Diabetes Treatment in the Future: Great Expectations

Oral agents and human insulins and analogues are the main treatments used for diabetes. With the growing epidemic of diabetes, the use of these treatments is expected to triple over the next 10 years.

This will be an expensive proposition costing about $20 billion for the medications alone in 2010. Thus, it remains important to prevent diabetes if possible.

Sales forecast for the global diabetes market

Source: IMS Therapy Forecaster

Oral agents: What's new?

TZDs (thiazolidenediones): These medications make insulin work more effectively and are theoretically beneficial at almost any stage of diabetes. These medications make insulin work more effectively and are theoretically beneficial at almost any stage of diabetes. These agents may preserve the Beta cells in the pancreas and may improve the overall response to oral agents. These medications may also have protective effects on blood vessels and prevent hardening of the arteries. New evidence suggests that these agents may lead to more frequent minor bone fractures in women. It is important for these women to have regular bone density testing.

Combinations: We now have access to pills that combine two medications into one tablet. This offers convenience and in some cases, some cost savings, one has to make sure that both medications are appropriate and safe.

Many of the combinations include an agent to stimulate the pancreas and the second agent to help the insulin work better.

Insulins: Several "designer" insulins are either fast acting or very slow acting, which makes it easier for those who need insulin to control their sugars at rest or at mealtimes. These include the rapid-acting insulin products Humalog®, Novolog®, and Apidra®; and the long-acting products Lantus® and Levemir®.

A number of pen-type devices have also been designed to make it easier for someone to take their insulin more accurately and conveniently.

The future

Practice: There will be an increase in the proportion of the population diagnosed with Type 2 diabetes and also a greater awareness of impaired glucose tolerance and dysmetabolic syndrome.

Dysmetabolic syndrome is perhaps the single biggest health care issue in North America and individuals with this syndrome are at high risk of diabetes and heart disease. Patients will be diagnosed much earlier and treated more aggressively to stop these conditions from developing.

New products

Byetta®: Byetta® (exenatide) was developed to improve glucose control in patients with type 2 diabetes who are not achieving target goals with current treatment regimens. It is administered by twice-daily subcutaneous injections. The US FDA approved Byetta in April 2005 for use in conjunction with other diabetes medications, but not as a stand-alone medicine.

Byetta’s active ingredient mimics a hormone found in the saliva of the poisonous Gila monster, the largest lizard native to North America, and the human gut polypeptide called glucagon-like peptide 1 (GLP-1). This substance decreases a person's appetite and slows down gastric emptying leading to weight loss. Moreover, it enhances the ability of the body to dispose of extra glucose in the blood stream after meals. Long-term, it may even promote new production of beta cells in the pancreas.

Symlin®: Symlin® (pramlintide acetate) is a synthetic version of human amylin, a hormone produced along with insulin by the beta cells in the pancreas. Symlin® has been studied for treatment in patients with type 1 diabetes or insulin-using type 2 diabetes. Patients inject it subcutaneously before meals. In March 2005, the US FDA approved its use only in conjunction with insulin injections.

New indications: The US FDA has approved Bristol-Myers Squibb's Glucophage® (metformin) for use in children. This is of particular importance with the increasing prevalence of Type 2 diabetes in children.

New drug class: Dipeptidyl Peptidase (DPP-4) Inhibitors: Januvia® (sitagliptin) was approved by the FDA in October 2006 for use in people with Type 2 diabetes. It can be used alone, with metformin or a thiazolidenediones, and is well tolerated. It is the first of a new type of drug to treat Type 2 diabetes. It helps the body respond to glucose from a meal by increasing insulin levels and adjusting other hormones. Another DDP-4 inhibitor may be approved in the near future. 

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