The Hatfields and McCoys of diabetes care

The worse your diabetes the greater the risk you have to run to deal with it. Drop the weight, watch your diet, get some exercise and listen to your doctor.

Merck Januvia and bottleAs big as the battle between statins was in the 1990s, the current battle between the two newest types of diabetes drugs, GPL-1s and DPP-IVs, could be bigger.

The market is immense, and literally growing fast. Aging and obesity are crafting an epidemic with millions desperate for help.

As noted here recently the most promising line of study involves Glucogen-like Peptides (GLP-1), a naturally-occurring body chemical. GLP-1 drugs increase it, DPP-IVs improve the body's use of GLP-1 it makes itself.

The best-known GLP-1 is Amlyn's Byetta, which is injected. The best-known DPP-IV is Merck's Januvia, a pill. It's their advocates who remind me of the famous hillbilly feuders.

But, as with the current election, there is good reason for both sides to fight hard.

Merck lost the last such war. Its Zocor was the first statin to reach the market. It famously lost control of the market to Pfizer's Lipitor, which was tested at higher dosages and, thus, delivered better numbers.

The statin lesson is that marketing wins, and science can be a branch of marketing.

So Merck is going all-out for Januvia, most recently winning approval in Australia as a standard treatment.

The recent problems with Byetta may be its chance. Six patients using it died of pancreatitis, leading to an FDA warning.

But are a few deaths among a million patients really cause for panic? Not according to David Kliff of DiabeticInvestor, who notes that the risk of pancreatitis, as reported by the FDA, is less for Byetta users than for the general population.

This is especially significant when credible experts acknowledge that patients with diabetes are at an increased risk for pancreatitis simply because they have diabetes.

It's a lesson to me and should be one to you, too. Drugs go through several phases of testing, similar to the alpha, beta, and market testing of computer software.

The first tests tell if the drugs work, the second tell if the drugs are safe, the third should prove a net societal benefit.

Kliff dubs Januvia "Junknuvia" and I can't really evaluate that claim. But drugs also have something in common with school prayer. If it's strong enough to do good it can do harm, and if it's weak enough not to do harm it can't possibly do any good.

That's the key take-away for diabetes sufferers, who should be taking their cues from doctors, not stock analysts, and never reporters.

The worse your diabetes the greater the risk you have to run to deal with it. Drop the weight, watch your diet, get some exercise and listen to your doctor.

Just because you're part of a big market is no reason to act like a guinea pig.

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