body lower blood glucose (sugar) levels, promotes weight loss, reduces stress and enhances overall fitness. Nutrition: What, when and how much you eat all play an important role in regulating blood sugar levels. Weight management: Maintaining a healthy weight is especially important in the management of type 2 diabetes. Medication: Type 1 diabetes is always treated with insulin. Type 2 diabetes is managed through physical activity and meal planning and may require medications and/or insulin to assist your body in controlling blood sugar more effectively. Stress management: Learning to reduce stress levels in day-to-day life can help people with diabetes better manage their condition. Blood pressure: High blood pressure can lead to eye disease, heart disease, stroke and kidney disease, so people with diabetes should try to maintain a blood pressure level below 130/80. To do this, you may need to change your eating and physical activity habits and/or take medication(s). Continue reading >>

Canada Am Highlights Closest Thing To Diabetes Cure

Canada Am Highlights Closest Thing To Diabetes Cure

Canada AM highlights closest thing to diabetes cure This morning on Canada AM, country music star George Canyon and David Prowten, president of Juvenile Diabetes Research Foundation (JDRF) talked about their great hopes for a new stem cell device that could free diabetics from daily insulin injections. Mr. Canyon, who has had type 1 diabetes since age 14, called the device the closest thing to a cure that I have ever seen This is going to change the lives of 300,000 type 1 diabetics in Canada. Mr. Prowten, holding up the four-centimetre-longdevice, described it as a big step forward. The Encaptra device, developed by a California-based biotechnology company called ViaCyte Inc. with help from the University of Albertas Dr. James Shapiro, has been featured in this space before. Dr. Shapiro received Health Canadas approval earlier this year to conduct a Phase1/2 clinical trial of thestem cell-derived islet replacement treatment for diabetes. Itinvolves inserting thedevice, which is loaded with pancreatic progenitor cells, under the patients skin where new blood vessels grow around it and the bodys immune system doesnt try to destroy it, enabling regulation of blood glucose levels. The Edmonton-based trial, supported by Alberta Innovates Health Solutions and JDRF, follows one ViaCyte began last year in San Diego. According to the Canada AM report , the first patient has now received the device. The early stage testing will be to see if the device is safe and is well tolerated. Within a year to 18 months scientists should learn if it actually works. If it does, Thiscould give me 10 to 12 months at a time of not really having diabetes, being able to go a day without testing, and taking insulin, Mr. Canyon said. This is Disney World, right here. The report showshow close Cana Continue reading >>

New Drug May Be 'next Big Thing' In Type 2 Diabetes Management

New Drug May Be 'next Big Thing' In Type 2 Diabetes Management

New drug may be 'next big thing' in type 2 diabetes management Type 2 diabetes is a chronic but common condition that usually requires medication to keep blood sugar levels stable. Issues and side effects of some oral hypoglycemic agents (such as glyburide) and insulin use include low blood sugar (hypoglycemia) which can be dangerous and also can lead to weight gain. Newer injectable drugs (GLP-1 agonists) used in combination with older oral hypoglycemic agents or insulin can help people with Type 2 diabetes avoid low blood sugar and weight gain. Diabetes is a very common chronic disease which is challenging to manage. In Canada, about 90% of people with this condition have type 2 diabetes, which occurs when the body does not effectively make, release or use insulin (1). Insulin is a hormone that helps the body convert sugar into energy. For people with type 2 diabetes, sugar can quickly build up in the blood and cause hyperglycemia (high blood sugar) which can lead to serious health problems, even death (1). While changes in diet and physical activity are the first strategies used to manage type 2 diabetes, many people also use medication oral hypoglycemic agents (such as metformin) or insulin to help control their blood sugar levels. People who take insulin must monitor their blood sugar levels regularly and give themselves injections of insulin, often several times a day, as instructed by their health care providers. For many people with diabetes, taking insulin is a vital part of their self-care routine. However its not without its shortcomings. For example if insulin levels are not carefully balanced with diet, people can experience hypoglycemia (low blood sugar) and weight gain (2). Thats why a relatively new type of injectable drug is getting a lot of attention. Continue reading >>

Type 2 Diabetes Can Be Reversed, Say Canadian Researchers

Type 2 Diabetes Can Be Reversed, Say Canadian Researchers

Adult-onset, or Type 2, diabetes has long been considered a chronic disease that lasts a lifetime, but Canadian researchers believe they may have found a way to actually reverse the disease, putting it into remission. “We used to think that diabetes is irreversible and a progressive disease,” study author Natalia McInnes told CTV News Channel. “This new research suggests that it’s possible to reverse it.” The research team, from McMaster University in Hamilton, Ont., says an aggressive combination of a low-calorie diet, consistent exercise and the addition of several diabetes medications appears to have reversed the disease in some patients. Type 2 diabetes is diagnosed when an individual's body is no longer able to properly use insulin -- the hormone that allows cells to absorb glucose in the blood. As a result, blood sugars build up and cells do not receive the energy they need. To test whether the condition can be reversed, researchers first studied 83 patients with Type 2 diabetes and broke them into three groups. Two of the groups received an intensive “metabolic intervention” in which they were provided with a personalized exercise plan, and a meal plan that reduced their daily calorie intake by 500 to 750 calories a day. They also received the oral diabetes medications metformin and acarbose to tightly manage their blood glucose levels, as well as insulin injections at bedtime to give their pancreases a rest to allow them to recuperate. One group underwent the program for eight weeks, while the other was treated intensively for sixteen weeks. They were then compared to a third, control group, who received standard blood sugar management advice and lifestyle advice from their usual healthcare provider. Three months later, 11 out of 27 participants in Continue reading >>

