New drug for diabetes
Improving glycaemic control for people with diabetes can be a convenient, once-a-day routine with the recent launch of a drug in Malaysia.
Developed by MSD, the drug in question is an oral type 2 diabetes medication that combines sitagliptin phosphate with extended-release metformin hydrocloride.
The growing incidence of diabetes represents a major public health challenge in Malaysia.
Diabetes is a chronic and progressive disease that affects approximately 1.9 million people in Malaysia, and 382 million people worldwide.
At least 90% of all cases are type 2 diabetes, in which the body is able to produce insulin, but either this is not sufficient, or the body is unable to respond to its effects (also known as insulin resistance), leading to a build-up of glucose in the blood.
The risk factors for developing type 2 diabetes include obesity, advancing age, family history of diabetes, ethnicity, high blood glucose during pregnancy affecting unborn child, excess body weight and physical inactivity.
The National and Health Morbidity Survey in 2011 (NHMS 2011) reported the national prevalence of diabetes in Malaysia as 15.2%.
The increasing prevalence of diabetes is attributed to increased urbanisation, which is often associated with sedentary lifestyles and obesity.
According to the International Diabetes Federation (IDF)’s latest findings in 2013, diabetes patient population in the Western Pacific Region is expected to increase from 138.2 million to approximately 201.8 million people within 20 years.
In Malaysia, some 24,049 people aged 20–79 died due to diabetes in 2013 alone.
Total healthcare expenditure on diabetes in the region was estimated to be RM88.4bil in 2013.
By 2035, this figure is expected to increase to approximately RM98.4bil annually.
Overall, the global diabetes population is predicted to have an average annual growth of approximately 2%, which is nearly two times the annual growth of the adult population worldwide.
“As type 2 diabetes mellitus is a chronic and progressive disease, many people with diabetes will eventually require multiple medications to help control their blood sugar.
“Fixed-dose combination therapy will help to reduce pill burden and improve compliance,” said senior consultant endocrinologist Prof Chan Siew Pheng, at the official launch event of the drug.
“Achieving optimal glycaemic control continues to be a real challenge for people with diabetes and healthcare professionals.
“In Malaysia, a recent audit conducted showed that out of the 1,549 patients with type 2 diabetes, only 11.4% achieved the target glycosylated haemoglobin (HbA1c) level of less than 6.5% recommended by the Malaysia Clinical Practice Guidelines (CPG) for the Management of Type 2 Diabetes Mellitus 4th Edition,” added Prof Chan.
The approval of the drug in Malaysia offers a convenient once-daily treatment option for appropriate patients who need help to improve their blood sugar level. It targets three key defects of type 2 diabetes: insulin deficiency from pancreatic beta cells, insulin resistance, and overproduction of glucose by the liver.
The drug combines two medicines, sitagliptin phosphate and metformin HCI extended-release, each with demonstrated ability to improve blood sugar control without increasing the risk of hypoglycaemia.
Metformin works by decreasing glucose production in the liver, decreasing glucose uptake in the gut, and improves insulin sensitivity by increasing glucose uptake by muscle cells from the blood.
Metformin extended-release works in the same way as immediate-release metformin, but over an extended time period, thus allowing it to be dosed once-daily.
Sitagliptin, a once-daily dipeptidyl peptidase-4 (DPP-4) inhibitor, works by increasing insulin synthesis and release from pancreatic beta cells as well as by decreasing overproduction of glucose by the liver in a glucose dependent manner.
It has been reported that lower dosage frequency of medication, i.e. once-daily compared to twice or three times daily, resulted in higher patient compliance.
According to senior consultant endocrinologist Dr Zanariah Hussein, who was also present during the launch event, people with diabetes will suffer from various complications such as heart disease and stroke, vision loss and blindness, kidney failure and lower limb amputation if left untreated.
“Managing type 2 diabetes, such as making healthy food choices, regular exercise, taking diabetes medicines exactly as the doctor prescribes and monitoring blood sugar levels are essential steps that will keep your blood sugar level closer to normal, which can delay or prevent complications,” said Dr Zanariah.
“Failure to control one’s sugar level may result in hypo- or hyperglycaemia, each scenario presenting the diabetes patient with life-threatening complications.
Category: Features, Pharmaceuticals
