Poorly controlled Type 2 Diabetes is a worldwide problem- Prof. Zafar Iqbal

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 SAFES SUMMIT Proceedings-IV

Poorly controlled Type 2 Diabetes is a
worldwide problem- Prof. Zafar Iqbal

Failure to control Blood Sugar with three months OAD and
Insulin should lead to intensification of insulin therapy

NOVO Nordisk launches Ryzodeg a new combination
making Bangladesh the third country where this insulin
combination has become available

From our correspondent

DHAKA (BANGLADESH):  Novo Nordisk was one of the major sponsors of Second SAFES SUMMIT 2015 held at Dhaka, Bangladesh from April 24-26. The conference attracted a large number of diabetologists and endocrinologists from India, Bangladesh, Sri Lanka, Nepal and Pakistan. Novo Nordisk also availed this opportunity to launch its new preparation, Ryzodeg a combination of  70% insulin degludec and 30% insulin aspart rDNA origin injection. Thus Bangladesh became the third country in the world where Novo Nordisk has made this preparation available.  

A formal launch ceremony was held on the first day of the conference on April 24th 2015 followed by dinner. Ambassador of Denmark in Bangladesh was also present on this occasion. This session was presided over by Prof. A. K. Azad Khan from BIRDEM. The new preparation is said to be a simple regimen with few injections than basal or bolus therapy.  In people with diabetes, multiple daily injections can be a barrier to adherence and patient compliance can be poor while progressive Type 2 Diabetes  can  cause HBA1C to increase overtime. In the introductory remarks Camilla Sylvest remarked that Ryzodeg successfully reduces HBA1c.

Giving details of the company operations worldwide Maziar Mike Vice President International Operations at Novo Nordisk said that NOVO has five production facilities while a few products are also manufactured in collaboration with local companies. Currently over forty one thousand employees work in NOVO and company products are marketed, sold in  one hundred eighty countries while  24.4 million patients were using NOVO Nordisk products. As regards diabetes, almost 50% do not know that they are suffering from diabetes and of the remaining 50%, who know they have diabetes, 50% of them have no proper treatment and we wish to improve this situation. We have the largest portfolio of Insulin products and a rich pipeline in the field of diabetes. At present many Phase-I studies are underway, a few have been completed and approved. The company spends over two Billion US$ on Research and Development every year. We came to this part of the world fifty years ago and Bangladesh Diabetic Associaton is a global role model for treatment of diabetes mellitus.

Prof. Zafar Ahmad Latif Director at BIRDEM Academy in his presentation stated that there are six million people with diabetes in Bangladesh. China has 98.4 Million, India has 65.1 Million, and USA has 24.4 Million while Brazil has 11.9 Million people with diabetes. Poorly controlled Type 2 Diabetes is a worldwide problem. He also talked about advancing insulin therapy in diabetes and  strategies for intensification. While basal insulin may only control breakfast blood sugar, it may not be good for PPBS. If a patient after three months on oral antidiabetic drugs and insulin fails to control the blood sugar one should go for intensification of insulin therapy with multiple injections. One should use basal insulin with every meal. If the meal is small, insulin dose should also be smaller but if one used large meal, high dose of insulin may be required. Use of premix insulin twice a day is more flexible for the patient. His conclusions were that there are barriers at physician level, at patient’s level. There is a fear of hypoglycemia. Use of multiple injections limit adherence and simplicity was the key to insulin intensification.

Yan Cai Corporate Vice President in NOVO Nordisk in her presentation highlighted the efficacy and safety of this new combination Ryzodeg. It is rationally designed beyond sequeale modification. Its small molecular size, she said,  rapidly absorbs after injection.  It lowers the risk of hypoglycemia and successfully reduces HBA1c. She discussed the rationale for the co-formulation of basal and bolus insulin in a single injection. This can be administered once or twice daily as per patient requirement. Her conclusions were that it is the first co-formulation of two insulin’s  in the ratio of 70/30.

Dr. Sanjay Kalra from India in his presentation said that this unique preparation provides both short acting and long acting coverage. It is safe, effective and highly tolerated by the patients. Patients not responding to insulin therapy should have intensification of therapy. He also pointed out that all basal insulin’s are not the same hence it cannot be termed the failure of basal insulin. It could be basal insulin inadequacy. It offers low weight gain.  Meta analysis of two   BOOST trials showed that chances of hypoglycemia are less with this combination. The patient may also require 10-20% less insulin. During the maintenance period, the required dose of insulin will be less, there will be low weight gain and chances of hypoglycemia are also reduced. Not only that this combination also reduces the number of insulin injections required per day.

Giving findings from BOOST trial in Japan, he said the patients were administered one injection per day. Reduction in HBA1c was seen. Hence it can also be used for intermediate treatment. IDegASP offers better fasting control in elderly, adolescents and children. There are less chances of hypoglycemia and it is also effective in post transplant diabetics. It can be used just like the DOT therapy. The drug is well tolerated and there is a low risk of hypoglycemia, he added.

Prof. A.K. Azad Khan in his concluding remarks said that in Bangladesh we have seen the Good and Bad days. But we have never been short of Insulin. If we had no money, we were provided insulin on credit. However, he cautioned that the new combination was an expensive drug which needs to be used very judiciously. He hoped that as the sale of this new preparation goes up, the company will reduce its price as well.