Merck's Diabetes Franchise And The Perils In Proving A Drug's Medical Value

Merck’s Januvia (sitagliptin) and its metformin combination, Janumet, are important drugs for type 2 diabetes patients as well as for Merck’s bottom line. These drugs, which are DPP-4 inhibitors, account for more than $6 billion in sales for this drug giant. Given the growing incidence of obesity and type 2 diabetes in the world, this franchise is poised for continued growth.
However, Merck has competition in this field with a number of other drug companies, a notable one being Eli Lilly. Lilly has a variety of products for diabetics, including Jardiance (empagliflozin), a drug that acts by blocking SGLT2. (Lilly co-developed Jardiance with Boehringer Ingelheim.) Both Januvia and Jardiance lower high blood sugar, the cause of the downstream consequences of diabetes such as heart disease, kidney failure, blindness and amputations. However, just because a drug lowers blood sugar doesn’t ensure that it will reduce the ultimate complications of diabetes. Nevertheless, over the years diabetes drugs have been approved on the basis of blood sugar lowering alone.
However, last December, Lilly raised the bar for oral diabetes drugs with the acceptance by the FDA of its data showing that Jardiance not only lowered blood sugar but, in doing so, also reduced cardiovascular events in diabetic patients with heart disease. These data were generated in a trial known as the EMPA-REG OUTCOME trial. Last December, the FDA effectively blessed this work and allowed Lilly to add the cardiovascular outcome benefit to the Jardiance label. This was a big advantage to Lilly because its sales r Continue reading

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The Uniquely Dangerous Eating Disorder Symptom in Type 1 Diabetes

Eating disorders in type 1 diabetes (T1DM) are rarely understood or recognized outside the T1DM patient and medical community. In fact, there is still a lack of awareness even inside of the world of T1DM. Despite this reality, girls and women with T1DM are close to 2.5 times more likely to develop eating disorders than those who do not have diabetes. This is a serious women’s health problem in diabetes, and it is associated with severe medical consequences.
Eating disorders in T1DM often involve a uniquely dangerous symptom – namely insulin restriction as a means of calorie purging. It is important to note that not all people with T1DM and eating disorders restrict insulin; however, the large majority of research in this area has focused on this particular eating disorder symptom. The media and lay public use the term “Diabulimia,” when referring to an eating disorder involving insulin restriction. When insulin doses are skipped or under-dosed, blood glucose levels rise, and the body attempts to excrete that glucose in the urine and thereby loses or purges calories.
Insulin restriction can lead to rapid and dramatic weight loss but also increases the risk of both acute and long-term T1DM complications and even an increased risk of death. We do not yet definitively know if there are identifiable factors that increase eating disorder risk at diabetes diagnosis or throughout the duration of T1DM. Most importantly, even less is understood about effective treatments for eating disorders in the context of T1DM.
Treatment guidelines have been created based on expert clinic Continue reading

Parenting Your Teen with Type 1 Diabetes

By Nicole Kofman and Ashley Dartnell
Twitter summary: Teenagers + type 1 diabetes = a challenge! Tips from #CWDFFL15 & a parent
For most families, “‘adolescence is second only to infancy’ in terms of the upheaval it generates” within a household. Add managing type 1 diabetes into the mix, and things can get complicated. For parents, it can be daunting to balance giving teens space to grow and monitoring a 24/7 condition as dangerous as type 1 diabetes.
At CWD’s Friends For Life conference in July, Dr. Jill Weissberg-Benchell and CDEs Natalie Bellini and Marissa Town led a workshop called “Parenting Your Teen with Type 1.” There, they elicited an impressive list of diabetes-specific concerns that parents have regarding their teens, including but not limited to:
How can they have the peace of mind of knowing their child is reasonably within range without being a helicopter parent?
What will happen when their teen begins to drive and could have a low?
How do growth hormones interact with insulin and affect blood sugar?
How will alcohol affect diabetes management?
What additional steps do people with type 1 diabetes need to take to be prepared for college entrance exams?
All that – on top of keeping up with schoolwork and extracurricular activities! We learned some great tips from the experts and parents at this workshop. Plus, we sat down with Ashley Dartnell, a parent of one of diaTribe’s summer associates who has type 1 diabetes, to learn more about her personal experience parenting a teen with type 1 and to gain a unique perspective outside of what we lear Continue reading

The fast answer to beating type 2 diabetes

More than 29 million people in the U.S. have diabetes and another 86 million adults (more than one in three) are pre-diabetic.
And according to the CDC, 15 to 30 percent of those people with prediabetes will develop type 2 diabetes within five years without major lifestyle changes.
Even worse, the percentage of people developing diabetes has continued to rise year over year for the last 50 years thanks to our increasingly sedentary lifestyles and the low-fat food trend that upped the amount of blood sugar-elevating carbs in the American diet.
If you are one of the more than 100 million Americans who either suffers from diabetes or has blood sugar problems, changing your diet the best place to start.
Eating more vegetables, fiber and fish are all parts of the “Diabetes Diet” as well as avoiding sugar and processed foods.
While those are all good things, there is a simple dietary trick that most doctors completely neglect in helping patients avoid Type 2 diabetes…
Fasting and your blood sugar
Fasting is reducing or completely eliminating the consumption of food or drink for a certain amount of time.
Studies have shown fasting may improve pancreatic function, improve your insulin levels and your insulin sensitivity, enhance metabolism and weight loss, improve body composition and prevent and even reverse type 2 diabetes.
There are a number of ways to achieve the blood sugar control benefits delivered by fasting and you can choose the method that works best for you…
#1 – Alternating days
In this model of intermittent fasting, you alternate days of normal calorie consu Continue reading

7 Ways to Stop the Progression of Prediabetes into Diabetes

Not only is diabetes a huge health threat, but millions of Americans are already struggling with the condition also.
But prediabetes is something that people sadly take for granted.
Not only is it a sign of diabetes development, but it is also a sign that you can help your system to prevent actually getting diabetes.
An estimated number of 37 million Americans experience symptoms of prediabetes.
A more alarming number is the number 87, which indicates the 86 million of Americans that have a prediabetes diagnosis already.
A number of 471 million people globally is the expected estimate of people with prediabetes by 2035.
What Is Prediabetes?
Prediabetes is the condition that has an elevated blood sugar level, and the percentage is right under the scale of the diagnosis for diabetes.
Basically, before a person develops diabetes type II, they become prediabetic.
Having prediabetes puts you at a risk a lot higher than normal people for developing cardiovascular diseases, as well as diabetes type II.
Even though there are rare and clear symptoms of prediabetes, if you get checked, and your levels are the following:
Fasting blood glucose: 100 to 125 mg/dl
A two-hour blood glucose: 140 mg/dl – 199 mg/dl
A1C: 5.7% – 6.4%
You unfortunately most likely have prediabetes.
However, some cases experience diabetic symptoms, but are actually prediabetic.
Feeling abnormally thirsty, abnormally urinating, and feeling fatigues are some of the symptoms prediabetics also might experience.
Prediabetes Risk-Factors
The older you get, the risk of developing prediabetes gets higher and higher.
Continue reading