Story URL: http://news.medill.northwestern.edu/washington/news.aspx?id=106819
Story Retrieval Date: 5/25/2013 8:22:42 AM CST
WASHINGTON -- By the time Dana Metzger started college, she wanted an alternative to the daily insulin shots she’d been taking for 10 years.
Diagnosed with Type 1 diabetes at age 9, Metzger spent her life experimenting with different regimens before finding the insulin pump, a treatment that fit her busy lifestyle.
“Diabetes is like a 24-hour job for me,” said Metzger, 23, who works at a Maryland public relations firm. “It’s something I think about every second of my day.”
In America, 17.9 million diagnosed diabetics share Metzger’s plight—and that number is growing. Last month, the Centers for Disease Control announced that the rate of new diabetes cases nearly doubled over the last decade.
Given the staggering number of diabetics requiring care, the disease is a $225 billion per year industry. With so much money up for grabs, pharmaceutical companies are constantly researching the next great treatment.
But what do patients want?
Recently, diabetics have flocked to long-acting insulins and insulin pumps, two minimally invasive treatments that require less effort to administer than traditional methods.
Still, diabetics crave better treatments—treatments that might actually give them a shot at a normal life.
The possibility of living a normal life depends on how well a diabetes drug can mimic a functioning pancreas, the problematic organ in a diabetic’s body. Diabetics can’t regulate their glucose levels because insulin, produced in the pancreas, is responsible for turning glucose into energy.
In Type 2 diabetes, often associated with old age and obesity, the diabetic’s body can’t use insulin properly, or the pancreas no longer produces insulin. Some Type 2 diabetics require insulin shots, but others get by relying on exercise, a healthy diet and oral medications.
Type 1 diabetics, on the other hand, must administer insulin by injection or pump because their bodies destroy the cells that make insulin. Type 1, often called juvenile diabetes, is an autoimmune disease and cannot be cured.
Even while diabetics hope the future holds more inventive, non-invasive treatments—insulin sprays or inhalers—improvements in injection techniques over the past decade have proved a real boon.
“The methods deliveries we have are really phenomenal and do an excellent job of controlling diabetes,” American Diabetes Association spokesman Matt Petersen said.
Sick of injecting themselves several times a day, many diabetics have turned to Lantus and at least one other once-daily, 24-hour insulin. Lantus provides the body with a constant stream of medication instead of causing the uncomfortable insulin spikes characteristic of other drugs.
Before switching to the insulin pump, Dana Metzger used Lantus. She took it every morning to achieve a stable baseline level of glucose. Even so, Lantus takers must administer additional injections before meals to control increases in blood sugar caused by eating.
Like any medication, Lantus isn’t perfect.
Metzger sometimes found it hard to control her blood sugar, explaining that “the insulin you take at 9 a.m.” won’t work “the same at midnight.” Other doctors and diabetics express the same concern.
When a patient does gripe about Lantus’ drawbacks, Dr. Zachary Bloomgarden often recommends the insulin pump.
“It has been a very important, useful way of treating diabetes,” said Bloomgarden, a New York endocrinologist. “For a Type 2 who has tremendous degree of variability in their blood sugar responses to insulin, it’s really helpful for micromanaging.”
Different pumps range from $5,000 to $8,000, but the set-up is similar: a small cartridge of insulin, fastened to a bra or waistband, is attached to a tube; the tube is connected to a needle that continuously sits under the skin; based on dosages set by the diabetic, the pump discharges insulin into the patient’s body automatically.
“Although the pump can be cumbersome, it’s the best treatment option because it allows me to get the tightest control,” Metzger said.
Like many diabetics, Metzger’s blood sugar is higher between noon and 2 p.m., so she programs the pump to inject more insulin into her system during those hours. With other treatments, she would have to take time out of her day to administer injections.
Despite these less painful and easier to use delivery technologies such as Lantus and the pump, some diabetics would prefer to break from injections altogether.
Generex Biotechonology Corp., a Canadian research and development firm, is testing an oral insulin spray called Oral-lyn. Unlike non-invasive, inhaled treatments that enter the lungs, Oral-lyn is absorbed through the lining of the mouth and goes directly into the bloodstream.
Although Generex plans to market the product to all sufferers, it’s ideal for children and needle-phobic diabetics.
“We’re the right product at the right time for the patients,” Generex spokesman William Abajian said.
But not everyone’s convinced.
Andrew Mandell, executive director of the Defeat Diabetes Foundation, has never seen Oral-lyn but voiced concern about whether patients can control their dosing with an oral spray. A similar treatment, Exubera, an inhaled insulin produced by Pfizer Inc., was pulled from the market after one year because it was unpopular among patients.
But Generex said Oral-lyn’s technology allows for regulated dosing by way of a valve that controls output. Abajian added that three phases of FDA trials have demonstrated “from spray to spray, patient to patient…the dose is absolutely consistent.”
Still, with any new treatment, even a possible “miracle drug,” Mandell recommends that patients wait “five years for the medication to prove itself to be valuable or not.”
Diabetics might prefer to try new drugs as soon as possible, but years of trial and error have proved that it’s not easy to determine what works best. The next break-through treatment could be the long-awaited miracle drug, or could be pulled from the market faster than it appeared.