By Dr. Ben Kim on June 11, 2007
* Health Warnings
* Natural Health Solutions
According to the World Book Encyclopedia, the average adult human body contains approximately 96,500 kilometers (60,000 miles) of blood vessels. This means that if you were to attach all of your blood vessels together end to end, they could wrap around the Earth almost two and a half times.
Some of your blood vessels are about as thick as a magic marker, while others are as thin as a strand of hair. All of your blood vessels are essential to your health because they provide the transportation network that allows your blood to carry nutrients and oxygen to each of your cells. Your network of blood vessels also allows your blood to remove waste products from all of your cells.
Diabetes mellitus type 2 (referred to as diabetes throughout the rest of this article) has the potential to be a devastating disease because it slowly clogs up your network of blood vessels, destroying the transportation system that your blood relies entirely upon to nourish and cleanse your cells. Imagine injecting sugar-rich honey or jam into your blood vessels and you have a good idea of why a high blood sugar level is dangerous to your health.
Left unchecked, diabetes can result in complete blockages in your circulatory system, paving the way to every health challenge that we know of, the most common ones being heart disease, neurological disease, vision loss, and sexual dysfunction.
How You Can Develop Diabetes
Whenever you eat sugar or foods that break down into sugar, your blood sugar level rises. Your body senses this rise and makes your pancreas release a hormone called insulin into your blood. Insulin circulates throughout your network of blood vessels along with sugar, and acts as key, opening channels that line your cells, which allows sugar to exit your bloodstream and enter your cells. The net effects of optimal insulin release and function are:
1. Lowering of your blood sugar level.
2. Making sugar available for energy production or storage by your cells.
You can develop diabetes if you regularly eat more sugar and refined carbohydrates than your body can properly use. With repeated intake of sugar and refined carbohydrates, your body is forced to produce and release insulin so frequently that one or both of the following conditions may arise:
1. Your pancreas may not be able to produce enough insulin to effectively deal with your sugar and refined carbohydrate intake.
2. Your cells may become resistant to the effects of insulin.
One or both of these conditions will eventually lead to a high blood sugar level, which over the long term, will dramatically increase your risk of developing blockages in your network of blood vessels.
How to Reduce Your Risk of Developing Diabetes
What follows are the most important steps that you can begin taking today to dramatically reduce your risk of developing diabetes.
1. Regularly engage in some form of exercise that builds and/or maintains your muscle mass. Muscle tissue has significant capacity to store excess blood sugar in the form of glycogen. Simply put, the more muscle you have, the more capacity you have to "soak up" excess blood sugar and maintain a healthy blood sugar level. This is one of the biggest benefits to doing some resistance training on a regular basis.
2. Be active! The more you move your body throughout the day, the more sugar your cells need to burn up to produce energy.
3. Reduce or eliminate your intake of the following most common, sugar-rich foods in today's grocery stores:
* Pop (soda)
* Doughnuts
* Pastries
* Conventional store-bought cookies, cakes, and muffins
* Conventional chocolate/candy bars
* Many boxed breakfast cereals
4. Eat magnesium-rich foods on a regular basis. Studies conducted by researchers from Harvard University and published in the January 2004 issue of the journal Diabetes Care indicate that consistent intake of magnesium-rich foods can significantly lower your risk of developing diabetes. Healthy magnesium-rich foods include:
* Brown rice
* Raw almonds
* Spinach
* Swiss chard
* Lima beans
* Avocado
* Raw peanuts
* Raw hazelnuts
* Okra
* Black-eyed peas
5. Consider consuming prickly pear cactus, called nopal in Mexico. Nopal is a natural plant that is grown throughout Mexico and the southwestern United States, and has been shown through several studies to be effective at promoting optimal blood sugar levels.
If you follow the measures described above, you can confidently expect to reduce your risk of developing diabetes and improve your overall health.
Please note: Nopal cactus and magnesium-rich spinach are key ingredients in our super green food mixture, which is why I regularly recommend our greens to people who are looking for nutritional support to prevent diabetes mellitus type 2.
Kamis, 14 Agustus 2008
Why Drug Combinations Are Used to Treat Type 2 Diabetes
The medicine cabinets of people with type 2 diabetes don't have much space. Most people still produce at least some of their own insulin, a hormone that converts sugar into energy. But they often don't make enough to overcome the body's resistance to the hormone.
While dieting and exercise can lower blood sugar—so the insulin they do make is more effective—sometimes that's not enough.
That's where a complex variety of drugs come in. These drugs work in different ways to help lower blood sugar to safe levels and are often more effective when used in combinations.
Among adults with diabetes, 57% take oral medication and 12% take both insulin and oral medication, according to the Centers for Disease Control and Prevention.
Most people start with metformin
The first drug people take is usually metformin, an oral medication that is found in the brand-name drugs Glucophage and Glucophage XR. As time goes on and diabetes progresses (natural insulin production can decline over time), their doctor often adds another type of oral medication, insulin, or some other injectable drug to the regimen.
Metformin is a biguanide that decreases the liver's excess glucose production. If it's not controlling blood sugar on its own, doctors might add a sulfonylurea, which stimulates the pancreas to make more insulin. Or they might add a thiazolidinedione, which increases the body's sensitivity to insulin.
Now that multidrug therapy is common practice among endocrinologists, more drugs are available in a single pill. For example, metformin has been combined with sulfonylureas (called Metaglip and Glucovance), a thiazolidinedione (known as Avandamet), and a sitagliptin (called Janumet). In addition, doctors might consider adding the injectable medications Byetta (exenatide) or Symlin (pramlintide acetate), to a patient's metformin, says Dace Trence, MD, an endocrinologist and director of the Diabetes Care Center at the University of Washington Medical Center in Seattle.
"The thinking is that if you treat people with two drugs instead of one, you can get down to the targeted levels quicker and it stays down there longer," said Dr. Trence.
You may also need to take insulin
Daytime activity can increase the body's sensitivity to insulin, so an oral drug, such as metformin, may control the fasting blood sugar. But since people are sedentary at night, they may need long-lasting insulin shot before bedtime.
"That will carry them into the next day," Dr. Trence said.
In time, they may also need a short-acting insulin, which is taken just before eating, to control blood sugar after meals.
