Rapid- and slow-acting insulins help control diabetes

If the united states' healthcare trend continues on its current course, in 20 years the number of people with diabetes will more than double to 50 million. This dismaying prediction comes from a new report from the Yale Schools of Public Health and Medicine in conjunction with the Institute for Alternative Futures. If the current trend continues, by 2025:

"In general, rapid-acting insulins are more effective in controlling blood sugar levels after a meal, compared to regular insulin," says Mark Abramowicz, MD, editor of The Medical Letter on Drugs and Therapeutics, a non-profit newsletter that critically appraises drugs. "With all insulins, the greatest risk is hypoglycemia."

In addition, American Healthways gathers clinical data on all patients, stratifies them, and proactively calls those at substantial risk. "It might be once a quarter, or as often as every day, depending on the immediate manifestations of the disease and complications," says Bob Stone, the company's executive vice president.

XLHealth, which serves 40,000 members with diabetes, has set up regional assessment centers. "Most of our patients are seniors, and we believe a face-to-face component is most effective for assessment and education in this age group," says Harry Leider, MD, MBA, chief medical officer of XLHealth. "In addition, a core component of our diabetes program is finding patients who've lost feeling in their feet, and proactively taking steps to prevent ulcers and ultimately amputations. You can only assess neuropathy face-to-face."

BYETTA SLOW TO WIN MARKET

Byetta, a new medication for diabetes, was approved by the FDA in late spring. Byetta (exenatide) is an injectable drug that stimulates the release of insulin from the pancreas, and is used for patients with type 2 diabetes who haven't been able to control blood sugar levels through other medications. The principal benefit of adding Byetta to oral therapy is its ability to improve glycemic control without leading to weight gain; its wholesale monthly cost ranges from $147 to $172.50 depending on dosage level.

"Whether the absence of weight gain is reason enough to try this medication before starting insulin remains to be determined," says Dr. Abramowicz.

"While Byetta has been approved by FDA, there's a big learning curve right now, and it's expensive," says Patricia Roberts, MS, CNN, director of clinical solution design for American Healthways. "We find very few health plans are adding it to their formularies."

Pharmaceutical companies have been searching for more user-friendly ways to supply insulin to the body. Oral-Lyn, from Generex, is an oral insulin spray that could be used shortly before a meal. It is not approved in the United States, but went on sale in Ecuador recently.