In my last blog I made reference to some new drugs that are entering the diabetes domain. Dapagliflozin, or Forxiga, is a new oral medication, and it is described as a sodium glucose cotransporter. (A second similar drug, Canagliflozin is yet to be approved for the American market; the decision is due at the end of this month).
In simple terms, the drug acts on the kidneys, so that more glucose is excreted in the urine. Obviously this is quite a change to the current oral drugs we use, which all act on the digestive process in some way.
I have managed to get myself a place on one of the launch events for dapagliflozin in London, so it will be very interesting to hear what the manufacturers have to say about it.
There are downsides as always with the likely side-effects caused by the high levels of glucose in the urine, such as vulvovaginitis, balanitis, and urinary tract infections. Let’s not forget that it should also enhance weight loss, a bonus when you consider the struggles many of those with diabetes constantly grapple with.
The Scottish Intercollegiate Guidelines Network (SIGN) has approved the drug for restricted use, but the National Institute for Health and Clinical Excellence (NICE) is particularly concerned about the possible effects on long-term renal function, so their guidance will not be available until June this year.
I think we need to move cautiously and follow the leads of the diabetes experts in how we use this class of drug. How many of us now use both the DPP4 inhibitors (glptins) and the GLP1s or incretin mimetics (exenatide/liraglutide)? A new member of the latter class Lixisenatide should soon now be available for us to use.
I have found the DPP4 class normally work well, but I am particularly enthusiastic about the GLP1 group. With their resulting weight loss and decrease in Hba1c, they are well worth having around, as long as patients can get past the side effects of extreme nausea. These drugs have the advantage that they do not induce hypoglycaemia, except if used alongside Insulin, where care must be shown.
Delgudec is a new long-acting insulin which Novo Nordisk have recently launched in the UK. It’s brand name is Tresiba and is claimed to have a duration of action over 42 hours, so would only need to be injected three times weekly. Degludec has been combined with novo rapid (insulin aspart) to create Ryzodeg, also to provide both fasting and post-prandial glucose control in one injection.
There is always something new around the corner in the world of diabetes, not only in terms of medications but also in technology. There are insulin pumps, which a growing number of people with type 1 diabetes now possess (although cost does limit their use).
Also, there are some amazing blood glucose meters such as the Insulinx, which helps patients to calculate their carbohydrate intake versus insulin dosage, and is proving very popular. Nurses working with such patients need a little training/guidance to that they can give adequate support to patients using these meters.
Diabetes itself seems to become more complex and there is an ever-increasing variety of drug therapy available. This is certainly no time for complacency.
Watch out for free updates; many free ones are offered online. If you can’t make it to meetings or conferences, there are web-based lectures and discussions to tap into to help you.
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