The object of adoration wasn't a movie star or even a person, but rather a diabetes drug called Byetta, which helps to lower blood sugar. The new drug sold nearly $100 million in the last three months, partly because of an intriguing side effect: It helps people lose weight.
"I saw a man crying because he couldn't get in," wrote Kelly Close, who attended the event earlier this summer and compiles Diabetes Close Up, an industry newsletter.
Diabetes care used to be dominated by insulin, which comes in long-, intermediate- or rapid-acting forms and must be injected daily.
But as the diabetes meeting showed, a cavalcade of new products is turning diabetes into something of a shopping experience.
More than a half-dozen new drugs are crowding pharmacists' shelves along with a handful of improved devices to monitor blood sugar or deliver insulin more efficiently.
Even the 84-year-old insulin treatment is trading in the needle for a sleek new inhaler; for the first time it can be breathed in as a powder in a product called Exubera.
More options for patients
While all the new treatments have flaws - nearly 40% of Byetta takers experience nausea, for instance - the products give patients with insurance options they haven't had before. Increasingly, doctors are turning to a mix-and-match of new and old treatments, looking for combinations that will hold blood sugar in check and stave off crippling complications and even death.
"If you look in the early 1990s, there was not much available," says Barry Goldstein, director of the division of Endocrinology, Diabetes and Metabolic Diseases at Thomas Jefferson University.
The potential market is so vast that even mediocre products can become successful. Diabetes has reached epidemic proportions in the United States, with an estimated 21 million patients, according to the diabetes association, and growing by 1 million every year.
One in every three people born in 2000 in this country will develop diabetes, the group predicts.
Most patients do not have their blood sugar under control, the group said, making diabetes the major cause of amputations in the U.S. If unchecked, the disease also causes heart disease, kidney failure, blindness, dental disease and sexual dysfunction. People with Type 2 diabetes are twice as likely to develop Alzheimer's disease, recent research has shown.
Among the array of new products to treat diabetes and its complications is an insulin pump that doesn't require a catheter; a foot thermometer that measures inflammation to prevent ulcers; and a glucagon kit with picture instructions that family members can use to give an injection, warding off low blood sugar.
Still no cure
But the torrent of new products isn't going to reverse this disease.
"It's more of an evolution than a revolution," says Stuart Weinzimer, a diabetes specialist at Yale, who has conducted clinical trials coupling insulin pumps with glucose monitors to regulate blood sugar in children.
All the new drugs are second-line drugs and must be taken with an existing generic drug, Metformin.
Makers of insulin are on the offensive. Last month, Sanofi Aventis asked the news media to remind consumers that insulin "will remain a cornerstone of treatment for both Type 1 and Type 2 diabetes."
In diabetes, the body can't effectively break down glucose, or sugar, in the blood.
People with Type 1 diabetes have an autoimmune disorder that causes the body to attack the delicate beta cells that make insulin in the pancreas. Those patients must take insulin to survive. The disease usually shows up when patients are children or young adults.
In Type 2 diabetes, sometimes called late-onset, generally people become overweight, triggering fat cells to secrete chemicals that make the body increasingly resistant to insulin. More puzzling is that not all people who develop Type 2 diabetes are overweight.
Many Type 2 diabetics try to control blood-sugar levels without taking insulin, while others find themselves on a roller coaster as they struggle to balance their blood-sugar levels throughout the day.
Since doctors first used insulin on a diabetic patient in 1922, most progress has come in how to refine the compound, deliver it more effectively, or make it longer-acting.
But insulin has downsides: Patients need to estimate the right dosage and inject the drug themselves. If they use too little, glucose levels will rise quickly. If they inject too much, they'll drive their blood sugar levels dangerously low and their body will crash, starved of energy.
Doctors caution that the current crop of drugs are treatments, not a cure, and can't replace a good diet and exercise.
Robert A. Rizza, president of medicine and science with the American Diabetes Association, said complications from diabetes will overburden the health system and cost trillions of dollars unless more patients, including the poor, get better treatment now.
"The therapies are escalating," says Rizza, "but if we reshape health care to make sure everyone has the best diabetes care every day, we'd be saving many more people." |
