Diabetes News
Week of April 30, 2000 |
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New 24-Hour Smooth Action Insulin
People with diabetes soon will have access to a true basal
insulin that begins working in 2 to 4 hours and has the same
action, with no peaks or valleys, for the next 24 hours.
The pharmaceutical company Avantis has been given
FDA approval for a new long-acting insulin called Lantus (Insulin Glargine). This synthetic compound is
similar to the body's own insulin, but has been genetically
engineered by changing the order of the amino acids.
The new insulin will eliminate the inconvenience of multiple
injections of long-acting insulin but, more importantly, also
will eliminate the unpredictable action of current long-acting
insulin. This should enable users with Type 1 or Type
2 diabetes to have better glycemic control. People with Type 1 may use Lantus as their
long-acting insulin. For those with Type 2, Lantus may be taken
just once at bedtime, along with their regular oral medication.
The most common side-effects of the drug are hypoglycemia and
pain at the injection site. Although this insulin has a much
more predictable action time, it may also create some problems.
Because of its consistency, it becomes more important for users
to inject at a consistent time each day. For instance, someone
who take their injection at 7 a.m. on weekdays, but at 9 a.m. on
Saturday and Sunday, may find a gap in their insulin action and
higher blood sugars on Saturday morning, but a doubling of
insulin action over a couple of hours on Monday morning. Despite
or because of its consistent action, it may be used more safely
as a twice a day insulin.
The company plans to release Lantus in
September. Avantis encourages those who want their insurance providers to cover this drug
to begin lobbying immediately, as long delays in approval are
likely, as was seen with Humalog.
Clinton Responds To Drug Inflation
For older Americans living on a fixed income, the recent
trend in sky-rocketing prices of prescription drugs is
especially disheartening. President Clinton is responding to
this crisis by proposing that Medicare cover prescription drugs
for those who are 65 and older.
A study presented to Congress shows that drug prices have
increased at a rate greater than that of inflation, sometimes
two or three times greater. The study shows that the prices of
fifty prescription drugs commonly used by senior citizens rose
by 3.9% last year, compared to the 2.7% overall rate of
inflation. One particular drug used for diabetes, Glucophage,
rose in annual price from $661 to $708. Overall, drugs commonly used by
seniors have increased an average of 30% since 1994.
The study of drug prices was commissioned by the group
Families USA, which supports the idea of universal health care
for all Americans, and also supports Clinton's proposal.
The GOP strongly opposes Clinton's plan, and believes that
drug coverage should go to those with low incomes only, and not
to those who may already have coverage through their HMOs or
retirement plans. Republican leaders have created an alternative
plan, in which private health plans would offer drug benefits as
well as government subsidies to pay drug costs for those seniors
with low incomes. Clinton believes that this plan just doesn't
go far enough.
Poor Diabetes Care In The UK
Over half of the people with diabetes in the UK are not receiving
adequate care.
This is the finding of the UK Audit Commission, which recently completed a two-year
National Health Service study of 1,400 people with diabetes in
English and Welsh hospitals. They found that half the people
with diabetes still received care at hospitals, instead of
through a general practitioner familiar with the illness.
Furthermore, two-thirds of these hospitals had no
idea how many of their patients with diabetes had had full
health checks. Waiting times up to three months for
consultations were common, and two-fifths of general
practitioners had no referral guidelines for diabetes.
The Audit Commission recommends that health
authorities plan ahead for an increase in the number of people
diagnosed with diabetes, particularly Type 2. The commission
advises health authorities to improve early detection of the
disease through better doctor education. Diabetes is known to affect 3% of adults in the UK and
accounts for 9% of total hospital costs.
One of the specific problem in diabetes care in the UK
appears to be the very restricted use
of insulin
pumps. Although the UK was among the leaders in pump
technology and practice in the late 1970s and early 1980s, pump use has
never taken hold due to socialized medicine. A variety of early
pump problems were highlighted in an extensive study during that time, and medical interest in pumps declined. Health
authorities became reluctant to fund this treatment.
