Welcome to the first blog post of Sestron’s Clinical Research News Room. We are very excited to begin sharing some great resources for information on Clinical Research with you. We will also share related materials regarding medical advances in the treatment of many diseases we are conducting Clinical Trials on here in Marietta, GA. The first article I would like to share comes from Medscape. It covers the some of the greatest game changers in diabetes over the past 20 years.
At Sestron we are conducting clinical trials using the newest medications for the treatment and maintenance of Type 1 and Type 2 Diabetes. We hope these medications will make the list for “Landmarks in Diabetes” for the 21st century.
Editor’s Note: To commemorate Medscape’s 20th anniversary, they asked several experts to describe how the management of diabetes has evolved over the past 20 years.
The discovery of insulin in 1921 and the availability of home blood glucose monitoring in 1981 perhaps represent the greatest advances thus far in the world of diabetes. But in the past 20 years, numerous incremental developments have also remarkably improved the prognosis and quality of life for patients with both type 1 and type 2 diabetes.
“Twenty years ago, every minute of every day there were patients in my lobby with below-the-knee amputations, seeing-eye dogs, or white canes. Today this is so rare, I am convinced that we are only beginning to understand what the natural history of diabetes will be in the 21st century,” says John Buse, MD, PhD, professor of medicine, dean for clinical research, and chief of the Division of Endocrinology at the University of North Carolina School of Medicine, Chapel Hill. In contrast, he says, “The prognosis for a normal lifespan free of disabling complications, I think, is excellent for people living with diabetes today.”
Of course, progress is often cumulative, and the advances over the past 20 years were built on earlier progress, such as the 1993 landmark Diabetes Control and Complications Trial and the Lower Extremity Amputation Prevention (LEAP) program. The former study found that maintaining blood glucose levels as close to normal as possible slowed the organ damage that often occurs in diabetes. The latter study established the use of the monofilament as an easy, in-office test for foot sensation, notes Charles Clark, MD, professor emeritus of medicine and now associate dean for continuing medical education at the Indiana University School of Medicine.
Looking back over the past 20 years, five particular advances stand out for their role in improving the lives of people with diabetes.
Metformin: The Game Changer
In the United States, 2015 marks the 20-year anniversary of the arrival of the first oral medication for type 2 diabetes that does not cause hypoglycemia. Metformin had been available outside the United States for over a decade, but its approval here was delayed while the US Food and Drug Administration (FDA) focused on removing a related but more toxic compound, phenformin, from the market.
Today, metformin still is used as first-line therapy for type 2 diabetes, owing to its relative efficacy, safety, and low price as a generic.
Add-on glucose-lowering medications offer the advantages of weight loss and improved blood pressure levels. In 2005, the FDA approved the first glucagon-like peptide 1 receptor agonist (exenatide), followed in 2006 by the first dipeptidyl peptidase 4 inhibitor (sitagliptin); the first sodium/glucose cotransporter 2 inhibitor (canagliflozin) arrived in 2013.
For type 2 diabetes, the biggest advance is “the sheer number of effective drugs that have been developed within the past 15 years,” says Cyrus Desouza, MBBS, professor and chief of the Division of Diabetes, Endocrinology and Metabolism at the University of Nebraska Medical Center. “Physicians treating type 2 diabetes have never had so many choices and combinations as now,” he continues. “From a patient’s perspective, this has led to better diabetes control and hence decreased microvascular complications.”
Still, lingering long-term safety questions, the high cost, and the moderate (at best) ability of these agents to lower blood glucose mean that there is plenty of room for further innovation in the years to come.
As Dr. Clark sees it, “Once you had metformin, everything else was incremental. Metformin was the game changer.”
Glucose Monitoring and Insulin Pumps
Continuous glucose monitoring (CGM) has revolutionized the care of type 1 diabetes, and it has also allowed for better troubleshooting in some patients with type 2 diabetes. CGM can provide information on daily glucose fluctuations and how those numbers are affected by everyday activities and stress levels. It also plays an integral part in emerging technology billed as an “artificial pancreas,” partnering with continuous sensing technology to form a closed-loop glycemic control system that includes an insulin pump and controlling algorithms.