The First Step in Treating Type 2 Diabetes

According to the American Diabetes Association, 8.3% of the population has diabetes, making it a pretty common ailment. A vast majority of those cases fall into the type 2 class that typically develops in adults.

Type 2 diabetes is usually a relatively slowly progressing disease. Unlike type 1 diabetes, where patients require insulin initially, type 2 diabetics start off with unhealthy-but-manageable blood sugar levels, affording time for doctors to intervene with lifestyle changes -- diet and exercise -- as well as drugs to keep blood sugar levels in check.

The first treatment that almost every type 2 diabetetic gets is merformin, a drug originally brought to market by Bristol-Myers Squibb (NYSE: BMY  ) as Glucophage, which has long since been available as a generic.

It isn't entirely clear how metformin acts, but the drug ultimately suppresses blood sugar production in the liver and increases insulin sensitivity, which can lower blood sugar levels further.

Fewer pills is better
Metformin is typically taken twice a day, which is less convenient than a daily pill, so a few companies have developed extended-release tablets -- Bristol's Glucophase RX, Shionogi's Fortamet, and Santarus' (NASDAQ: SNTS  ) Glumetza -- that only have to be taken once a day. The slow release can also reduce some of the side effects seen in patients that take the twice daily version.

Despite the cheap competition from twice-daily generics, Santarus managed a 33% year-over-year increase in sales of Glumetza. It's unlikely to become a blockbuster, but $41.5 million in quarterly sales isn't too shabby for a small specialty pharma. Shares of Santarus have tripled over the last year.

Metformin+
Since many type 2 diabetics start on metformin, many branded drugs now come as combination products containing metformin. The idea is simple: If merformin is working, but not completely controlling blood sugar levels, adding another drug could help. And offering it as a single pill makes it easier for patients.

Brand Name Drug

Combined With Metformin

Company

Januvia

Jaumet/Janumet XR

Merck (NYSE: MRK  )

Actos

ActoPlus Met/ActoPus Met XR

Takeda Pharmaceuticals

Tradjenta

Jentadueto

Boehringer Ingelheim and Eli Lilly

Nesina

Kazano

Takeda Pharmaceuticals

Onglyza

Kombiglyze XR

Bristol-Myers Squibb and AstraZeneca 

Avandia

Avandamet

GlaxoSmithKline

Source: Drugs@FDA.

There used to be a competitive advantage to having a metformin combination product, but now that almost every diabetes drug is available as a combination, that's vanished. The main competition now comes from the underlying branded product, where Merck's (NYSE: MRK  ) Januvia/Janumet is leading the pack after side effects derailed Actos and Avandia.

The other consideration is whether the metformin is the standard twice-daily version, or available as a once-daily extended release, usually designated as XR. Januvia, Tradjenta, and Onglyza, for example, are all in the same class of drugs called DPP-4 inhibitors. But only Januvia and Onglyza are available as a combination with extended-releases metformin, making it harder for Trajenta/Jentadueto to compete.

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Read/Post Comments (9) | Recommend This Article (11)

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  • Report this Comment On May 11, 2013, at 12:57 PM, cevmike wrote:

    This article is unfortunate as most experts agree that diet and nutrition are the keys to type 2 diabetes. Countless individuals, myself included, have been able to live drug free despite genetic and familial tendencies. Countless others have been healed of the "disease" completely.

    Check out cevhealth dot com...some interesting testimonials there...

  • Report this Comment On May 11, 2013, at 2:38 PM, dangler1 wrote:

    I completely cured myself of type 2 diabetes, the trick? no carbs for 2 months, I dropped 40 lbs. now i can tolerate normal healthy carbs,(no sweets) also your blood sugar should not rise above 120 even after you eat, if it does, you have eaten too many carbs, it wasnt hard to do.

  • Report this Comment On May 11, 2013, at 2:39 PM, intogiants wrote:

    At 43, I started Metformin. My doctor didn't inform me that it makes you FERTILE. So, two months later I'm pregnant. I didn't want too be at this age. I did at 40. We thought it just didn't work. I was super high risk, but so far everything is fine. My little Metformin girl is a blessing.

  • Report this Comment On May 11, 2013, at 3:14 PM, Moe1957 wrote:

    A friend sent me Death to Diabetes when I was diagnosed. I learned how foods really do affect our bodies. In 4 months my A1C went from 10.1 to 5.2 and my doctor was shocked. I dropped lbs and went off the drugs and have been off two years. Long term metformin will destroy the liver. It takes life style changes. My entire family has benefited from eating healthier....low carb, low glycemic and exercise.

  • Report this Comment On May 11, 2013, at 6:57 PM, cfrench180 wrote:

    It's well known that dietary changes can help prevent, delay or control type 2 diabetes......BUT what is not recognized enough is the fact that increasing magnesium in your diet will do wonders to regain blood sugar control. Metformin has side effects which need to be known by everyone told to take Metformin.......and magnesium does not have side effects. Research has proven that magnesium can lower insulin resistance, lower blood sugars, and go a long way to lowering weight and blood pressure as well as cardiac risks. Please read up on how magnesium can help you before taking pharmaceutical drugs!

    As a diabetic (type 1) and an independent researcher the first thing I would tell anyone diagnosed with pre-diabetes, metabolic syndrome, or diabetes type 1 or type 2 would be to start increasing their magnesium intake either with food or supplements. Well over 50% of diabetics do not even get the recommended daily allowance of magnesium!!!!

    Please learn more about this for your own good:

    The Insulin Magnesium Story: http://drsircus.com/medicine/magnesium/the-insulin-magnesium...

    Claudia French

    IMVA

    http://drsircus.com/international-medical-veritas-associatio...

  • Report this Comment On May 12, 2013, at 12:22 AM, stockwatcher0153 wrote:

    What about Belviq by Arena Pharmaceuticals? A safe appetite suppressant that will begin to be sold this June.

  • Report this Comment On May 12, 2013, at 2:12 AM, pearl112944 wrote:

    i stopped all carbs 2 months ago,i lost weight and my sugar has been in the very normal range,i cant believe it! it's true,carbs are no good! i'm a witness...

  • Report this Comment On May 12, 2013, at 10:44 AM, sgf1376 wrote:

    I was on Metformin for about 3 years. I must caution anyone taking this drug to check the side effects regularly and follow your health practitioners instructions. The side effects can be very bad. Now, after having lost about 40 pounds and become much more active my problem has ceased to be a problem and I am off all medication for diabetes.

  • Report this Comment On May 12, 2013, at 9:53 PM, jhines59 wrote:

    Hello I am a new diabetic, yes I was given Metformin 2 in the morning and 2 at night. I have a high count anyway, all of the stuff you all have posted will help me I go back to the doc tomorrow to see how I am doing, I will ask about the metformin I thought 4 a day was a lot. Plus I take other meds for other problems. I have lost some weight or course never enough. I am watching my diet, my flippin blood goes up and down ... We will see tomorrow about how she thinks I am doing this has only been a month but I am frightened...Thanks for listening

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