It is a known fact that diabetes cannot be cured but it can be managed effectively for decades. Apart from the cost of tests and medicines, the biggest downside is that you have to take medicines and insulin injections - very often four in a day - for the rest of your life.
New generation of safer, more effective diabetes medicines and treatments now use long-lasting insulin analogues (a chemical compound similar to the hormone insulin) to control glucose fluctuations in the blood of the patient.
Over the past five years, three diabetes treatments have been approved: exenatide injection (injected twice a day at mealtime by people with type-2 diabetes with poor blood glucose control), pramlintide injection (as an add-on to insulin therapy to lower blood glucose spikes and food intake) and sitagliptin, saxagliptin, and linagliptin (taken once a day to release insulin over a longer period of time).
"None of these drugs are a panacea but help, in combination with each other, to customise treatment to individual needs and treat those whose diabetes cannot be controlled with conventional drugs such as metformin or glitazone used to regulate blood sugars," says Dr Ambrish Mithal, chairman, endocrinology and diabetes, Medanta - the Medicity.The injections - exenatide and pramlintide - also cause weight loss.
Around 65 million people have diabetes in India, with the number expected to grow to 100 million by 2030. This makes the diabetes drug market as one of the fastest growing pharmaceutical segments in India, currently valued at around Rs 5,000 crore. It is expected to be valued at Rs 6,500 crore by 2015, an annual growth of 30%.
In the pipeline
Currently, two new classes of drugs are in the final stages of getting Drug Controller General of India (DCGI) approval and are expected to hit the market within six months.
Among them is a sodium-glucose co-transporter-2 (SGLT2) inhibitor called gliflozin. It is an oral medication to be taken once a day with or without meals and is used for treating type-2 diabetes.
"SGLT2 inhibitors block glucose reabsorption in the kidney, increase glucose excretion, and lower blood glucose levels," says Mithal. "These were approved in the US and EU in 2013. Insulin degludec, an ultra-long-acting basal insulin, is the other. It's a convenient option for people who need flexibility in adhering to an insulin regimen for reasons such as frequent travel," says Mithal.
Globally, drug development is moving at a break-neck speed. Ongoing research has the potential of keeping diabetes at bay for a long duration.
Salk's Gene Expression Lab announcing earlier this year that injecting the protein FGF1 restored the blood sugar levels to within normal range for more than two days without side effects.
Sustained treatment with the protein didn't just keep blood sugar under control, but also reversed insulin insensitivity, the underlying physiological cause of diabetes without side effects, report researchers in the acclaimed science journal Nature.
"Since type-2 diabetes is progressive, therapies need to be changed often as it may lose its effectiveness over time. For example, some people with type-2 diabetes start with oral medications, and then move to insulin for more control," says Dr Sujeet Jha, head of endocrinology at Max Super Speciality Saket, New Delhi."Prevention, which includes a healthy diet and physical activity, is the way ahead, but it requires effort. The choices are there; we just have to nudge people towards choosing right," says Mithal.