New Type 2 Diabetes Treatment Options

DPP-4 inhibitors include the oral drugs Januvia, Nesina, Onglyza, and Tradjenta. These protect a natural compound in the body -- GLP-1 -- from breaking down. GLP-1 helps lower blood glucose.
Incretin mimetics or GLP analogs include the injected drugs Byetta and Victoza. They use the body's own signaling system to boost insulin after meals.  

Sodium-glucose co-transporter 2 (SGLT2) inhibitors work by blocking glucose from being reabsorbed by the kidneys. That raises the amount of glucose urinated, and lowers the amount of glucose in the blood. Currently, Invokana (canaglifozin) is the only drug in this class that's approved by the FDA. More SGLT2 inhibitors are being developed.  

Other drugs include Symilin, an injectable synthetic hormone. It helps lower blood sugar after meals in people with diabetes who use insulin.

Combination drugs have made a difference. They join different medications in one pill -- often metformin and a sulfonylurea, a meglitinide, a DPP4 inhibitor, a thiazolidinedione, or a thiazolidinedione in combination with a sulfonylurea. This cuts down the number of pills a person has to take. Combination drugs include Actoplus MET, Avandamet, Duetact, Glucovance, Metaglip, Kazano, Oseni, and PrandiMet. There can be drawbacks. They tend to cost more than generic drugs. They can also make it harder to fine-tune the treatment. "When you have a combination drug, you can't adjust the dose of one drug without adjusting the other too," says a MD. "There is less room for precision."

New types of insulin allow some people to take just one injection of a long-acting insulin each day. That can be much easier than multiple injections of standard insulin.

Future medications. Other classes of medication are in development. One type doesn't affect insulin, unlike most diabetes drugs. It blocks the body from re-absorbing glucose from urine, says a Dr. While the FDA has not approved any drug from this class, it could in the future.

Despite the advances, Dr. points out that many people with diabetes have probably not changed their prescriptions much over the last decade. "In some ways, there's been a lot of consistency," . "Metformin and the sulfonylureas [such as Amaryl, DiaBeta, Diabenese, Glucotrol, Glynase, and Micronase] and metformin are still the most commonly prescribed drugs for diabetes and they've been around for a long time."

While the new drugs may not have replaced the old, they have added options for people who had problems controlling blood sugar with standard drugs.

Problems with older drugs also emerged in recent years. In 2010, the FDA severely restricted the use of Avandia. Studies showed that it was linked with cardiovascular risks. In 2011, the FDA added a new warning to Actos, a drug from the same class, because it may increase the risk of bladder cancer.

Type 2 Diabetes Treatment: Glucose Monitoring and Insulin Pumps

Experts say that there have been great strides in glucose monitoring and insulin pumps. Continuous glucose monitors work with a tiny sensor that a doctor implants in the skin. The sensor sends data about current glucose levels to a wireless device that looks like a pager. The sensors need to be replaced every three to seven days.

"Once, people had to urinate on a strip of paper to get even a rough idea of their glucose levels," says a Dr. "Now, they can get a precise update every few minutes with a continuous glucose monitor. It's amazing."

For people with type 2 diabetes who need injected insulin, insulin pumps are now more refined.  The devices give smaller and more precise doses.

Many companies are working on technology that will fully automate the interaction between a continuous glucose monitor and a pump. You would not have to press the button on your pump when your monitor alerts you. Instead, the monitor would trigger the pump to give the insulin dose directly.  The two would operate without your input -- creating what many experts call an "artificial pancreas."

We've known for a long time that lifestyle -- such as diet and exercise -- play a key role in controlling type 2 diabetes.She says that the last decade of research has only made the connection more clear.

Studies show that aggressively controlling glucose with lifestyle changes can reduce heart risk in people with diabetes. Experts generally recommend that people with diabetes get at least 150 minutes of aerobic activity each week coupled with strength training.

When it comes to food choices, Dr. says that there is no one-size-fits-all diabetes diet. "You have to be flexible and creative in developing a meal plan," he says. He says that many people -- but not all -- do well on low-carb and Mediterranean diets. The key is to work with an expert, such as a dietitian with experience treating diabetes. You need a custom plan. It has to be something that you can stick with for the long haul.

