"Bitter pills in sugar coating. The pills are harmless: the poison is in the sugar."
While early 20th Century Polish poet Stanislaw Jerzy Lec was figuratively writing about the dangers of deception, especially when wrapped in sweet coverings, the growing population of diabetics can literally speak to the dangers of sugar in any form, and the necessity of their pharmaceutical therapies.

An editorial in this week's New England Journal of Medicine states that the prevalence of diabetes mellitus is rising at "an alarming rate and is projected to more than double by 2030." The disease currently afflicts 171 million people globally, with 23.6 million in the U.S. This week, the American Diabetes Association held its annual meeting in New Orleans, highlighting a great deal of new clinical research in the field to manage this growing patient population.

While there is a trend toward transitioning to an insulin regimen earlier, managing patients with diabetes though oral agents for longer periods of time, is becoming more viable as the treatments have improved, as well as being more convenient and less costly to the patient.

The controversial drug Avandia got a boost this week when results of the RECORD trial, which involved nearly 4,500 participants, revealed that the type 2 diabetes drug does not increase the risk of cardiovascular (CV) disease or death, as previous studies, such as ACCORD and ADVANCE, have suggested. However, the study revealed that using Avandia more than doubles the risks of heart failure. While much attention was paid to the positive findings related to CV disease or death, some doctors remain wary because Avandia's manufacturer, GlaxoSmithKline, funded the study.

Yet, a new type 2 diabetes drug may be on the horizon, as the phase II SYNCHRONY study showed that aleglitazar, which is a PPAR co-agonist, is safe and effective. None of the safety concerns, such as toxic effects, that have previously plagued PPAR co-agonists arose in the trial, and therefore, the drug entered its phase III trialing.

For insulin treatment, the once-daily liraglutide diabetes drug performed substantially better at controlling blood glucose in type 2 diabetes than the twice-daily exenatide in the LEAD-6 study. However, liraglutide was reviewed by an FDA advisory panel on April 2, which expressed concerns that the drug causes thyroid tumors.

There still remains a search for a new gold standard for the treatment of type 2 diabetes, and with each new therapy, new caveats emerge. However, with behavior modifications and properly tailored treatment, the disease can be controlled, and can allow for a moderately healthy, long life, which is the precarious hope for us, as Lee suggests: "Youth is the gift of nature, but age is a work of art."

On these topics, or any others, please feel free to contact me.

Justine Cadet