Patients estimate the amount of insulin they need based on their exercise, calorie and carbohydrate consumption, and their blood-sugar readings, said Glenn Cunningham, MD, an endocrinologist and professor at Baylor College of Medicine in Houston.
You may not need to take medication forever
The primary challenges are making sure the blood sugar doesn't get too low from all the medications, a condition known as hypoglycemia, as well as preventing weight gain. There's more risk with certain drugs (such as insulin and sulfonylureas), than others. However, uncontrolled diabetes can lead to coronary heart disease, kidney failure, blindness, limb amputations, and premature death.
"We have to remember the cost of not doing the job," said Daniel Einhorn, MD, an endocrinologist and medical director of the Scripps Whittier Institute for Diabetes in La Jolla, Calif.
People who shed excess weight may—or may not—be able to come off their diabetes treatment. Genetics plays a role, as well as how far the disease has progressed. If a person has more vulnerable beta cells—the cells that make insulin in the pancreas—they'll need more medication, regardless of weight loss.
(from:http://www.health.com/health/condition-article/0,,20189191,00.html)
While dieting and exercise can lower blood sugar—so the insulin they do make is more effective—sometimes that's not enough.
That's where a complex variety of drugs come in. These drugs work in different ways to help lower blood sugar to safe levels and are often more effective when used in combinations.
Among adults with diabetes, 57% take oral medication and 12% take both insulin and oral medication, according to the Centers for Disease Control and Prevention.
Most people start with metformin
The first drug people take is usually metformin, an oral medication that is found in the brand-name drugs Glucophage and Glucophage XR. As time goes on and diabetes progresses (natural insulin production can decline over time), their doctor often adds another type of oral medication, insulin, or some other injectable drug to the regimen.
Metformin is a biguanide that decreases the liver's excess glucose production. If it's not controlling blood sugar on its own, doctors might add a sulfonylurea, which stimulates the pancreas to make more insulin. Or they might add a thiazolidinedione, which increases the body's sensitivity to insulin.
Now that multidrug therapy is common practice among endocrinologists, more drugs are available in a single pill. For example, metformin has been combined with sulfonylureas (called Metaglip and Glucovance), a thiazolidinedione (known as Avandamet), and a sitagliptin (called Janumet). In addition, doctors might consider adding the injectable medications Byetta (exenatide) or Symlin (pramlintide acetate), to a patient's metformin, says Dace Trence, MD, an endocrinologist and director of the Diabetes Care Center at the University of Washington Medical Center in Seattle.
"The thinking is that if you treat people with two drugs instead of one, you can get down to the targeted levels quicker and it stays down there longer," said Dr. Trence.
You may also need to take insulin
Daytime activity can increase the body's sensitivity to insulin, so an oral drug, such as metformin, may control the fasting blood sugar. But since people are sedentary at night, they may need long-lasting insulin shot before bedtime.
"That will carry them into the next day," Dr. Trence said.
In time, they may also need a short-acting insulin, which is taken just before eating, to control blood sugar after meals.
Patients estimate the amount of insulin they need based on their exercise, calorie and carbohydrate consumption, and their blood-sugar readings, said Glenn Cunningham, MD, an endocrinologist and professor at Baylor College of Medicine in Houston.
You may not need to take medication forever
The primary challenges are making sure the blood sugar doesn't get too low from all the medications, a condition known as hypoglycemia, as well as preventing weight gain. There's more risk with certain drugs (such as insulin and sulfonylureas), than others. However, uncontrolled diabetes can lead to coronary heart disease, kidney failure, blindness, limb amputations, and premature death.
"We have to remember the cost of not doing the job," said Daniel Einhorn, MD, an endocrinologist and medical director of the Scripps Whittier Institute for Diabetes in La Jolla, Calif.
People who shed excess weight may—or may not—be able to come off their diabetes treatment. Genetics plays a role, as well as how far the disease has progressed. If a person has more vulnerable beta cells—the cells that make insulin in the pancreas—they'll need more medication, regardless of weight loss.
(from:http://www.health.com/health/condition-article/0,,20189191,00.html)
Rabu, 13 Agustus 2008
Innovations in Diabetes Medication: Diabetic Hope In Pan Asia For Profits?
Frost & Sullivan Asia Pacific
By Chew Li Sa, Industry Analyst
Frost & Sullivan, Healthcare Asia Pacific
The Pan Asian Overview: Snapshot of Incidence and Market Revenue
Diabetes affects at least 140 million people worldwide, and Pan Asia has the highest prevalence. In 2000, this region was believed to have at least 96.0 million diabetics and by 2010, the number of diabetes patients is expected to reach 139.0 million. India topped the highest number of diabetic patients with 24 million cases, followed by China with 22 million diabetics. Despite the high incidence rate however, diagnosis rates are relatively low; it is estimated that in this region, only 50 percent of the estimated number of diabetic patients are undergoing treatment, that is, about 46 million patients. In this entity, approximately 10 percent of the total diabetes cases belong to the Type 1 category while 90 percent belong to Type 2 category. While the incidence of Type 1 diabetes is predicted to remain stable, Type 2 diabetes is expected to increase due to the increasing influence of western lifestyles and rapid urbanization in this region.
In terms of market revenue for 2002, Frost & Sullivan predicts the total Pan Asian diabetes medication market to reach up to $1.77 billion, with the growth rate predicted at 10.3 percent. There are two main product lines in diabetes medication, namely insulin and oral anti diabetics (OAD). The insulin market accounts for 32 percent of these revenues while OAD make up the remaining 68 percent. Most countries in this region posted growth rates between 15 percent and 20 percent (with the exception of Japan as it recorded a low growth rate of only 3 percent due to market saturation). The high overall growth rate was due to flourishing markets in the other nations. By 2007, the market revenue for diabetes medication in Pan Asia is forecasted to reach $2.85 billion, with the compounded annual growth rate (CAGR) from 2001 to 2007 registered at 10.1 percent.
Chart 1
Revenue forecasts for the Pan Asian diabetes medication market from 1997 to 2007.
