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This month along with medical updates, we will begin to bring you information on new glucometers and insulin supply systems. We will continue to try to keep our readers up to date on new medications and breakthroughs, as well as answering your questions about what is on the horizon.
We get a great many questions about new insulin delivery equipment and asking us what is coming down the road in blood glucose monitoring and testing. When we note something new, we will contact the manufacturer and forward the information to you. Remember, please, that this is publicity information supplied by the manufacturer and should not to be considered an endorsement by Diabetic-Lifestyle Online Magazine, or its owners and staff. Thanks for your input and please continue to ask. We will report our findings.
First, late-breaking news:
San Carlos, CA, June 16, 1998 -- Inhale Therapeutic Systems today announced the results of three-month clinical trials with 121 outpatients conducted by its collaborator Pfizer, Inc. on the effectiveness of insulin absorbed into the body by inhalation. As announced at the American Diabetes Association meeting in Chicago, the new insulin delivery system is still in the testing stage. A Pfizer spokesperson said there is optimistic hope that the system may one day become available worldwide. Roughly the size of a large flashlight, the new system is an inhaler which delivers insulin in dry powder form by mouth. The device is limited to Regular insulin at this time. It is not known if Humalog, which is one sixth the size of Regular hexamer and has a very different protein structure, can be delivered in the same way.
Although inhaled insulin might not completely replace injections, the two studies so far suggest diabetics who are taking two to three injections per day might be able to reduce their injections to once daily.
Type 1 diabetics and persons with Type 2 diabetes using Regular insulin who are interested in participating in Phase 3 trials of inhaled insulin pumps should call Pfizer Inc. at 1-800-438-1985. Persons outside of the United States should send their inquiries to Pfizer Inc. Medical Information, 235 East 42nd, New York, NY 10017. In the future, the feasibility of pediatric use of a modified-dosage system will be studied.
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A news release was received from the Bayer Diagnostics Division for release in the United States only. The DEX Blood Glucose Monitoring System represents a revolution in convenience because it is American’s first no-strip meter. The company sees testing convenience as a vital factor in patient compliance and therefore, the DEX system is expected to make a major contribution to improved patient self-management and better control of diabetes.
Cartridge Convenience: Instead of having to insert and discard a test strip each time they test, the diabetic will simply insert a circular-shaped test-sensor cartridge which is good for 10 tests. This means less handling and greater ease of use. The DEX system will free people from having to carry test strips during the day, or overnight. In addition, the cartridge calibrates the meter for all 10 tests. This eliminates the risk of error.
Easing the pain and inconvenience of testing: The new system uses the smallest blood drop required by any monitor, so it is less painful to obtain a sample for testing. The test sensor actively draws up just the amount needed which means no more applying and smearing of hanging drops of blood. It virtually eliminates the need for retesting as a result of the blood sample being too small. Test results are displayed in 30 seconds.
Flexible data management capacity: The DEX system is flexible: it can store up to 100 test results and can download directly into a personal computer and then be faxed or e-mailed to a health care professional. Using the WinGlucofacts Software, the DEX Meter results can be transformed into easy-to-understand computer graphics. The Bayer Corporation can be visited on the Web at http://www.bayerdiag.com/. Their phone number is (914) 631-8000 or FAX: (914) 534-2132.
More next month.
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The Associated Press reported on an article in the New England Journal of Medicine based on a study of 1.34 million residents of Ontario, Canada, and the medications that were prescribed to them. The article indicates that secondary diseases are often untreated in chronic patients. Of interest to us is that one of the three chronic diseases examined is diabetes. Women with diabetes were found to be 60% less likely than those without it to be given estrogen, which helps prevent osteoporosis and heart disease. Dr. Frank Vinicor, Director of Diabetes Research at the U.S. Centers for Disease Control and Prevention, was not surprised by the findings. He stated that managed care has resulted in shorter patient visits and that there are new treatments for diabetes which were not accounted for in the study. He did think that doctors spend what time they have with diabetes-related issues and have less time to deal with unrelated chronic problems which could be effectively treated. The researchers could not determine whether doctors failed to diagnosis these secondary conditions or didn’t treat them because of side effects of medications, drug interactions, or patient resistance.
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Insulin Lispro: A Fast-Acting Insulin Analog, by Nobel, SL et al in American Family Physician, January, 1998, 57(2): 1790806, 289-9-92 discusses the new insulin analog, Lispro, and how it differs from Regular human insulin for the treatment of type 1 diabetes. Compared with Regular insulin, the analog offers faster subcutaneous absorption, an earlier and greater insulin peak, and a more rapid postpeak decrease. It begins to exert its effects within 15 minutes of administration, and peaks 30 to 90 minutes after. Duration of activity is less than 5 hours. Rates of insulin allergy, lipodystrophy, hypoglycemia, and abnormal results are essentially the same in patients using Lispro and in those using regular human insulin.
