New medicine for Type II diabetes shows considerable promise

The global pharmaceutical company Novo Nordisk has announced that its new drug semaglutide had reduced blood glucose levels and lowered body weight to a statistically significant degree more than those treated with the competing drug dulaglutide.

The Danish global pharmaceutical company Novo Nordisk claimed that its late stage trial had met its main goal of reducing glucose (BG) levels in a trial involving about 1,200 patients over a forty-week period. Both those using Eli Lilly's dulaglutide and Novo's semaglutide also used metformin pills.

There was also a significant reduction in body weight among participants as well. Some diabetes medications are associated with a risk of increasing body weight. Novo Nordisk hopes that its new drug will become a standard therapy for treating type 2 diabetes. Novo Nordisk is headquartered in Bagsvaerd Demark but has production facilities in 8 different countries and affiliates or offices in 75 countries. Its key products include diabetic medicines and treatment devices.

Type 2 diabetes is contrasted with Type 1 which requires insulin injection for treatment from the beginning. Unlike Type I type 2 usually begins in middle-aged or older patients especially those who are obese and do not exercise, but there are also often generic factors involved. The incidence of type 2 appears to be increasing among younger people. Early treatment often involves just proper diet and exercise but as the disease progresses pills are used and often insulin injections are needed.

Wikipedia describes type 2 as follows:Diabetes mellitus type 2 (also known as type 2 diabetes) is a long-term metabolic disorder that is characterized by high blood sugar, insulin resistance, and relative lack of insulin.[6] Common symptoms include increased thirst, frequent urination, and unexplained weight loss. Symptoms may also include increased hunger, feeling tired, and sores that do not heal.[3] Often symptoms come on slowly.[6] Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations.[

Type 2 accounts for more than 90 percent of all diabetes cases. Although there was some concern that the drug may have caused more retinopathy leading to vision loss, Novo Nordisk said that the number of patients reporting on increased retinopathy was low and the two drugs had similar rates.

Both semaglutide and dulaglutide belong to a class of drugs called GLP-1 (Glucagon-like Peptide 1). They "imitate" an intestinal hormone that stimulates insulin production and helps to lower blood glucose levels. One advantage of these drugs over insulin is that the dosage can be administered weekly. Eli Lllly's Trulicity has already been approved some time ago. However pricing and side effects are a problem.

The cost of 4 pens with each pen containing a weekly dose is around $700 US and that is with discount coupons. Presumably, Novo Nordisk pricing will be in the same ball park. This is much higher than the cost of conventional insulin treatment along with other medications which may work just as well in many cases. There also can be severe side effects of taking the medicine. While many effects may be less bothersome after longer use, other effects are so severe that the patient must stop using the medicine altogether. Many patient reviews of the effects of Trulicity can be found here. Wikipedia describes some of the side effects:The most common side effects include gastrointestinal disorders, such as dyspepsia, decreased appetite, nausea, vomiting, abdominal pain, diarrhea.[6] Some patients may experience serious adverse reactions: acute pancreatitis (symptoms include persistent severe abdominal pain, sometimes radiating to the back and accompanied by vomiting), hypoglycemia, renal impairment (which may sometimes require hemodialysis). The risk of hypoglycemia is increased if the drug is used in combination with sulfonylureas or insulin.[7][8]

While this may make one wonder why anyone would take the drug, there are many users who find that the drug has worked when everything else has failed and many may have only mild if any negative side effects of its use. Being able to inject just once for a whole week of treatment will appear as a large plus to those who now must inject insulin several times a day. The control of blood glucose levels is essential in avoiding complications from diabetes. Any new drug to do that will be a plus for many patients.

New study shows a glass of red wine each day is beneficial to type 2 diabetics

A new study shows that moderate consumption of red wine can help people with type 2 diabetes to manage their cholesterol and cardiac health as well as controlling the blood sugar levels.

Type 2 or "adult onset" diabetes contrasts with type 1 or gestational diabetes. The main types are set out in Wikipedia:

Type 1 DM results from the pancreas's failure to produce enough insulin. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes". The cause is unknown.[3]

Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly.[3] As the disease progresses a lack of insulin may also develop.[6] This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The primary cause is excessive body weight and not enough exercise.[3]

Gestational diabetes, is the third main form and occurs when pregnant women without a previous history of diabetes develop a high blood-sugar level.[3The reference to type 2 as non-insulin dependent is hardly accurate since often, as the disease progresses, one needs to use insulin, and blood sugar needs to be controlled by injecting insulin. I myself have been doing this for several years. I wish I had gone to insulin earlier as it has provided much better control in my case. I do not find injection painful at all,

The relation of drinking to diabetes control is complicated. Some of the issues are listed here. The complete Canadian Diabetes guidelines can be found here. I drink only one bottle of beer a day and often not that. It does not appear to have any impact on control as far as I can tell.

This new study shows that alcohol at least in the form of a glass of red wine a day can actually improve cardiac health and cholesterol levels in Type 2 diabetic patients. I have never had trouble with cholesterol but maybe I will try the wine anyway. The new study was carried out in a two-year randomized controlled trial (RCT) led by researchers at Ben Gurion University in Israel, although researchers from other countries also participated,including from the University of Leipzig in Germany, and Karolinska Institute in Sweden. Prof. Meir Stampfer of Harvard University in the US was also one of the researchers. This study is the first long term study of alcohol effects. The study published in the well-regarded Annals of Internal Medicine is titled, "Effects of Initiating Moderate Alcohol Intake on Cardiometabolic Risk in Adults With Type 2 Diabetes".

The researchers found that both red and white wine could improve sugar control. Those with diabetes are prone to having lower levels of "good" cholesterol than those in the general population. Any recommendations of alcohol consumption for people with diabetes have remained controversial due to the lack of long term randomized trials. The positive results for blood sugar control only resulted for diabetics who were slow rather than fast alcohol metabolizers. About one in five of the participants were fast alcohol metabolizers.

There are other properties of red wine that apparently make it superior to white win in overall results:“Red wine was found to be superior in improving overall metabolic profiles, mainly by modestly improving the lipid profile, by increasing good (HDL) cholesterol and apolipoprotein A1 (one of the major constituents of HDL cholesterol), while decreasing the ratio between total cholesterol and HDL cholesterol... "initiating moderate wine intake, especially red wine, among well-controlled diabetics, as part of a healthy diet, is apparently safe, and modestly decreases cardio-metabolic risk. The differential genetic effects that were found may assist in identifying diabetic patients in whom moderate wine consumption may induce greater clinical benefit."Sleep quality was improved in participants whether they drank white or red wine as compared with those in a control group who drank water. The study also found no adverse effects such as change in blood pressure, liver function, growth in fat levels or other adverse symptoms.

The study was carried out on 224 diabetes type 2 patients who were aged 45 to 75. Most of the participants abstained from alcohol. The participation rate over the two year study was 87 percent a very high participation rate. Perhaps the wine was of high quality. The results were rather different than the researchers originally thought. Red wine appears to have non-alcoholic constituents that provide further benefits that are lacking in white wine. Perhaps the effects might be different with different wines as well. Subjects of the study were subject to a constant and comprehensive set of medical tests including monitoring of blood pressure, heart rate and blood glucose levels. I am hoping the next study will use beer. I am ready and willing to volunteer.