THE DIABETES DABBLERS
The key market players in the Pan Asia diabetes medication are mainly the multinationals. In Australia, Hong Kong, Malaysia, and Singapore, multinational companies such as Novo Nordisk, Servier, and MSD dominates the market while the local companies are mainly generic manufacturers. In Japan, South Korea, Taiwan, China, and India, both these multinationals and local companies such as Takada Chemical, Yamanouchi and YSP are equally dominant industry participants, especially in the OAD market segment. In fact in Japan, India, and South Korea, local companies have a higher market share than their multinational counterparts. Market leaders in Asia however are Novo Nordisk and Takeda. Other new entrants are GlaxoSmithKline and Novartis. These two companies are infact the innovators of the new OAD (Oral Anti Diabetics) segment. GlaxoSmithKline introduced Avandia (rosiglitazone) to Pan Asia countries in early 1999, while Novartis introduced Starlix (nateglinide) for type 2 diabetes
Chart 2
Total Diabetes Medications Market: Market Share by Companies (Pan Asia), 2002
DIZZYING INNOVATIONS
It is pertinent to highlight that the diabetes medication market had actually been stagnant for at least three decades! The new advances in knowledge, medication and technology however in diabetes management, approximately since 1995, is quite dizzying really. The only kinds of medication available before was insulin and classes of drugs known as sulfonylureas and the biguanides but since then new classes of medications have been introduced to the market to lower blood sugar including a newer generation of sulfonylureas, coupled with major advances in insulin treatments.
In the insulin market segment for eg, the first analogue insulin, (Humalog) introduced by Eli Lilly in 1998, had resulted in increased revenues in countries such as Australia, India, Malaysia, and Singapore. Humalog is a shorting acting insulin class which claimed to more effective than the regular human insulin, in that it provided better glycemic control, especially at mealtimes. Additionally, it was also observed that there was an increasing trend of adopting early insulin therapy among Type 2 diabetics. The concept of “early” insulization among Type 2 diabetics is believed to prevent late complications in diabetes and hopefully prolong the survival period for patients. Obviously this is another niche sector that the insulin manufacturers should focus on very closely.
Similarly, Novo Nordisk had introduced a short acting analogue insulin in Japan, Australia, India, and other markets in this region, to compete with Eli Lilly. Another new player in the block, Aventis is expected to compete in the analogue insulin market, with its latest long acting analogue insulin. This is the first insulin of its kind, as the long acting feature allows consistent gylcemic control for 24 hours, which is ideal for diabetic patients with nocturnal hypoglycemia complications. This is anticipated to path a lucrative pathway for manufacturers to tap into the Type 2 diabetic market, as comparable to the regular insulin.
In the OAD (oral antidiabetics) segment, market leader Takeda formed an alliance with Novo Nordisk to distribute Novonorm (the first insulin sentisizer) in Japan in the third quarter of 2001. As Takada has long dominated the Japanese OAD market, this alliance actually allowed Novo Nordisk a strategic opportunity to tap into the Japanese OAD market. The most exciting trend in the Pan Asian OAD market was when, a new class of treatment known as the glitazones was introduced in 1999 to offer even better glycemic control for Type 2 diabetics. Here the compounds work on improving insulin resistance; another concept that is closely related to prevent late complications of diabetes. This marked the birth of Avandia by Glaxo SmithKline. GSK successfully launched Avandia in most parts of Pan Asia like China, India, South Korea, Singapore, Malaysia and Taiwan and gained significant market share within two years. Another market player, Novartis introduced Starlix, another type of insulin sentisizer., which is already available in Singapore and the Philippines. Starlix is chemically different from other compounds as it can normalize mealtime glucose spikes. Due to its fast and short acting feature, it has minimal chances of causing hypoglycemia, which is one of the constant problems reported by many Type 2 diabetics at mealtimes. Frost & Sullivan strongly believes that the Pan Asia diabetes medication market will continue pressuring manufacturers to offer new products in an effort to gain market share. Hence, the total market is expected to grow rapidly.
DIABETIC OR DYNAMIC PROFITS FOR THE INNOVATORS ?
These new launches infact did spur market growth in the Pan Asia region. New innovations definitely were and are promising but the real challenge however is whether the manufacturers would be able to compete and ensure profits and a lucrative ROI. All in all, there are a couple of factors that will pose as major hurdles in the Pan Asian markets
One frustrating hurdle is that there is still a preference for the older drug generations (such as the glibenclamide, and the metformins) in the Pan Asia market due to several factors. One reasons forwarded on why physicians still prescribe this class of drugs is the fact that the older products are much lower in cost and also have had a long established proven clinical data. This has indeed made changing physicians’ mindset quite a challenge. In this aspect, manufacturers need to aggressively and continuously provide new clinical findings of new drugs to turn over this perception. Additionally, continuous medical education for the physicians need to be emphasized to influence the prescriptions patterns of the physician so that they understand issues such as benefits of early insulin therapy, insulin resistance etc.
Another influential negative impact on market revenues would be the rapid mushrooming of generic products. Generic manufacturers are gaining market recognition especially in older OAD products such as, sulphonylureas, biguamides, etc. Since late 1997, the generic market share has increased significantly. This is due to the low purchasing power triggered by the financial crisis in this region resulting in popularizing generic substitutes. In 2002, most generic companies recorded at least a 30 percent growth rate. The market share of the older generations of generics has increased significantly between 10 percent and 20 percent. This may reduce market attractiveness and restrain growth for the branded drugs.
Additionally Frost & Sullivan also noted that in most national health insurance-reimbursed markets such as Australia, South Korea, Japan and Taiwan, the governments have recently embarked on newer measures to remain profitable. Initially, most of them had undertaken huge reimbursement expenses because at least 90 percent of their respective population were being heavily subsidized in health bills. In the diabetes medication expenses, especially the OAD products, sulphonylureas and metformin are preferred over newer agents due to affordability reasons. In Taiwan, the policy makers are constantly revamping their annual strategy for tighter drug purchase control to ensure profitability. Their latest measure is by imposing the requirements for pharmaceutical companies to implement an annual revision on the drug prices if their respective drugs were to remain in the reimbursement listing. Then, in July 2002, they fixed an annual drug spending budget allocated to each hospital, which meant that hospitals are now in charge of their own drug spending.
