Weighing Diabetes Drugs
Risk and Benefits
June 2013 — I've written before about how I find type 2 diabetes the ultimate DIY, or do it yourself, disease.
While most of us visit an endo every few months to check our weight, blood pressure, heart, and A1C readings, the hard work of taking care of diabetes really falls on daily care as you monitor sugars, take your medications, exercise, watch your carb and calorie intake, and stay alert to the latest diabetes news.
So when the Internet began to buzz with reports on issues with Byetta and Bydureon — two drugs that I've injected separately over the past four years — my ears perked up.
There were a few things that concerned me. First, there was a report from Johns Hopkins that people taking these classes of diabetes drugs were twice as likely as those on other forms of sugar-control medication to be hospitalized with pancreatitis, or inflammation of the pancreas. Then came an FDA advisory announcing that the agency planned to take a second look at the new class of diabetes drugs known as incretin mimetics. These drugs, which include Byetta, Bydureon, Januvia, and Victoza, mimic incretin hormones that the body usually produces to naturally stimulate the release of insulin. The FDA wanted to reexamine them in relation to pancreatitis and pre-cancerous cellular changes in patients with type 2 diabetes. While they studied the drugs, the FDA recommended that patients continue to take their medication until they talked to their doctors.
Worried, I took my concerns to my endo. My doctor, a caring and skilled endocrinologist who is notable for taking his time during visits, addressing my concerns seriously, and sharing everything he knows honestly, shook his head and said, "The problem is, we don't know much more than you."
He went on to add that these studies often include people with pancreatic problems who he wouldn't prescribe this class of drugs to in the first place. He said that if I were going to have contracted pancreatitis from Byetta, it would have evidenced itself by now, and probably in a very extreme way that have required hospitalization.
As to the cancer reports, he said that his readings indicated that these signs were extremely early and very remote and that once again, the studies had included folks who were prone to that disease.
All of which made me feel marginally reassured. I knew beforehand that pancreatitis wasn't a new concern with these drugs. Warnings accompanied both medications, and my pharmacist and the nurse who taught me how to mix and inject Bydureon had noted the risks.
But how was I to weigh all of this information? Was the chance of contracting pancreatitis or pancreatic cancer worth the stellar A1C results these medications have helped me to achieve?
The bottom line is that these drugs are very new. Long-term studies have not been done. One thought is perhaps they should be kept off the market until such studies have been performed, but that is at the cost of preventing their very real benefits for the millions of patients who currently use them.
So what to do?
At this moment, as I write this, I am still injecting Bydureon once a week, impressed by how it lowers my sugars without visible side effects. But I have to admit that I remain nervous about the long-term effects of the drug, and about the future conclusions of the FDA.
I'd be lying it I didn't admit that it's a little bit more responsibility that I can stand from a chronic illness that already asks so much.
Read Ilene's blog.
dLife's Viewpoints columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences, most often at a set point in time. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team before acting on anything you read here to find out what will work best for you.
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As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...