Inhalers may replace needles in diabetes breakthrough
Wednesday, March 30, 2005
In the eight decades since Canadian scientists developed a life-saving treatment for diabetes, sufferers have always had to inject insulin to control blood sugar. While monitoring and treatment have improved and needles are smaller, the bothersome injections, several times a day, have remained a mainstay of life as a diabetic. But that could soon change. Drug companies are preparing to unveil inhaled insulin, a powdered form of the drug that is taken with an inhaler similar to those used by asthmatics. The product, which has been extensively tested, could revolutionize diabetes treatment and shake up the $3-billion (U.S.) annual market for injection insulin. “I think this would rank as one of the biggest developments since the discovery of insulin,” said Dr. Ronnie Aronson, an endocrinologist and director of the Lifestyle Metabolism Centres, a Toronto-based weight-loss centre that caters to diabetics. Patients, for their part, are awaiting the new drug impatiently. “I would pick inhaled over injected any day,” said Meegan de Bock, a 23-year-old retail worker from Sarnia, Ont. For two years, she was part of a clinical trial that allowed her to drop needles and use an inhaler, and she loved the change in lifestyle. “Some people freak out about the needle, especially when you take your insulin in public,” Ms. de Bock said. She has injected insulin four times a day for the past decade, after being diagnosed with Type 1 diabetes. (Insulin is a hormone that helps regulate blood sugars usually secreted by the pancreas. In Type 1 diabetes, the body fails to produce insulin. In Type 2, the body’s ability to respond to insulin is weakened. All Type 1 diabetics inject insulin. Type 2 diabetics can control blood sugars with drugs, exercise and by maintaining a healthy weight, but sometimes require injected insulin as well.) Ms. de Bock said inhaled insulin was not only esthetically more pleasing — she hates the needle tracks on her arms and finds the alcohol swabbing before injections dries her skin — but allowed for much better control of her blood sugars. “My sugars were much more stable, and I really liked that.” To date, studies have shown that inhaled insulin works just as well as injected insulin. The main unanswered question is long-term safety of the product. “Like any new therapy, there are some unknowns, like: ‘What is the consequence of inhaling insulin for many years?’ ” said Dr. Bernard Zinman, an endocrinologist at Mount Sinai Hospital in Toronto. Doses of insulin that are inhaled are much greater than those that are injected, and there are concerns lung function could be affected. But many researchers believe those potential risks are more than offset by the fact that inhaled insulin will make it more likely that many patients will treat their diabetes routinely. That is particularly true of Type 2 diabetics, who tend to develop the disease later in life and are more squeamish about needles and more apprehensive about treatment in general. “I personally believe this will be an important therapy for diabetes because it will facilitate managing people with diabetes,” Dr. Zinman said. While a number of drug companies are working on inhaled insulin, the product at the most advanced stage of development is Exubera, a joint effort from the pharmaceutical giants Pfizer Inc. and Sanofi-Aventis SA. They have requested approval from regulatory authorities in Europe to market Exubera, and are expected to do the same in the United States within a year. Companies usually seek approval in Canada after a drug has been marketed in the United States. About 2.25 million Canadians have diabetes, according to the Canadian Diabetes Association. About 90 per cent suffer from Type 2, and the balance have Type 1. Diabetes is one of the leading causes of death in Canada, accounting for about 41,500 deaths annually. Left untreated or improperly managed, the high levels of blood sugars associated with Type 2 diabetes can damage blood vessels, resulting in a host of complications. Diabetes dramatically increases the risk of heart disease and stroke, and it is a leading cause of kidney disease, blindness and amputation. People who are overweight — particularly if they have excess abdominal fat — and have a sedentary lifestyle are at high risk of developing diabetes.
source: globeandmail.com