In Japan, the National Health Insurance reduced the drug reimbursement scheme by 7 percent in 2000 and encouraged co-payments by patients. This resulted in greater sales of cheaper products and physicians were encouraged to prescribe older products. Similarly the Australia national insurance council has plans to switch to cheaper drugs in order to cut expenses. The council has plans to shift physicians’ prescriptions to generic brands, and at the same time would implement co-payments by patients.
These policies and price control measures have reduced companies’ continued interest and indulgence in this market. The resulting crisis is that new products are facing extreme difficulties in penetrating the market due to its high prices. For now, this factor only poses a moderate impact on the market, as most governments have only begun implementing and fine-tuning their healthcare policies. But in the long run, this may pose quite a formidable threat to market development.
Last but not least, cost is a major factor. As manufacturers spend enormous R&D dollars in innovations, timing for ROI is critical. Many of them had market these new innovations few times higher than the classic drugs. For example, Avandia is known to be priced at 4 times the price of Daonil (a popular sulphonylyrea) in many Asian markets. Many physicians hence are hesitant to expand their prescriptions volume and in some cases, even refused to prescribe! In many markets, new innovations were only used as a second or third option when older drugs fail in alleviating the pain and torment of the diabetics. Manufacturers should seriously concentrate on shifting the mindset of the physicians.
NEW HORIZONS FOR DIABETES
What lies ahead in the Pan Asia diabetes medication market? With the promising biotechnology achievements, multinationals are racing to offer better treatment options, if not, a cure to diabetes. The long awaited changes in drug delivery methods are finally happening in the insulin market. One of the biggest restrictions in many insulin markets is due to its injection form. In fact this has prevented insulin to realize its fullest commercial potential in the far larger market segment; the Type 2 diabetes. In years to come, non-injectable insulin will open up the lucrative Type 2 diabetes market for insulin manufacturers. Leading the race now is another multinational, Pfizer, which had formed a joint venture with Inhale Therapeutic Systems and Avnet to product inhalable insulin products. The product is expected to be introduced to Pan Asia within a couple of years which will surely revolutionize the industry, promising tremendous growth. Existing manufacturers such as Novo Nordisk and Eli Lilly are equally pressured to develop various insulin delivery options including oral route to maintain their market positions. In the OAD segment, we predict that more new improved insulin sentisizers would enter the market, offering a better option to the Type 2 diabetics.
Other exciting advances are also happening. One is called the Islet Cell Transplant which is a new technique has shown promise in people with Type 1 Diabetes. Called the 'Edmonton' technique, the transplants have resulted in seven patients becoming insulin free for up to 14 months after treatment. Clinical trials are now underway to see if the insulin reversal can be successful.
The Edmonton technique uses islet cells (cells from the pancreas) from two or more donor pancreases. The cells are transplanted into a person with diabetes and then special medications are given to prevent rejection of the new cells. One difficulty with the transplants is that even though a person may become free of the need to take insulin, the medications to prevent rejection of new tissue must be taken for a lifetime. These medications have side effects.
The decoding of the human genome of course is a monumental achievement and offers tremendous hope for diabetics. Scientists have identified a gene called SHIP2 that seemingly regulates insulin. Other studies are being conducted as possible gene therapy for diabetic retinopathy.
Another eureka in the world of diabetes medication is the creation of a drug, a peptide that actually can stop the destruction of pancreatic beta cells in humans. This possibly could prevent type 1 diabetes in people at high risk and help slow the progress of diabetes for those already diagnosed with it. Additional research, promising data, successful clinical studies..all in all the future of diabetes treatment indeed looks very promising for sufferers and obviously offers lucrative revenues for the innovators and manufacturers
By Chew Li Sa, Industry Analyst
Frost & Sullivan, Healthcare Asia Pacific
The Pan Asian Overview: Snapshot of Incidence and Market Revenue
Diabetes affects at least 140 million people worldwide, and Pan Asia has the highest prevalence. In 2000, this region was believed to have at least 96.0 million diabetics and by 2010, the number of diabetes patients is expected to reach 139.0 million. India topped the highest number of diabetic patients with 24 million cases, followed by China with 22 million diabetics. Despite the high incidence rate however, diagnosis rates are relatively low; it is estimated that in this region, only 50 percent of the estimated number of diabetic patients are undergoing treatment, that is, about 46 million patients. In this entity, approximately 10 percent of the total diabetes cases belong to the Type 1 category while 90 percent belong to Type 2 category. While the incidence of Type 1 diabetes is predicted to remain stable, Type 2 diabetes is expected to increase due to the increasing influence of western lifestyles and rapid urbanization in this region.
In terms of market revenue for 2002, Frost & Sullivan predicts the total Pan Asian diabetes medication market to reach up to $1.77 billion, with the growth rate predicted at 10.3 percent. There are two main product lines in diabetes medication, namely insulin and oral anti diabetics (OAD). The insulin market accounts for 32 percent of these revenues while OAD make up the remaining 68 percent. Most countries in this region posted growth rates between 15 percent and 20 percent (with the exception of Japan as it recorded a low growth rate of only 3 percent due to market saturation). The high overall growth rate was due to flourishing markets in the other nations. By 2007, the market revenue for diabetes medication in Pan Asia is forecasted to reach $2.85 billion, with the compounded annual growth rate (CAGR) from 2001 to 2007 registered at 10.1 percent.
Chart 1
Revenue forecasts for the Pan Asian diabetes medication market from 1997 to 2007.
THE DIABETES DABBLERS
The key market players in the Pan Asia diabetes medication are mainly the multinationals. In Australia, Hong Kong, Malaysia, and Singapore, multinational companies such as Novo Nordisk, Servier, and MSD dominates the market while the local companies are mainly generic manufacturers. In Japan, South Korea, Taiwan, China, and India, both these multinationals and local companies such as Takada Chemical, Yamanouchi and YSP are equally dominant industry participants, especially in the OAD market segment. In fact in Japan, India, and South Korea, local companies have a higher market share than their multinational counterparts. Market leaders in Asia however are Novo Nordisk and Takeda. Other new entrants are GlaxoSmithKline and Novartis. These two companies are infact the innovators of the new OAD (Oral Anti Diabetics) segment. GlaxoSmithKline introduced Avandia (rosiglitazone) to Pan Asia countries in early 1999, while Novartis introduced Starlix (nateglinide) for type 2 diabetes
Chart 2
Total Diabetes Medications Market: Market Share by Companies (Pan Asia), 2002
DIZZYING INNOVATIONS
It is pertinent to highlight that the diabetes medication market had actually been stagnant for at least three decades! The new advances in knowledge, medication and technology however in diabetes management, approximately since 1995, is quite dizzying really. The only kinds of medication available before was insulin and classes of drugs known as sulfonylureas and the biguanides but since then new classes of medications have been introduced to the market to lower blood sugar including a newer generation of sulfonylureas, coupled with major advances in insulin treatments.
