Slowing a diabetic's decline (American College of Physicians annual meeting)

With more diabetes patients living longer, a greater number need more intensive glucose-controlling regimens and help with managing complications.

By Victoria Stagg Elliott, AMNews staff. June 4, 2007.

Reports from conferences important to physicians

A handful of newly approved therapies for patients with diabetes have very different profiles from those previously available -- complicating questions about what to do as the disease progresses, according to presentations at Internal Medicine 2007, the American College of Physicians' annual meeting, in April in San Diego.

"The choices have exploded," said Irl B. Hirsch, MD, professor of metabolism, endocrinology and nutrition at the University of Washington School of Medicine.

The Food and Drug Administration approved exenatide, the first drug to affect incretin hormones, in April 2005. Sitagliptin, by itself and in a pill combined with metformin, was approved within the past year.

Both of these new treatments have been proven to improve control, but it's not entirely clear how they will work alongside the many other medicines that diabetics frequently take.

"We're going to need more data to know how these drugs fit into our armamentarium," said Janet A. Schlechte, MD, professor of internal medicine at the University of Iowa College of Medicine in Iowa City.

For instance, patient response to exenatide has been mixed. The drug needs to be injected, and many physicians consider the needle to be a barrier to getting patients to accept it. Some are now reporting that patients have been able to get past that issue primarily because exenatide has been shown to cause weight loss. Still, experts caution that insulin is still preferred as early as appropriate.