Ask the Pharmacist
by Ron & Marla Chapleau

April 3, 2016


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Q) I understand there have been some new diabetic medications released on the market. What can you tell me about them?

A) There have been three “new” diabetic medications that have appeared on the Canadian scene over the last few months, perhaps reflecting the ever increasing incidence in our aging population.

According to the Canadian Diabetes Association, there are currently 3.4 million Canadians (9.3% of the population over the age of 20) who have been diagnosed with diabetes and another 5.7 million (22.1% of the same population) who are in what is termed a pre-diabetic state. This same association estimates these numbers will rise by the year 2025 to 5 million and 6.4 million respectively, a 44% increase.

 Whether these numbers are exaggerated or not, it’s hard to argue that Canada (as are the U.S. & Europe) is in the midst of a diabetic crisis that has not yet crested and drug companies are both paying attention and hoping to profit from it.

Unfortunately, like many other recent additions to our medical arsenal, these 3 agents aren’t really all that new. They are just the newest members to 2 pre-existing families of drugs so that while they may meet a niche for some patients, they are collectively far from a new breakthrough.

The first two drugs are called Trulicity (dulaglutide) and Bydureon (exenatide ER) and they belong to the drug family known as the glucagon-like peptide-1 agonists (Glp-1). This family (which also includes Victoza (liraglutide) and Byetta (exenatide)) helps treat type 2 diabetes by stimulating insulin release after eating, reducing the production of glucagon (which raises blood sugars), slowing down the emptying of our stomach and increasing the sensation of being full. The long and short of these four mechanisms is that these drugs can be expected to lower blood sugars and lead to weight loss. It is this latter fact that is leading to the increasing popularity of this family as so many of the other diabetic options can contribute to weight gain, a massive challenge for many diabetics to begin with.

 The other claim to fame for this family is that they show little potential to make your blood sugars to go too low, thus making them possibly a safer option for those diabetics whose sugars are prone to crashing suddenly putting their health in jeopardy. One of the downsides of this family is that they must be self injected rather than taken orally as most other diabetic drugs can be.

This is where Trulicity and Bydureon offer a significant advantage over the older two members. These two drugs need only be injected once weekly whereas Victoza require a once daily administration and Byetta need to be injected twice a day.

Side effects tend to be similiar (nausea- especially with Byetta which tends to fade with time, rarely pancreatitis, potential for worsening of kidney function and a possible association with thyroid C-cell tumors which has only been demonstrated in rodents but bears watching nonetheless) as does effectiveness (they all reduce A1C (the standard measurement of sugar lowering) effectiveness by 1.5 % except for Byetta which tends to lower it by 1%).

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Cost is an issue for all four as Byetta goes for about $150/ month, Trulicity and Bydureon for $150/ month and Victoza is priced at $270/ month.

All of these drugs are considered add-ons, meaning they should not be used to control diabetes on their own.

The other new entry onto the diabetic market is Basaglar which is a new version of insulin glargine. This is the same form of insulin as Lantus and as such, Basaglar is simply an alternative to its pre-existing competitor.

These insulins (along with Levemir) provide what is known as basal levels of insulin. This means that a single injection of any of these three will provide a low level of insulin for a 24 hour period much like our body continually produces low levels until it cranks up the insulin levels to deal with the sugar surge that comes with consuming food or beverages. It c an be used in either type of diabetes and both on its own or (more likely) with other pills or shorter acting insulins.

 Basaglar has similar sugar lowering capabilities and hypoglycemic risk as its alternatives so its attempt to differentiate itself comes down to price. Basaglar costs about $17 per cartridge as compared to $20 for Lantus and $23 for Levemir.

So while none of these three new drugs can be considered a true game changer in the management of diabetes, they do offer the potential for benefits either in the form of cost savings or convenience.

For more information about this or any other health related questions, call the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination in Kincardine and Port Elgin Pharmasave.

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Sunday, April 03, 2016