In the insulin market segment for eg, the first analogue insulin, (Humalog) introduced by Eli Lilly in 1998, had resulted in increased revenues in countries such as Australia, India, Malaysia, and Singapore. Humalog is a shorting acting insulin class which claimed to more effective than the regular human insulin, in that it provided better glycemic control, especially at mealtimes. Additionally, it was also observed that there was an increasing trend of adopting early insulin therapy among Type 2 diabetics. The concept of “early” insulization among Type 2 diabetics is believed to prevent late complications in diabetes and hopefully prolong the survival period for patients. Obviously this is another niche sector that the insulin manufacturers should focus on very closely.
Similarly, Novo Nordisk had introduced a short acting analogue insulin in Japan, Australia, India, and other markets in this region, to compete with Eli Lilly. Another new player in the block, Aventis is expected to compete in the analogue insulin market, with its latest long acting analogue insulin. This is the first insulin of its kind, as the long acting feature allows consistent gylcemic control for 24 hours, which is ideal for diabetic patients with nocturnal hypoglycemia complications. This is anticipated to path a lucrative pathway for manufacturers to tap into the Type 2 diabetic market, as comparable to the regular insulin.
In the OAD (oral antidiabetics) segment, market leader Takeda formed an alliance with Novo Nordisk to distribute Novonorm (the first insulin sentisizer) in Japan in the third quarter of 2001. As Takada has long dominated the Japanese OAD market, this alliance actually allowed Novo Nordisk a strategic opportunity to tap into the Japanese OAD market. The most exciting trend in the Pan Asian OAD market was when, a new class of treatment known as the glitazones was introduced in 1999 to offer even better glycemic control for Type 2 diabetics. Here the compounds work on improving insulin resistance; another concept that is closely related to prevent late complications of diabetes. This marked the birth of Avandia by Glaxo SmithKline. GSK successfully launched Avandia in most parts of Pan Asia like China, India, South Korea, Singapore, Malaysia and Taiwan and gained significant market share within two years. Another market player, Novartis introduced Starlix, another type of insulin sentisizer., which is already available in Singapore and the Philippines. Starlix is chemically different from other compounds as it can normalize mealtime glucose spikes. Due to its fast and short acting feature, it has minimal chances of causing hypoglycemia, which is one of the constant problems reported by many Type 2 diabetics at mealtimes. Frost & Sullivan strongly believes that the Pan Asia diabetes medication market will continue pressuring manufacturers to offer new products in an effort to gain market share. Hence, the total market is expected to grow rapidly.
DIABETIC OR DYNAMIC PROFITS FOR THE INNOVATORS ?
These new launches infact did spur market growth in the Pan Asia region. New innovations definitely were and are promising but the real challenge however is whether the manufacturers would be able to compete and ensure profits and a lucrative ROI. All in all, there are a couple of factors that will pose as major hurdles in the Pan Asian markets
One frustrating hurdle is that there is still a preference for the older drug generations (such as the glibenclamide, and the metformins) in the Pan Asia market due to several factors. One reasons forwarded on why physicians still prescribe this class of drugs is the fact that the older products are much lower in cost and also have had a long established proven clinical data. This has indeed made changing physicians’ mindset quite a challenge. In this aspect, manufacturers need to aggressively and continuously provide new clinical findings of new drugs to turn over this perception. Additionally, continuous medical education for the physicians need to be emphasized to influence the prescriptions patterns of the physician so that they understand issues such as benefits of early insulin therapy, insulin resistance etc.
Another influential negative impact on market revenues would be the rapid mushrooming of generic products. Generic manufacturers are gaining market recognition especially in older OAD products such as, sulphonylureas, biguamides, etc. Since late 1997, the generic market share has increased significantly. This is due to the low purchasing power triggered by the financial crisis in this region resulting in popularizing generic substitutes. In 2002, most generic companies recorded at least a 30 percent growth rate. The market share of the older generations of generics has increased significantly between 10 percent and 20 percent. This may reduce market attractiveness and restrain growth for the branded drugs.
Additionally Frost & Sullivan also noted that in most national health insurance-reimbursed markets such as Australia, South Korea, Japan and Taiwan, the governments have recently embarked on newer measures to remain profitable. Initially, most of them had undertaken huge reimbursement expenses because at least 90 percent of their respective population were being heavily subsidized in health bills. In the diabetes medication expenses, especially the OAD products, sulphonylureas and metformin are preferred over newer agents due to affordability reasons. In Taiwan, the policy makers are constantly revamping their annual strategy for tighter drug purchase control to ensure profitability. Their latest measure is by imposing the requirements for pharmaceutical companies to implement an annual revision on the drug prices if their respective drugs were to remain in the reimbursement listing. Then, in July 2002, they fixed an annual drug spending budget allocated to each hospital, which meant that hospitals are now in charge of their own drug spending.
In Japan, the National Health Insurance reduced the drug reimbursement scheme by 7 percent in 2000 and encouraged co-payments by patients. This resulted in greater sales of cheaper products and physicians were encouraged to prescribe older products. Similarly the Australia national insurance council has plans to switch to cheaper drugs in order to cut expenses. The council has plans to shift physicians’ prescriptions to generic brands, and at the same time would implement co-payments by patients.
These policies and price control measures have reduced companies’ continued interest and indulgence in this market. The resulting crisis is that new products are facing extreme difficulties in penetrating the market due to its high prices. For now, this factor only poses a moderate impact on the market, as most governments have only begun implementing and fine-tuning their healthcare policies. But in the long run, this may pose quite a formidable threat to market development.