Currently, only 350 people in the UK use pumps, compared with
well
over 100,000 pumpers worldwide, and extensive use in Germany and
other European countries. Most of the pumpers in the UK do
receive funds through the Health Authority, but the common
practice of the Health Authority is to fund new pump users
restrictively, only when the pump is considered the "last
resort." Some pumpers complain that funds have been withdrawn, and defective pumps are not being replaced. Thus,
pumpers are forced to pay for their treatment themselves, or
discontinue use of the pump. Although there has lately been more
interest in pump therapy, funding problems are still the norm.
National standards on the treatment of diabetes are expected
to be released by the UK government in 2001.
Doxazosin Discontinued To Save
Hearts
Sometimes the risks of a drug are not
worth the benefits. Such is the case of doxazosin, sold under
the name Cardura, a high blood
pressure drug found to dramatically increase the rate of heart
failure.
Researchers behind a study on doxazosin have recently
published their results in The Journal of the American Medical
Association. The study showed that those taking doxazosin had a 25% increase in their risk of
combined cardiovascular problems, such as coronary heart
disease death, nonfatal heart attack, and stroke. Compared with
those who were taking the diuretic chlorthalidone, heart failure was
twice as common in those taking doxazosin. Stroke was 19% more
common, chest pain was 16% more common, and procedures like
angioplasty or bypass surgery were needed 15% more often.
The effectiveness of using doxazosin and chlorthalidone was also compared among
different groups. Results of the drugs held regardless of study
participants' age, ethnicity, and presence of diabetes.
Results of the study prompted researchers to discontinue the
doxasosin part of the ALLHAT (Antihypertensive and
Lipid-Lowering Treatment to Prevent Heart Attack Trial) before
the anticipated end date. JAMA, vol. 283, pgs. 1967-75, 2000.
Glucosamine Sulfate Worsens Insulin
Resistance
In recent years, it has become common practice to take
glucosamine sulfate to relieve the painful effects of
osteoarthritis. Now, a new study in Lancet, a British medical
journal, warns that people taking the
supplement need to be aware of an increased risk of insulin
resistance.
Researchers at the Los Angeles College of Chiropractic and
MetaResponse Sciences recently studied the effects of
glucosamine sulfate on fifteen people without diabetes. Each
participant was given the usual dose of 1500 milligrams of the
supplement or an inactive placebo for twelve weeks. At the end
of the study, researchers found that blood insulin levels had
increased in those taking glucosamine. Researchers project that the supplement would have even
greater effects on insulin resistance among people with Type 2
diabetes, but say more studies are needed.
Insulin resistance is linked not only to higher blood sugars
and more Type 2 diabetes, but also to high blood pressure, high
triglycerides, low HDL, and gout. People with Type 2 diabetes who are currently taking
glucosamine sulfate should inform their doctors of this
increased risk for insulin resistance and
monitor their blood sugar carefully for higher readings.
High Death Rates Among Australian Aborigines
In Australia, people who are Aborigines are
much more likely to die at a young age than white people in that
country.
The Australian Bureau of Statistics recently released some
very discouraging mortality data. The death rate of Aborigines
was found to be higher than that of whites in all age groups.
Deaths by suicide and preventable diseases were also much
higher. The bureau also reported that 53% of Aboriginal men die
before they reach 50, while only 13% of white men die by that
age.
In comparison, 41% of Aboriginal women die before they're 50,
and only 7% of white women do so.
There are currently 353,000 Aborigines living in Australia,
making up only 2.1% of the population. They comprise the poorest
and least healthy group, and have the shortest life span and
highest infant mortality rate. The most common causes of death
are heart disease, injury, respiratory disease, cancer, and
diabetes.
New Anti-Rejection Drug Transplants
Hope
Organ failure is a critical occurrence in many diseases, such
as diabetes, heart disease and others. Organ transplants have become a fairly common
way to deal with the problem, but transplants carry their own
problem. They are often rejected by
the body.
Isotechnika Inc. has recently developed a drug which may help
prevent the body from rejecting transplanted organs. This
immunosuppressive drug, called ISAtx247, has now been approved
by the FDA for human trials. These trials will be conducted
beginning in May through Covance Inc. of Madison, Wisconsin.
Similar trials will be conducted in Canada, through Phoenix Life
Sciences International in Montreal.
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