Health & Fitness

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Q)  I understand there’s a new medicine available for Type 2 diabetes. What can you tell me about it?

A) The new drug is called Victoza or liraglutide. It acts just like the GLP-1 incretin hormone that is produced in our gut mainly after we eat. 

This hormone’s job is twofold: it stimulates our pancreas to produce more insulin and, at the same time, produce less glucagon. The increased insulin helps remove sugars from our blood  while the decrease in glucagon tells our liver to produce less glucose (our body’s natural sugar).  

The end result of this is a lowering of our blood sugars both after meals and much later on as well (i.e. after fasting). For those with a strong knowledge of diabetes, this will sound identical to how Januvia (sitagliptan, a diabetic pill introduced to Canada in 2008) works. But there are significant differences between the two medicines.  

First off, Januvia slows down the elimination of GLP-1 thereby enhancing its action in the body. Victoza mimics GLP-1. 

Secondly, Victoza seems to be substantially more effective. It lowers the A1C (a measure of our average blood sugar over the previous three months - we should be less than seven) by about 1.3 per cent when added to metformin (the most common diabetic pill) versus 0.7 per cent with Januvia.  It also helps some people lose weight - 2.5 kilograms on average which is better than Januvia’s results.

However, Victoza is less well-tolerated with nausea and vomiting being relatively common at first. It has also been associated with pancreatitis rarely and carries a warning about a possible risk of thyroid tumours (note: these tumours have only been seen in rodents during testing and not, as of now at least, in humans).  

Victoza is also much more expensive. It costs about $5 per day and is not covered by the Ontario government’s drug plan, as of yet.  

The last main difference between the two drugs is that while Januvia is a pill taken once daily, Victoza is given once daily by a subcutaneous injection, just like insulin. While injections are far less of a hassle than most people fear, they are certainly not everybody’s cup of tea.  

So, while Victoza is effective at lowering blood sugars and weight, the fact that it’s an expensive injection with a still-unproven, long-term safety record probably means it should be reserved only for those who have tried other options and are not achieving their goals.

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Monday, July 19, 2010