Last but not least, cost is a major factor. As manufacturers spend enormous R&D dollars in innovations, timing for ROI is critical. Many of them had market these new innovations few times higher than the classic drugs. For example, Avandia is known to be priced at 4 times the price of Daonil (a popular sulphonylyrea) in many Asian markets. Many physicians hence are hesitant to expand their prescriptions volume and in some cases, even refused to prescribe! In many markets, new innovations were only used as a second or third option when older drugs fail in alleviating the pain and torment of the diabetics. Manufacturers should seriously concentrate on shifting the mindset of the physicians.
NEW HORIZONS FOR DIABETES
What lies ahead in the Pan Asia diabetes medication market? With the promising biotechnology achievements, multinationals are racing to offer better treatment options, if not, a cure to diabetes. The long awaited changes in drug delivery methods are finally happening in the insulin market. One of the biggest restrictions in many insulin markets is due to its injection form. In fact this has prevented insulin to realize its fullest commercial potential in the far larger market segment; the Type 2 diabetes. In years to come, non-injectable insulin will open up the lucrative Type 2 diabetes market for insulin manufacturers. Leading the race now is another multinational, Pfizer, which had formed a joint venture with Inhale Therapeutic Systems and Avnet to product inhalable insulin products. The product is expected to be introduced to Pan Asia within a couple of years which will surely revolutionize the industry, promising tremendous growth. Existing manufacturers such as Novo Nordisk and Eli Lilly are equally pressured to develop various insulin delivery options including oral route to maintain their market positions. In the OAD segment, we predict that more new improved insulin sentisizers would enter the market, offering a better option to the Type 2 diabetics.
Other exciting advances are also happening. One is called the Islet Cell Transplant which is a new technique has shown promise in people with Type 1 Diabetes. Called the 'Edmonton' technique, the transplants have resulted in seven patients becoming insulin free for up to 14 months after treatment. Clinical trials are now underway to see if the insulin reversal can be successful.
The Edmonton technique uses islet cells (cells from the pancreas) from two or more donor pancreases. The cells are transplanted into a person with diabetes and then special medications are given to prevent rejection of the new cells. One difficulty with the transplants is that even though a person may become free of the need to take insulin, the medications to prevent rejection of new tissue must be taken for a lifetime. These medications have side effects.
The decoding of the human genome of course is a monumental achievement and offers tremendous hope for diabetics. Scientists have identified a gene called SHIP2 that seemingly regulates insulin. Other studies are being conducted as possible gene therapy for diabetic retinopathy.
Another eureka in the world of diabetes medication is the creation of a drug, a peptide that actually can stop the destruction of pancreatic beta cells in humans. This possibly could prevent type 1 diabetes in people at high risk and help slow the progress of diabetes for those already diagnosed with it. Additional research, promising data, successful clinical studies..all in all the future of diabetes treatment indeed looks very promising for sufferers and obviously offers lucrative revenues for the innovators and manufacturers
Sabtu, 09 Agustus 2008
Masih Belajar Tentang Blog
Selamat datang ke blog saya.
Blog ini masih dalam tahap pembenahan, karena saya pun masih baru dalam dunia blog.
Maaf atas tampilannya yng masih apa adanya.
Tapi thx guys, ini posting pertama saya.
Salam kenal yagch.
Sering sering mampir donk...
Blog ini masih dalam tahap pembenahan, karena saya pun masih baru dalam dunia blog.
Maaf atas tampilannya yng masih apa adanya.
Tapi thx guys, ini posting pertama saya.
Salam kenal yagch.
Sering sering mampir donk...
Jumat, 08 Agustus 2008
New Diabetes Medication: Walking!
A study done by Newcastle University has shown that a 45 minute daily walk can help to control diabetes. Dr Michael Trenell and Prof Roy Taylor led the research, which found that people with Type 2 diabetes who walk regularly can reduce some of the negative effects of diabetes.
In the study, published in the journal Diabetes Care, ten people with Type 2 diabetes were paired with a control group who didn't have diabetes. Each person was given a pedometer and asked to walk over 10,000 steps a day. The researchers found that walking for an extra 45 minutes daily meant that the people with diabetes burnt 20% more fat - improving their muscles' ability to store sugar, which helps to control the diabetes.
Dr Trenell, who led the study, said:
What is exciting about this study is that it provides an immediate way to help control diabetes without any additional drugs. By building physical activity into everyday life the difficulty of making time to go out just for exercise is avoided. It is an important and simple health message - walking 45 minutes extra a day helps diabetes.
Other Benefits of Walking
The sample size in the study was very small, and would warrant further research before firm conclusions are drawn about managing diabetes with a daily walk. But the wider benefits of walking - for those with diabetes and those without - are well-attested. If you're yet to establish the habit of walking every day, remember that walking can:
Help you to lose weight, or maintain weight loss
Reduce your percentage of body fat
Increase bone density
Lower your blood pressure
Help with mild depression
Make you more flexible
And walking is one of the best exercises you can do, because:
It doesn't cost anything
You don't need any special clothes or kit
If you're very overweight, you can just walk slowly for a few minutes
Friends and family can easily join you on a walk
You can walk anywhere: cities, countryside, inside shopping malls...
One of the most common reasons given for not exercising is lack of time, but there's really no excuse for not fitting walking into your day. As Dr Trenell says,
What we've found is that nearly everyone with diabetes is able to become more active through walking. In our study many people got off the bus a few stops earlier and some took a walk at lunchtime.
Has walking helped you to stay fit, lose weight, or manage diabetes? Do you have any great walking tips to share?
(from: http://www.diet-blog.com/archives/2008/07/30/new_diabetes_medication_walking.php)
In the study, published in the journal Diabetes Care, ten people with Type 2 diabetes were paired with a control group who didn't have diabetes. Each person was given a pedometer and asked to walk over 10,000 steps a day. The researchers found that walking for an extra 45 minutes daily meant that the people with diabetes burnt 20% more fat - improving their muscles' ability to store sugar, which helps to control the diabetes.
Dr Trenell, who led the study, said:
What is exciting about this study is that it provides an immediate way to help control diabetes without any additional drugs. By building physical activity into everyday life the difficulty of making time to go out just for exercise is avoided. It is an important and simple health message - walking 45 minutes extra a day helps diabetes.