While research over the last decade has shown just how well lifestyle changes work for diabetes, there's a catch. We also have a clearer understanding of the drawbacks. It's hard to make big changes to your diet and lifestyle that stick, she says.

For that reason, she says that many diabetes doctors are now quicker to get people onto drugs than they were in the past. Given the importance of glucose control, doctors may be less likely to wait while a person keeps trying, without real success, to adopt healthier habits.

Type 2 Diabetes Treatment: Getting Control

One of the biggest changes in diabetes management has not come from a medication or a device. Instead, it's a different approach. Diabetes doctors are much more aggressive in treating the disease.

"There's much more emphasis on catching diabetes early and treating it earlier," says a Dr. "We have strong evidence of how poorly controlled diabetes can have serious complications later. We're acting faster in doing something about it."

More important than any specific treatment, experts say, is good control of your condition and regular medical care.  

"If you're getting the right support, managing diabetes is very straightforward," says the Dr. "With good treatment, anyone with diabetes can learn how to control this disease. It doesn't have to control you."

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What causes penile cancer? Signs, tests to diagnose, treatment options,

Human papillomavirus infection may increase the risk of developing penile cancer.

Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. People who think they may be at risk should discuss this with their doctor. Risk factors for penile cancer include the following:

Circumcision may help prevent infection with the human papillomavirus (HPV). A circumcision is an operation in which the doctor removes part or all of the foreskin from the penis. Many boys are circumcised shortly after birth. Men who were not circumcised at birth may have a higher risk of developing penile cancer.

Other risk factors for penile cancer include the following:

• Being age 60 or older.
• Having phimosis (a condition in which the foreskin of the penis cannot be pulled back over the glans).
• Having poor personal hygiene.
• Having many sexual partners.
• Using tobacco products.

Possible signs of penile cancer include sores, discharge, and bleeding.

These and other symptoms may be caused by penile cancer. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:

• Redness, irritation, or a sore on the penis.
• A lump on the penis.

Tests that examine the penis are used to detect (find) and diagnose penile cancer.

The following tests and procedures may be used:

• Physical exam and history: An exam of the body to check general signs of health, including checking the penis for signs of disease, such as lumps or anything else that seems unusual. A history of the patient's health habits and past illnesses and treatments will also be taken.
• Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

• The stage of the cancer.
• The location and size of the tumor.
• Whether the cancer has just been diagnosed or has recurred (come back).

Stages of penile cancer

After penile cancer has been diagnosed, tests are done to find out if cancer cells have spread within the penis or to other parts of the body.

The process used to find out if cancer has spread within the penis or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following tests and procedures may be used in the staging process:

• CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

• MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. A substance called gadolinium is injected into a vein. The gadolinium collects around the cancer cells so they show up brighter in the picture. This procedure is also called nuclear magnetic resonance imaging (NMRI). Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram. There are three ways that cancer spreads in the body. The three ways that cancer spreads in the body are: Through tissue. Cancer invades the surrounding normal tissue. Through the lymph system. Cancer invades the lymph system and travels through the lymph vessels to other places in the body. Through the blood. Cancer invades the veins and capillaries and travels through the blood to other places in the body. When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer. The following stages are used for penile cancer: Stage 0 (carcinoma in situ) In stage 0, abnormal cells are found on the surface of the skin of the penis. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ. Stage I In stage I, cancer has formed and spread to connective tissue just under the skin of the penis. Stage II In stage II, cancer has spread to: connective tissue just under the skin of the penis and to one lymph node in the groin; or erectile tissue (spongy tissue that fills with blood to make an erection) and may have spread to one lymph node in the groin. Stage III In stage III, cancer has spread to: connective tissue or erectile tissue of the penis and to more than one lymph node on one or both sides of the groin; or the urethra or prostate, and may have spread to one or more lymph nodes on one or both sides of the groin. Stage IV In stage IV, cancer has spread: to tissues near the penis and may have spread to lymph nodes in the groin or pelvis; or anywhere in or near the penis and to one or more lymph nodes deep in the pelvis or groin; or to distant parts of the body. Recurrent penile cancer Recurrent penile cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the penis or in other parts of the body. Treatment option overview There are different types of treatment for patients with penile cancer. Different types of treatments are available for patients with penile cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. Three types of standard treatment are used: Surgery Surgery is the most common treatment for all stages of penile cancer. A doctor may remove the cancer using one of the following operations: Mohs microsurgery: A procedure in which the tumor is cut from the skin in thin layers. During the surgery, the edges of the tumor and each layer of tumor removed are viewed through a microscope to check for cancer cells. Layers continue to be removed until no more cancer cells are seen. This type of surgery removes as little normal tissue as possible and is often used to remove cancer on the skin. It is also called Mohs surgery. Laser surgery: A surgical procedure that uses a laser beam (a narrow beam of intense light) as a knife to make bloodless cuts in tissue or to remove a surface lesion such as a tumor. Cryosurgery: A treatment that uses an instrument to freeze and destroy abnormal tissue. This type of treatment is also called cryotherapy. Circumcision: Surgery to remove part or all of the foreskin of the penis. Wide local excision: Surgery to remove only the cancer and some normal tissue around it. Amputation of the penis: Surgery to remove part or all of the penis. If part of the penis is removed, it is a partial penectomy. If all of the penis is removed, it is a total penectomy. Lymph nodes in the groin may be taken out during surgery. Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy. Radiation therapy Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated. Chemotherapy Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly onto the skin (topical chemotherapy) or into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated. Topical chemotherapy may be used to treat stage 0 penile cancer. New types of treatment are being tested in clinical trials. This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Biologic therapy Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy. Topical biologic therapy may be used to treat stage 0 penile cancer. Radiosensitizers Radiosensitizers are drugs that make tumor cells more sensitive to radiation therapy. Combining radiation therapy with radiosensitizers helps kill more tumor cells. Sentinel lymph node biopsy followed by surgery Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. After the sentinel lymph node biopsy, the surgeon removes the cancer. Stage I penile cancer If the cancer is only in the foreskin, wide local excision and circumcision may be the only treatment needed. Treatment of stage I penile cancer may include the following: Surgery (partial or total penectomy with or without removal of lymph nodes in the groin). External or internal radiation therapy. Mohs microsurgery. A clinical trial of laser therapy. This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site. Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I penile cancer. Stage II penile cancer Treatment of stage II penile cancer may include the following: Surgery (partial or total penectomy, with or without removal of lymph nodes in the groin). External or internal radiation therapy followed by surgery. A clinical trial of sentinel lymph node biopsy followed by surgery. A clinical trial of laser surgery. This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site. Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage II penile cancer. Stage III penile cancer Treatment of stage III penile cancer may include the following: Surgery (penectomy and removal of lymph nodes in the groin) with or without radiation therapy. Radiation therapy. A clinical trial of sentinel lymph node biopsy followed by surgery. A clinical trial of radiosensitizers. A clinical trial of chemotherapy before or after surgery. Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage III penile cancer. Stage IV penile cancer Treatment of stage IV penile cancer is usually palliative (to relieve symptoms and improve the quality of life). Treatment may include the following: Surgery (wide local excision and removal of lymph nodes in the groin). Radiation therapy. A clinical trial of chemotherapy before or after surgery. Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IV penile cancer. Treatment options for recurrent penile cancer Treatment of recurrent penile cancer may include the following: Surgery (penectomy). Radiation therapy. A clinical trial of biologic therapy. A clinical trial of chemotherapy.

Pancreatic Cancer Treatment Options

In situations where the cancer is contained within an organ (localized), surgery may be used to remove the cancerous tissue as well as a portion of tissue surrounding the area. In cases where a tumor cannot be removed by surgery (inoperable), other strategies may be considered to help relieve symptoms.

Surgery
When appropriate, minimally invasive surgical procedures may be used to treat pancreatic cancer. These techniques require only small incisions to accommodate thin, flexible laparoscopic instruments.

