The Ideal Diabetes Drug
“My ideal diabetes drug lowers blood glucose, helps reduce weight, improves cardiovascular risk factors, and preserves beta cells — and costs $4 a month. We don’t have that drug.” These words come from Dr. Anne Peters, professor of medicine at the Keck School of Medicine and director of the USC Clinical Diabetes Programs in Los Angeles, California.
Take away the $4 per month cost and what Dr. Peters is describing is actually here today and called a GLP-1. Notice that nowhere in her comments does Dr. Peters mention anything about how this ideal drug would be administered. Although not asked Diabetic Investor suspects that had she been asked for a preference oral administration would have been preferred to an injectable, but her comments speak volumes to what physicians truly care about and that’s fighting diabetes.
Although a GLP-1 is not the “perfect” diabetes drug it also has additional benefits beyond lowering blood glucose, helping reduce weight, improving cardiovascular risk factors and preserving beta cells- patients using a GLP-1 do not need to regularly monitor their glucose levels; something that must be done when using insulin. This aspect of GLP-1 therapy should not be underestimated as monitoring glucose levels is just one more reminder to the patient they have diabetes and often times creates more harm than good.
As Diabetic Investor has stated consistently a major reason patients don’t monitor their glucose levels regularly is they don’t understand what these numbers mean or how to use them to better manage their diabetes. Too often a newly diagnosed who starts out testing regularly quickly finds out that testing really doesn’t help much as there is no action step taken because of the test results. This particularly true with non-insulin patients, frankly a test result of 80 is really no different than one of 200, as it does not change when or how much medication they take. This is also true for many patients who use combination therapy, insulin plus orals, as the physician understands these patients typically don’t test their levels so the simply tell their patients to inject a set amount of Lantus each day.
Although testing supplies are covered by most insurance plans, the cost of glucose monitoring is also an issue. Even if the patient has decent insurance co-pays for test strips can range anywhere from $5 to $50 with each prescription. While this may not seem like much money a patient with a $25 co-payment who fills their prescription once a month spends $300 per year. While this seems like an affordable amount the fact is patients see the $300 as a waste as they are not personally benefiting from the information they are receiving, or put another way they don’t see any value created and therefore why spend money when no value is created.
This is another benefit of GLP-1 therapy, given that most patients lose weight when using a GLP-1, they actually see and feel a benefit from using the drug, something that does not happen with metformin or a DPP-4. The fact is a patient taking metformin really sees no tangible benefit produced by the drug. Yes metformin is very effective but in the real world when a patient is not testing regularly they don’t see any tangible benefit from taking their metformin as prescribed. Medication adherence is one of the biggest reasons why more than two-thirds of all patients are not properly controlling their diabetes.
Diabetic Investor cannot think of any drug currently on the market or under development that offers what a GLP-1 offers and once Bydureon gets here GLP-1 therapy can add another benefit, once-weekly administration. Yet even without Bydureon, a once daily injection which comes with Victoza® is actually easier for the patient than taking three doses of metformin each day. In the real world the fewer times a drug needs to be taken, whether it’s injected or taken orally, the better. This is why companies are trying to develop even longer acting insulin’s, the success of Lantus and Victoza shows that patients are not opposed to injections as long as they are not injecting multiple times per day.
Now before everyone jumps on the GLP-1 bandwagon, it’s important to remember that as effective as this therapy is, it’s not perfect. Although there is no evidence to support the belief that GLP-1 usage causes pancreatitis or thyroid cancer, physicians prescribing GLP-1 therapy must recognize the drug is not adverse event free. However, on balance when all the factors are considered, including medication adherence and glucose monitoring (or lack thereof), it’s easy to see why nearly every major diabetes drug company either has a GLP-1 or is developing one.
GLP-1 may not be the ideal drug described by Dr. Peters but it comes pretty damn close.