Other Benefits of Walking
The sample size in the study was very small, and would warrant further research before firm conclusions are drawn about managing diabetes with a daily walk. But the wider benefits of walking - for those with diabetes and those without - are well-attested. If you're yet to establish the habit of walking every day, remember that walking can:
Help you to lose weight, or maintain weight loss
Reduce your percentage of body fat
Increase bone density
Lower your blood pressure
Help with mild depression
Make you more flexible
And walking is one of the best exercises you can do, because:
It doesn't cost anything
You don't need any special clothes or kit
If you're very overweight, you can just walk slowly for a few minutes
Friends and family can easily join you on a walk
You can walk anywhere: cities, countryside, inside shopping malls...
One of the most common reasons given for not exercising is lack of time, but there's really no excuse for not fitting walking into your day. As Dr Trenell says,
What we've found is that nearly everyone with diabetes is able to become more active through walking. In our study many people got off the bus a few stops earlier and some took a walk at lunchtime.
Has walking helped you to stay fit, lose weight, or manage diabetes? Do you have any great walking tips to share?
(from: http://www.diet-blog.com/archives/2008/07/30/new_diabetes_medication_walking.php)
Selasa, 05 Agustus 2008
Oral Diabetes Medications (Diabetes Pills)
Oral diabetes medications help control blood glucose levels in people whose bodies still produce some insulin (the majority of people with type 2 diabetes). These diabetes medicines are usually prescribed to people with type 2 diabetes along with recommendations for making specific dietary changes and getting regular exercise. Several of these diabetes pills are often used in combination to achieve optimal blood glucose control.
Remember that people with type 2 diabetes tend to have two problems that lead to increased glucose in the bloodstream:
They don't make enough insulin to move glucose into cells where it belongs.
The body's cells become "resistant" to insulin ( insulin resistance), meaning they don't take in glucose as well as they should.
In time, people with type 2 diabetes develop what's called "beta-cell failure." This means that the cells in the pancreas that make insulin no longer are able to release insulin in response to high blood glucose levels. Therefore, these people often require insulin injections, either in combination with their oral diabetes medications, or just insulin alone to manage their diabetes.
What Types of Oral Diabetes Medications Are Available?
Oral diabetes medicines are grouped in categories based on type. There are several categories of oral diabetes medications -- each works differently.
Sulfonylureas. These diabetes pills lower blood glucose by stimulating the pancreas to release more insulin. The first drugs of this type that were developed -- Dymelor, Diabinese, Orinase and Tolinase -- are not as widely used since they tend to be less potent and shorter acting drugs than the newer sulfonylureas. They include Glucotrol, Glucotrol XL, DiaBeta, Micronase, Glynase PresTab and Amaryl. These drugs can cause a decrease in the hemoglobin A1c ( HbA1c) of up to 1%-2%.
Biguanides. These diabetes pills improve insulin's ability to move glucose into cells especially into the muscle cells. They also prevent the liver from releasing stored glucose. Biguanides should not be used in people who have kidney damage or heart failure because of the risk of precipitating a severe build up of acid (called lactic acidosis) in these patients. Biguanides can decrease the HbA1c 1%-2%. Examples include metformin (Glucophage, Glucophage XR, Riomet, Fortamet and Glumetza).
Thiazolidinediones. These diabetes pills improve insulin's effectiveness (improving insulin resistance) in muscle and in fat tissue. They lower the amount of glucose released by the liver and make fat cells more sensitive to the effects of insulin. Actos and Avandia are the two drugs of this class. A decrease in the HbA1c of 1%-2% can be seen with this class of oral diabetes medications. These drugs may take a few weeks before they have an effect in lowering blood glucose. They should be used with caution in people with heart failure. Your doctor will do periodic blood testing of your liver function when using this diabetes medicine.
Alpha-glucosidase inhibitors, including Precose and Glyset. These drugs block enzymes that help digest starches, slowing the rise in blood glucose. These diabetes pills may cause diarrhea or gas. They can lower hemoglobin A1c by 0.5%-1%.
Meglitinides, including Prandin and Starlix. These diabetes medicines lower blood glucose by stimulating the pancreas to release more insulin. The effects of these oral diabetes medications depend on the level of glucose. They are said to be glucose dependent. High sugars make this class of diabetes medicines release insulin. This is unlike the sulfonylureas that cause an increase in insulin release, regardless of glucose levels, and can lead to hypoglycemia.
Dipeptidyl peptidase IV (DPP-IV) inhibitors, including Januvia. The DPP-IV inhibitors (Januvia) work to lower blood sugar in patients with type 2 diabetes by increasing insulin secretion from the pancreas and reducing sugar production. These diabetes pills increase insulin secretion when blood sugars are high. They also signal the liver to stop producing excess amounts of sugar. DPP-IV inhibitors control glucose without causing weight gain. The medication may be taken alone or with other medications such as metformin.
Combination therapy. There are several combination diabetes pills that combine two medications into one tablet. One example of this is Glucovance, which combines glyburide (a sulfonylurea) and metformin. Others include Metaglip, which combines glipizide (a sulfonylurea) and metformin, and Avandamet which utilizes both metformin and rosiglitazone (Avandia) in one pill.
Studies have been done showing that some oral diabetes medications may help prevent diabetes and diabetes-related complications. Both metformin and Precose have been shown to reduce a person's risk of developing type 2 diabetes, particularly when combined with lifestyle changes such as a proper diet and regular exercise program. Actos has been shown to reduce the risk of heart attack, stroke and premature death in those with type 2 diabetes. Researchers continue to look into the preventative benefits of other medications.
(from: http://diabetes.webmd.com/guide/oral-medicine-pills-treat-diabetes)
Remember that people with type 2 diabetes tend to have two problems that lead to increased glucose in the bloodstream:
They don't make enough insulin to move glucose into cells where it belongs.
The body's cells become "resistant" to insulin ( insulin resistance), meaning they don't take in glucose as well as they should.
In time, people with type 2 diabetes develop what's called "beta-cell failure." This means that the cells in the pancreas that make insulin no longer are able to release insulin in response to high blood glucose levels. Therefore, these people often require insulin injections, either in combination with their oral diabetes medications, or just insulin alone to manage their diabetes.
