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Diabetes is a metabolic condition that leads to excessively high levels of sugar in the blood. Chronic exposure of various key organs and tissues - the eyes, blood vessels, kidneys, nerves, feet, heart and gums - to superfluous sugar has several serious consequences on health.
There are two kinds of diabetes: Type 1 and Type 2. In the first type, which constitutes only about 5 percent to 10 percent of cases, the body's immune system, charged with protecting the body from invasion by pathogens, mistakenly identifies the insulin-producing beta cells in the pancreas as an "enemy," destroys them, usually quite quickly, and the body does not produce any insulin. Excessive thirst and frequent urination are the most obvious signs.
A combination of heredity and environmental factors, many as yet unknown, trigger the autoimmune process. Complications and death will occur quickly unless the victim receives insulin by injection (via syringes or a pump worn on the body) several times a day.
Type 2 diabetes, a lifestyle disease with some genetic influences, develops gradually, usually without being noticed. Lack of exercise, overweight, a diet of junk food - especially simple carbohydrates - rather than whole grains and vegetables, can cause metabolic syndrome (pre-diabetes), which means higher-than-normal blood sugar levels along with high cholesterol and triglyceride levels in the blood and high blood pressure. If lifestyle changes are not made, this will develop into full-fledged Type 2 diabetes. As symptoms are not always as clear as in Type 1, people should go for lab tests on a regular basis, especially after the age of 40 and earlier if they are at high risk. Patients are prescribed various oral drugs, such as metformin, that reduce insulin resistance and increase insulin production by the remaining active beta cells. They are also put on a strict diet, ordered to lose weight and placed on a daily exercise regimen.
The most reliable way to monitor sugar levels is to test for a type of blood hemoglobin called HbA1C; if the result, which reflects the blood sugar level three months before the blood sample is taken, is higher than 7%, the patient's diabetes is not being properly controlled.
Two new drugs for Type 2 diabetics that significantly lower HbA1C levels were recently approved by the US Food and Drug Administration. It may take some time before they are approved by the Health Ministry, and there will be a struggle by diabetes experts to induce the government to include them in the basket of health services paid for by the health funds, as the number of would-be recipients who can benefit is very large. However, improved blood sugar control would actually save a great deal of public money because it can reduce the risk of hospitalization due to complications.
Januvia, developed and manufactured by Merck and Co., is the first in a new class of diabetes drugs known as DDP-4 inhibitors. Known generically as sitagliptin phosphate, Januvia has been proven to enhance the body's ability to lower elevated blood sugar, and it can be taken alone or in combination with other commonly prescribed oral diabetes medications, such as metformin.
Prof. Itamar Raz, director of the Diabetes Center at Hadassah University Medical Center in Jerusalem's Ein Kerem and head of the National Diabetes Council, said that Januvia, taken once daily, is in fact "a very important new drug for Type 2 patients and a significant breakthrough in our ability to balance their sugar levels more efficiently, while improving the functioning of insulin-producing cells without causing an increase in weight."
Since many of the 260,000 diagnosed Israeli diabetics - an equal number have it but have not been diagnosed - are not balanced enough with the existing arsenal of drugs, Raz said he hoped the ministry will speed up its registration and include it in the basket. According to clinical studies, more than twice as many patients reached the HbA1C target of 7% or lower with Januvia, compared to those who were taking only metformin.
THE SECOND new drug, Eli Lilly's Bayeta, has been shown to reduce HbA1C levels by more than 1% within a year - even better than Januvia, "and it also brings down the patient's weight by an average of four kilos," said Raz. The main disadvantage, however, is that it does not come in pill form but has to be injected twice daily.
But as the years pass, some Type 2 diabetics are unable to control their sugar levels this way and have to consider the use of insulin. Fortunately, injectable insulin has been available since 1923; before that, all Type 1 diabetics were condemned to a painful death.
It all started in 1922 when August Krogh, a Dane who won the Nobel Prize in Physiology, and his wife Marie, a Type 2 diabetic, travelled to Canada to visit researchers Frederick Banting and Charles Best, who a year before had begun to extract insulin from the pancreas of cows. The Kroghs returned to Denmark and in 1924, August Krogh established the Nordisk Insulin Laboratorium to produce the precious hormone for treating diabetics. Due to differences in views, one of the company's first staffers, Harald Pedersen, set up a competing insulin factory in 1925 that he called Novo Therapeutisk Laboratorium.
In 1989, after competing with each other for more than six decades, the two Danish companies decided to cooperate and meldmerge to become Novo Nordisk A/S. The new entity dedicated itself to developing new diabetes products, conquering world markets and, ultimately, to further the cure of diabetes. A public corporation that aims at making a profit, Novo Nordisk set up a foundation that has invested huge sums in research to improve its projects and help discover a cure, as well as instituted a social agenda and a firm policy to protect the environment. It also established the International Diabetes Federation, which promotes research, education and political action to fight diabetes.
With headquarters in Denmark, Novo Nordisk has 22,750 employees in 79 countries - including several dozen in Israel - and markets its products here and in 178 other countries. The company, which also manufactures NovoSeven for treating hemophiliacs, has strong ties with Israeli researchers, including Prof. Uri Martinovich of Sheba Medical Center, who has pioneered in the use of this drug in halting hemorrhages and saving lives of soldiers wounded in battle and victims of road accidents.
Since the era of the Kroghs, insulin has changed a great deal and become much more convenient and flexible and can be customized to meet the personal needs of each patient. Novo Nordisk modified the chemical structure of the human hormone to produce insulins that are better at mimicking those produced naturally by the body. For example, there are fast-acting insulins that can now be injected immediately before meals to control the "spike" in blood sugar that follows a meal; and there are long-acting modern insulins used once a day that take care of the body's constant basal insulin need. There is also dual-acting biphasic insulin, which combines both requirements.
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