Potential benefits of minimally invasive surgeries include:

• Less blood loss, pain and visible incisions
• Shorter hospital stays and recovery time
• Fewer post-operative complications
• Quicker return to normal activities

In addition to traditional surgical techniques, City of Hope surgeons are highly skilled in robotic-assisted surgery, using the most advanced da vinci S Surgical System. This system can achieve excellent results in complex lung operations . A surgeon directs and controls the movements of a specially designed robot, equipped with a camera and miniature surgical tools. At the same time, a sophisticated computerized imaging system provides real-time three-dimensional views of the surgical area, with better visualization than can be achieved with the surgeon’s eye alone.

Surgical Procedures

• Pancreaticoduodenectomy (Whipple procedure) This procedure involves removing the head of the pancreas along with the bile duct and the upper part of the intestine. During the surgery, the bile system, intestine and pancreas are reconstructed with tissue from the intestine. A portion of the pancreas is preserved to produce digestive juices and insulin.
• • Total pancreatectomy This operation removes the pancreas, part of the stomach and small intestine, the common bile duct, gallbladder, spleen and nearby lymph nodes. A restricted diet, supplemental digestive enzymes and insulin will be necessary for patients who undergo this procedure.
  • Distal pancreatectomy Tumors of the tail of the pancreas are often removed by performing a procedure known as a distal pancreatectomy. This may include removal of the spleen, which is located near the tail of the pancreas.
  • Central pancreatectomy Tumors of the main body of the pancreas can be treated using a central pancreatectomy, a complex operation that allows the removal of the tumor while preserving most of the pancreas. This minimizes the risk of developing diabetes and problems digesting food.
  Palliative Surgery Options
  In some cases, surgical removal of a tumor is not recommended. This includes cases in which a pancreatic cancer has spread beyond the pancreas itself, and where tumors are affecting the blood flow to the liver or intestine. In such cases, the following procedures, called “palliative surgery,” are not curative but may be considered to relieve symptoms:
  • Surgical biliary bypass If a tumor is blocking the bile system and causing bile to build up in the liver, a biliary bypass may be performed. The gallbladder or bile duct is attached to the small intestine to bypass the blocked area, which helps to relieve the buildup of bile and accompanying jaundice.
  • •  Stent placement If a tumor is blocking the bile duct, a stent may be inserted to drain the bile that has built up in the area. The stent may bypass the blockage and drain the bile into the small intestine, or it may drain outside the body. Stents can be placed during surgery or percutaneous transhepatic cholangiography, or in an endoscopic procedure.
    • Gastric bypass If a tumor is blocking the flow of food from the stomach, the stomach may be reattached to the small intestine, to make it easier to eat normally.
    Radiation Therapy
    Radiation therapy uses high-energy X-rays and other types of radiation to kill cancer cells. City of Hope was the first in the western U.S. to provide treatment for pancreatic cancer using the Helical TomoTherapy System. This innovative system couples three-dimensional imaging with innovative intensity-modulated radiation therapy to target the tumor with extreme precision. The system not only provides more effective and potentially curative treatment, it reduces unwanted exposure of normal tissues and reduces potential complications.
    
    Chemotherapy
    Chemotherapy drugs destroy cancer cells by interfering with their growth and multiplication. Some chemotherapies involve an infusion of drugs into a vein or central line. City of Hope actively conducts research into finding more effective drug treatments for pancreatic cancer.
    
    Pain Management
    Pain can occur when the tumor presses on nerves or other organs near the pancreas. When pain medicine is not enough, treatments may be given to reduce pain coming from nerves in the abdomen. Medicine may be injected into the area around affected nerves, or nerves can be cut to block the transmission of pain signals. Radiation therapy may also be used with or without chemotherapy to shrink tumors, which can help relieve pain.
    Nutrition Management
    Surgery to remove the pancreas may interfere with the production of pancreatic enzymes that help to digest food. As a result, patients may have problems digesting and absorbing nutrients into the body. To prevent malnutrition, medicines may be prescribed to replace these enzymes