What Types of Oral Diabetes Medications Are Available?
Oral diabetes medicines are grouped in categories based on type. There are several categories of oral diabetes medications -- each works differently.
Sulfonylureas. These diabetes pills lower blood glucose by stimulating the pancreas to release more insulin. The first drugs of this type that were developed -- Dymelor, Diabinese, Orinase and Tolinase -- are not as widely used since they tend to be less potent and shorter acting drugs than the newer sulfonylureas. They include Glucotrol, Glucotrol XL, DiaBeta, Micronase, Glynase PresTab and Amaryl. These drugs can cause a decrease in the hemoglobin A1c ( HbA1c) of up to 1%-2%.
Biguanides. These diabetes pills improve insulin's ability to move glucose into cells especially into the muscle cells. They also prevent the liver from releasing stored glucose. Biguanides should not be used in people who have kidney damage or heart failure because of the risk of precipitating a severe build up of acid (called lactic acidosis) in these patients. Biguanides can decrease the HbA1c 1%-2%. Examples include metformin (Glucophage, Glucophage XR, Riomet, Fortamet and Glumetza).
Thiazolidinediones. These diabetes pills improve insulin's effectiveness (improving insulin resistance) in muscle and in fat tissue. They lower the amount of glucose released by the liver and make fat cells more sensitive to the effects of insulin. Actos and Avandia are the two drugs of this class. A decrease in the HbA1c of 1%-2% can be seen with this class of oral diabetes medications. These drugs may take a few weeks before they have an effect in lowering blood glucose. They should be used with caution in people with heart failure. Your doctor will do periodic blood testing of your liver function when using this diabetes medicine.
Alpha-glucosidase inhibitors, including Precose and Glyset. These drugs block enzymes that help digest starches, slowing the rise in blood glucose. These diabetes pills may cause diarrhea or gas. They can lower hemoglobin A1c by 0.5%-1%.
Meglitinides, including Prandin and Starlix. These diabetes medicines lower blood glucose by stimulating the pancreas to release more insulin. The effects of these oral diabetes medications depend on the level of glucose. They are said to be glucose dependent. High sugars make this class of diabetes medicines release insulin. This is unlike the sulfonylureas that cause an increase in insulin release, regardless of glucose levels, and can lead to hypoglycemia.
Dipeptidyl peptidase IV (DPP-IV) inhibitors, including Januvia. The DPP-IV inhibitors (Januvia) work to lower blood sugar in patients with type 2 diabetes by increasing insulin secretion from the pancreas and reducing sugar production. These diabetes pills increase insulin secretion when blood sugars are high. They also signal the liver to stop producing excess amounts of sugar. DPP-IV inhibitors control glucose without causing weight gain. The medication may be taken alone or with other medications such as metformin.
Combination therapy. There are several combination diabetes pills that combine two medications into one tablet. One example of this is Glucovance, which combines glyburide (a sulfonylurea) and metformin. Others include Metaglip, which combines glipizide (a sulfonylurea) and metformin, and Avandamet which utilizes both metformin and rosiglitazone (Avandia) in one pill.
Studies have been done showing that some oral diabetes medications may help prevent diabetes and diabetes-related complications. Both metformin and Precose have been shown to reduce a person's risk of developing type 2 diabetes, particularly when combined with lifestyle changes such as a proper diet and regular exercise program. Actos has been shown to reduce the risk of heart attack, stroke and premature death in those with type 2 diabetes. Researchers continue to look into the preventative benefits of other medications.
(from: http://diabetes.webmd.com/guide/oral-medicine-pills-treat-diabetes)
What Are The Symptoms Of Type 2 Diabetes
Type 2 diabetes, which is sometimes called non-insulin dependent diabetes, is a condition that develops over time. Your body becomes resistant to the effects of insulin resulting in increased blood sugar levels. Family history of diabetes and obesity are two of the biggest risks factors for developing type 2 diabetes.
Insulin is a hormone that is produced by the pancreas. Normally, insulin levels fluctuate in relation to the amount of glucose in your body. The level will increase after eating and decrease if no food is being consumed. The main function of insulin is to move the glucose to various destinations throughout your body. If you have more glucose than your body needs, the excess will be stored in the liver, where it will be released as needed. It is a complex balance between the pancreas, liver, insulin and glucose.
In type 2 diabetes one of two things can occur. Your pancreas will stop producing the needed levels of insulin or your body will become resistant to insulin. In both cases, the result will be high blood sugar levels.
Your body has ways of telling you when something is wrong. It is important that you know the symptoms of type 2 diabetes because, the sooner treatment starts, the less damage will be done to your body. The following paragraphs will give you an idea of what to look for in type 2 diabetes.
Extreme fatigue is often an overlooked symptom of type 2 diabetes. This is probably due to the fact that it is such a general symptom and is associated with other factors such as busy lifestyle, not getting enough sleep or stress. However, if you always feel tired and sleepy, even after a good night's sleep, you should see your doctor.
A drastic change in weight is a good indicator of diabetes. You may eat more because you are feeling hungry all the time. This will result in weight gain. Excess fat in the tissues causes your body to become even more resistant to the effects of insulin. The opposite is true also. You may eat more than normal but start losing weight. This is due to the fact that your muscles don't get enough glucose to exert energy or grow.
Blurry vision is another sign of diabetes. High blood sugar levels will pull fluid from tissues. This includes the lenses of the eye, making it very difficult to focus. Most vision problems will be resolved once the diabetes is treated. However, in a few cases, blindness can result from diabetes, especially if it is left untreated.
Another symptom of type 2 diabetes is frequent infections or slow healing infections and cuts. Diabetes interferes with the healing process. Increased incidences of yeast infections is a big indicator of type 2 diabetes.
If you notice that your gums are becoming red, swollen and inflamed you need to see your doctor. Diabetes will increase the risk of developing infections in your gums and in the bones that hold your teeth in place.
Your body is an amazing , complex machine. Listen to what it has to say. If you are experiencing any of the above symptoms, see your doctor right away. The sooner treatment begins for type 2 diabetes, the sooner your life can return to normal.
Sometimes the best offense against diabetes is a good defense.
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