Innovative treatment advances for diabetes
Two advances in diabetes care have been announced – an insulin powder from Sanofi and a new oral drug combination from Boehringer Ingelheim/Eli Lilly.
Sanofi and MannKind Corp have developed Afrezza inhalation powder, which is administered via a portable inhalation device, giving patients the option of insulin inhalation for the first time. It is available by prescription in US pharmacies and approved to control high blood sugar in adults with type 1 and type 2 diabetes.
The Afrezza device
The dry insulin is administered at the start of a meal and is designed to be rapidly absorbed, having a short duration of action. It can help control high blood sugar as part of a diabetes management plan that may include diet, exercise and other diabetes medications. It is not intended as a substitute for long-acting insulin.
However, the new method of delivering insulin should not be used in patients with chronic lung disease, such as asthma or COPD, and cannot be used to treat diabetic ketoacidosis. Afrezza is not recommended in patients who smoke or who have recently stopped smoking.
Meanwhile, type 2 diabetics have a new oral treatment option for glycaemic control, with first-in-class Glyxambi (empagliflozin/linagliptin), combining SGLT2 and DPP-4 inhibitors, now approved in the US by the FDA.
Developed by Boehringer Ingelheim (BI) and Lilly, Glyxambi is designed to be used alongside diet and exercise to improve glycaemic control.
It is not recommended in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis.
Glyxambi combines the dual mechanisms of action of a sodium glucose co-transporter-2 (SGLT2) inhibitor and a dipeptidyl peptidase-4 (DPP-4) inhibitor in a once-daily tablet taken in the morning. SGLT2 inhibitors remove glucose through the urine by blocking blood glucose re-absorption in the kidney. DPP-4 inhibitors work by increasing hormones that stimulate the pancreas to produce more insulin and stimulate the liver to produce less glucose.
Paul Fonteyne, president and CEO of BI, said, "With Glyxambi, the dual inhibition of DPP-4 and SGLT2 — two proven targets in the treatment of type 2 diabetes — now provides US physicians and patients with an option to simultaneously address multiple pathways to improve glycemic control. For patients uncontrolled on metformin, phase III trial results showed Glyxambi provided significantly greater reductions in blood glucose levels compared with either empagliflozin or linagliptin alone."
The drug should not be taken by patients with severe renal impairment, end-stage renal disease or dialysis, a history of hypersensitivity reaction to linagliptin, or a history of serious hypersensitivity reaction to empagliflozin. There have been post-marketing reports of acute pancreatitis, including fatal pancreatitis, in patients taking linagliptin,
Glyxambi was developed by the diabetes alliance set up in January 2011, pooling the knowledge of BI and Lilly in this area.
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