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Diabetes Mellitus and Cardiovascular Disease in Women, Sowers, JR in Archives of Internal Medicine (1998, Mar23) 158 (6): 617-21. Coronary Heart Disease (CHD) is the leading cause of morbidity and mortality in women in the United States. Although CHD is less common in premenopausal women than in men, this difference begins to disappear after the onset of menopause, presumably related to reduced levels of female sex hormones. Results: An association between both postmenopausal increase in blood pressure and CHD that coincidence with loss of ovarian function suggests that estrogen and/or progesterone may be protective against hypertension and CHD. Diabetes removes the normal sex differences in the prevalence of CHD. Indicated mortality in women with CHD and diabetes compared with women without diabetes has been observed in epidemiological studies. Conclusions: Diabetes appears to obviate the protective effects of female sex hormones. The paper ends with a discussion of why this occurs and further research possibilities
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The American Heart Association stated on June 1, 1998 that obesity is a "major risk" factor in heart attacks, adding it to a list that includes smoking, high blood pressure, high cholesterol, and a sedentary lifestyle. This step has been taken because recent studies have found that an increasing number of Americans are becoming and remaining obese. The study which was published in the journal Science last month found that 54% of U.S. adults and 25% of U.S. children are overweight to a point of being unhealthy. The associations states that obesity is a chronic disease just like hypertension or high cholesterol. Robert Eckel, vice chairman of the heart association’s Nutrition Committee, said that studies have shown that gradual weight losses of between 5 and 10% of body weight can decrease blood pressure and cholesterol counts. The heart association is seeking funding for research on obesity. It also wants health care providers to launch an information campaign to stress the need for physical activity and a healthy diet.
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The Sulfonylurea Controversy: More Questions from the Heart, by Brady, PA and Terzic, A. in the Journal of American Cardiology (1998 Apr) 32 (5): 950-6 is a challenging article which explains the association between myocardial schema and infarction with substantially increased morbidity and mortality among patients with diabetes. Although many factors contribute to the increase in morbidity and mortality in patients with type 2 diabetes, one contributor may be the use of sulfonylurea drugs, the most widely used oral hypoglycemic agents. Such a possibility, which first arose over 25 years ago when it was observed that patients taking sulfonylurea drugs had increased cardiovascular mortality, has resurfaced after the discovery that sulfonylureas act by inhibiting adenosine triphosphate (ATP)-sensitive potassium channels. In the pancreas, inhibition of ATP-sensitive potassium channels induces the release of insulin; but in the heart, inhibition of these channels prevents schemic preconditioning, an endogenous cardioprotective mechanism that protects the heart from lethal injury. This review outlines the current understanding of the molecular pharacodynamics of sulfonylurea drugs and discusses the potential clinical consequences of inhibition of ACT-sensitive potassium channels in the heart of diabetic patients with cardiac disease in whom the use of sulfonylureaas may be harmful.
From our Mail:
The public relations people at Knoll Pharmaceutical Company have sent us the prospective on their new medication, Meridia, which they say is indicated for the management of obesity, including weight loss and maintenance of weight loss. It should be used in conjunction with a reduced calorie diet and is recommended for obese people with a Body Weight Mass of greater than 30 or a Body Weight Mass of greater than 27 in the presence of other risk factors such as hypertension, diabetes, and dyslpidemia. It is the first neurotransmitter uptake inhibitor to be used for weight reduction, however, drugs in this class have been used for years in other areas, such as Prozac for depression. The drug company reports no incidents of pulmonary hypertension in clinical studies. There was no increased incidence of valvular heart disease versus placebo in the treatment time of 7.6 months.
The medication is taken once a day and produced beneficial changes in serum lipids consistent with weight loss according to the manufacturer. Side effects to note are a published increase in blood pressure in some patients so that regular monitoring of blood pressure is required when prescribing Meridia. It should not be taken with MAO inhibitors which are given for depression, Parkinson’s disease, and some other diseases. It should not be taken with other weight loss products that act on the brain or over the counter and herbal products. Caution is noted for those with coronary artery disease, severe liver or kidney disease, or those who have had a stroke, have anorexia, take anti-depressants, are pregnant, or take any medication that regulates serotenin. For more information, contact your physician or Knoll Pharmaceutical Company at 3000 Continental Drive-North, Mount Olive, New Jersey 07828-1234.
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