Making the case for insulin – the Battle for type 2 patients isn’t limited to oral agents and GLP-1’s

Making the case for insulin – the Battle for type 2 patients isn’t limited to oral agents and GLP-1’s

While it would seem like overkill to conduct studies designed to prove the benefits of insulin therapy, this morning Sanofi-Aventis (NYSE:SNY) announced the results from several studies. According to a press release issued by the company:

“In the ELEONOR (Optimising basal plus insulin therapy in type 2 diabetes by telecare assistance for self-monitoring of blood glucose) and OPAL (Adding a single dose of insulin glulisine at breakfast or main meal to basal insulin and oral antidiabetic therapy) clinical studies, patients previously treated with LANTUS® and oral diabetes medications achieved significantly improved glycaemic control by implementing a “basal plus” regimen – adding one injection of APIDRA® at the main meal of the day. In the ELEONOR study, the addition of one APIDRA® injection resulted in a further A1C drop of 0.7-0.8%. In the OPAL study, A1C scores improved, significantly dropping 0.4% from baseline to endpoint in both patients that were administered APIDRA® at breakfast and patients who were administered APIDRA® at main meal.”

 In separate press release the company stated;

 “GINGER and LACE, presented at the 44th annual meeting of the European Association for the Study of Diabetes (EASD) demonstrated that a basal-bolus insulin regimen with LANTUS® (insulin glargine [rDNA origin] injection) once daily (basal insulin) and rapid-acting APIDRA® (insulin glulisine [rDNA origin] injection) at mealtime (bolus insulin) produced greater A1C reductions versus pre-mixed insulin in people with type 2 diabetes. Both studies, GINGER (a clinical trial) and LACE (real life patient data) confirmed the superior efficacy of

LANTUS®/APIDRA® basal-bolus therapy when compared to pre-mixed insulin regimens.”

Speaking on the ELEONOR and OPAL Dr. Del Prato, Professor of Endocrinology and Metabolism and Chief of the Section of Diabetes at the School of Medicine, University of Pisa, Italy stated““With so many people living with diabetes not reaching their A1C goals, we’re always looking for new ways to help manage blood glucose levels. The results from ELEONOR and OPAL show us that a basal plus strategy is an option for insulin intensification for Type 2 Diabetes insufficiently controlled despite optimized titration of LANTUS® combined with oral antidiabetic drug therapy.”

Not to disrespect what Dr. Prato stated there is nothing new here. The benefits of insulin therapy are well known. It is also well known that basal bolus therapy is one of the most effective therapy options as proved by the many studies done with insulin pump patients.

What Diabetic Investor finds most revealing here is that anyone would need more studies to prove what is already well known. This is like doing a study that proves people shouldn’t drive a car while intoxicated. But just as people do drive while drunk, there are physicians who will not prescribe insulin therapy for their type 2 patients. This has more to do with their own fears rather than lack of information on how effective insulin therapy can be.

The fact is many physicians will not prescribe insulin therapy because it requires more work on their part. It’s simple and cost effective to put a patient on oral medications. There is no need to educate the patient and pills are easy to administer. Patients do not need to monitor their glucose levels when on oral medications something they must do when taking insulin. Compared to insulin therapy there is less risk of hypoglycemia with oral medications.

Instead of spending money for studies that prove an already well established fact they should be taking that money to promote patient education. Instead of telling physicians something they should already know they should be helping these physicians educate their patients on insulin therapy. They should partner with blood glucose monitoring companies so that patients and physicians understand the importance of glucose monitoring. They should partner with insulin pump companies and promote the benefits of basal bolus therapy.

We already have easy to use insulin delivery systems whether its insulin pens or smart insulin pumps. We have pen and syringe needles that are shorter, thinner and lubricated making injecting a less painful experience. What’s truly lacking is a coordinated effort to improve the dismal state of patient and physician education.

Diabetic Investor does understand why these studies are done, however this does not change the fact that insulin sales would grow faster if an equal amount of capital was spent on improving patient and physician education. This would be a far more effective use of capital and far more lucrative in the long run.

Given the controversy surrounding some oral agents and now GLP-1’s, insulin companies have an opportunity. The door is wide open as physicians seek proven therapy options for their type 2 patients. The question is will they take full advantage of this opportunity and do what’s necessary. More studies that prove the benefits of insulin therapy are only half of what’s needed. Given that billions in sales are at stake here and that the type 2 market is ripe for the taking one would think insulin companies would make every effort to capture this market.

As Sidney Hook wrote; “The consequences of a lost chance rarely close the doors to future choice. But they narrow them to alternatives that are all relatively unfavorable in comparison with earlier possibilities.”