How New Research Hopes To One Day Manage Type 2 Diabetes Without Medication

How New Research Hopes To One Day Manage Type 2 Diabetes Without Medication

How new research hopes to one day manage Type 2 diabetes without medication How new research hopes to one day manage Type 2 diabetes without medication An experimental treatment for Type 2 diabetes, which aims to allow patients to manage their disease without taking medication, has entered its third round of clinical trials at St Joseph's Healthcare London. Researchers say the treatment 'resets' the disease, allowing patients to manage it without drugs Posted: Jan 03, 2018 5:03 PM ET | Last Updated: January 3 About 1 in 10 Ontarians suffer from diabetes and most treat by taking medications, such as daily injections of insulin. (Reed Saxon/The Associated Press) An experimental treatment for Type 2 diabetes, which aims to allow patients to manage their disease without taking medication, has entered its third round of clinical trials at St Joseph's Healthcare London. It means the program will be accepting new patients for the third time since it began in 2015. Doctor Irene Hramiak is an endocrinologistat St Joseph's Healthcare London and a researcher with the Lawson Research Institute who has been working on the exploratory treatment since the beginning. How the treatment works in a nutshell 0:17 Under normal circumstances, Type 2 diabetes is treated with insulin and doctors will add other drugs as the disease progresses andthe symptoms worsen. Under the experimental treatment, patients in the early stages of Type 2 diabetes are subjected to a new diet andexerciseregimen. Then they'regiven a combination of drugs to help bring their blood sugar levels back to near-normal levels, allowing the pancreas to rest and reset itself and hopefully put the disease into remission. "That's exactly what we're trying to do is to sort of do a reset, you know as you push your computer's r Continue reading >>

Stem Cell Implant Trial Aims To Reverse Type 1 Diabetes | Vancouver Sun

Stem Cell Implant Trial Aims To Reverse Type 1 Diabetes | Vancouver Sun

The device created by ViaCyte contains millions of cells in packets that are implanted under the skin, in hopes they will function like pancreatic cells. The Human Trial / PNG About 10 British Columbians with Type 1 diabetes will be surgically implanted with packets containing lab-grown cells that are coaxed into behaving like true insulin-producing pancreatic cells in hopes of reversing their disease. The first patient to receive the implants is keen to exchange his regime of daily pinprick blood tests and insulin injections for a handful of pills for immune suppression. My blood sugar can go down all day without my noticing, so Im always at risk for passing out among other health problems, said Joshua Robertson. The risks of immune suppression (medication) are well known and its no comparison. Joshua Robertson is a participant in a trial of a new treatment for Type 1 diabetes created by ViaCyte.UBC / PNG The trial follows a procedure that successfully cured mice with diabetes, pioneered byTimothy Kieffer at the University of B.C. After receiving implants of millions of stem cells, the mice were weaned from insulin over the course of several months. Lead investigator, UBC endocrinologist David Thompson called the new treatment the most promising he has ever worked on. If the goal is to allow people to stop taking insulin, this trial has the potential to do it, he said. Robertson was implanted last month with several packets smaller than a credit card each containing millions of immature pancreatic cells, grown from embryonic stem cells using a technique developed by the San Diego biotech firm ViaCyte. UBC and Vancouver Coastal Health are running the two-year trial supported by a $500,000 grant from Stem Cell Network of Canada. If the cells multiply and develop as hope Continue reading >>

Canadian Scientists To Test New Diabetes Treatment

Canadian Scientists To Test New Diabetes Treatment

Canadian scientists to test new diabetes treatment By Carmen Chai Senior National Online Journalist, Health Global News TORONTO Canadian doctors are the first in the world to test an innovative therapy that could change the face of diabetes treatment. Scientists at Mount Sinai Hospital in Toronto say that using insulin at the onset of diabetes could stop the disease in its tracks. Theyre putting their findings to the test in a landmark clinical study in which diabetes patients will receive insulin therapy for a week every few months to stave off the condition. The novel idea flips traditional therapy on its head right now, insulin is usually the last option in the course of treatment for patients. But at that point, the bodys ability to produce insulin is almost gone. Lead scientist Dr. Ravi Retnakaran, an endocrinologist at the hospital and University of Toronto professor, says that readers should compare the new therapy to getting a haircut. I liken the treatment to treating your hair you get a haircut every six to eight weeks. Were saying that perhaps we can treat diabetes this way. Give intensive insulin, improve beta cells, stop and let the person go on with their lives. Then three months later, treat them again for just one week, and then keep doing this, he told Global News. The therapy is called RESET IT or Remission Studies Evaluating Type 2 Diabetes Intermittent Insulin Therapy. Retnakaran is recruiting 150 patients for his study. They can be men or women between 30 and 80 years old who are no more than five years into their diabetes. The research will be conducted at Mount Sinai in Toronto, along with sites in London and Hamilton, Ont. The fundamental problem in diabetes is a defect in the cells in the pancreas that make insulin or a decrease of beta cells. Continue reading >>

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