Parkinson's disease: Popular western medicine Apomorphine now launched in Bengaluru

In a boon to patients in the middle stages of Parkinson’s Disease, a private hospital in Bengaluru, in association with UK-based specialty pharmaceutical company, has launched Apomorphine for the first time in India. Apomorphine, available both as injections and infusion pumps, has been popular in the West for over 15 years in the management of Parkinson’s, but Indian patients could not benefit from it until now because of a lack of regulatory approvals. Now, it will be given on compassionate grounds to a select number of patients.

This powerful new drug stimulates the production of dopamine by nerve cells in the brain, providing quick and effective relief to patients and improving their quality of life. A Parkinson’s Disease and Movement Disorders Specialist,  where the drug will be available, said, “Currently in India, patients of Parkinson’s have only two options: either oral treatment for the early stages of the disease, or very expensive Deep Brain Stimulation (DBS) surgery for advanced stages. There was no treatment for the middle stages of the disease. Most patients in India cannot afford DBS. This procedure is also not a choice for all ages or stages of Parkinson’s Disease.”
“Introduction of apomorphine in India has given an important medical option to doctors in the middle stages of the management of Parkinson’s Disease,” Dr.  said. Dr.  said once the Drug Controller General of India approves the drug it will be available at other hospitals. The prevalence of Parkinson’s Disease in India is 300-400 out of 100,000, which is expected to double by 2030.

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New device for diabetics ensures that patients miss fewer insulin doses

A new device known as OneTouch is an on-demand insulin delivery system in development that helps diabetics discreetly with their treatment.

 While syringes, pens, insulin pumps and jet injectors have given diabetics options for their insulin delivery for many years now, a new device called OneTouch Via could change the game.

People with type 1 and type 2 diabetes who used the new OneTouch Via mealtime, on-demand insulin delivery system reported they missed fewer doses and felt less stress about dosing compared to multiple daily injections, according to research presented by Calibra Medical, Inc., one of the Johnson & Johnson Diabetes Care Companies, at the annual American Diabetes Association (ADA) conference.


Results of the Market Acceptance Evaluation (MAE) study also demonstrated that physicians were more likely to recommend the innovative insulin delivery device to patients who are not at A1C goals or who are new to rapid-acting insulin (RAI) therapy.

The new OneTouch Via is a wearable, on-demand insulin delivery system in development that allows patients to discreetly deliver rapid-acting, or bolus, insulin at mealtimes by simply pressing two buttons on the device, accessible even through clothing. The thin, water-resistant patch can be worn continuously for up to three days, providing injection-free delivery of insulin when needed.

‘People with diabetes can often feel embarrassment or discomfort when they need to inject insulin at mealtimes or when snacking. In a social situation, they may choose to miss a dose so they don’t have to take themselves out of the moment, but avoiding needed insulin doses may lead to serious health complications over time,’ said Dr. Brian Levy. 

Levy added, ‘Because patients in the study were empowered to dose discreetly with the OneTouch Via, they felt encouraged to dose more often – and ultimately, they reported missing fewer doses and better adherence to their treatment regimen.’

The healthcare professionals who assisted with the study noted that they preferred the OneTouch Via over both insulin pens and syringes (75 % and 100 %, respectively) and would be likely to recommend it to their patients. The doctors also reported that they would start patients on mealtime insulin earlier because of the ease of use of the OneTouch Via patch. The study appears in American Diabetes Association (ADA) Conference.

 Read: Keep your insulin levels in control to keep your lungs healthy

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Bionic pancreas a benefit to people with diabetes

Stanley Baker can’t remember feeling quite so free in a very long time.


Baker is one of 52 people ages 12 and older with Type 1 diabetes who for five days tested in real-world settings a “bionic pancreas,” designed to take over the job of providing insulin on a minute-by-minute basis when the body’s real organ fails.


“This totally relieves you of managing the diabetes,” said Baker, 76, of Ipswich, Massachusetts. “It was extremely liberating.”


The mechanical device worn outside the body was designed by Edward Damiano, a Boston University engineer who has worked on the technology ever since his 15-year-son was diagnosed with diabetes as an infant. It kept patients at near normal levels in two trials and prevented dangerous blood sugar drops better than standard therapy, according to a report Sunday at the American Diabetes Association meeting in San Francisco.


It is among the first tests of such a system outside of a tightly controlled setting, according to Damiano, who said the investigators are starting a new, larger trial in four cities Monday and plan to have an improved version of the device on the U.S. market by the end of 2017.


The bionic pancreas is composed of five parts connected externally to one another and the body. It includes two pumps attached to the abdomen to deliver hormones, a glucose monitor with a wire that runs just under the skin and a computer program that calculates proper doses in a closed-loop system.

Adults using the device, which checks their blood every five minutes, roamed Boston unfettered, eating and exercising normally, ignoring the condition that typically weighs on their daily activities. Adolescents younger than 20 given the technology were attending a diabetes summer camp. Both groups were closely monitored 24 hours a day.


“There’s no current standard-of-care therapy that could match the results we saw,” said Damiano. The results were simultaneously published in the New England Journal of Medicine.


About 3 million Americans have Type 1 diabetes, in which the pancreas stops secreting the hormone insulin used to convert food into energy. Patients typically test their blood several times a day to measure glucose levels, then calculate the amount of insulin they need to inject based on their diet and exercise. High blood sugar can lead to organ damage and death, while too little can trigger unconsciousness or a coma.


The device isn’t being tested on people with the more common Type 2 diabetes, which typically develops in adults and is linked to a sedentary lifestyle. People with Type 2 produce insulin, though their bodies don’t use it properly.


The researchers used commercially available equipment, including a glucose monitor from Dexcom and two pumps. They crafted their own computer algorithm and ran it on an iPhone 4 to wirelessly connect the component parts and calculate how much of each hormone the patient needed.


“It’s constantly adapting to the patient’s ever-changing insulin needs,” said Damiano, who built the device with a colleague.


Other companies, including Medtronic and Johnson & Johnson, are working on similar products.

The bionic pancreas tested by the Boston researchers goes further, by constantly measuring blood-sugar levels and predicting the amount of insulin needed.


It is unique because it also administers glucagon, another hormone that causes the liver to release glucose.

THIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES.

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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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