With a dozen-plus agent classes for diabetes, what do physicians address first in patients?
Eliot Brinton, MD, President of the Utah Lipid Center, Salt Lake City, UT: As we have developed more and more classes of agents for type 2 diabetes — and we now have more than 12 classes of agents, it's amazing how many classes we have for this disease entity — it has become easier for us to customize the treatment for the individual patient. And there's some very general and obvious things like:
All these things are important background questions for the next question, which is, "How do I best individualize treatment for this particular patient?" And it's a very complicated question. If we look at the different elements, of the pathophysiology of type 2 diabetes, we have this term "the Ominous Octet," where we have at least 8 different organs or cell types within an organ that are involved in the pathophysiology of type 2 diabetes.
Thinking about what may be most relevant in that patient, and then trying to target the diabetes treatment at those particular organs or those particular causes, I think is helpful. That being said, most of our diabetes agents will address more than 1 of those organ systems or cell types, so it's not a clean situation.
The concept of understanding the situation of the patient in general, trying to look at those individual organs or cell types that are involved in that patient, and then trying to have the treatment target those, I think that's all appropriate, that's all important. One of the other things we always deal with as physicians is of course the question of insurance coverage. Like it or not, it's part of the equation. So, if we have generic products, we try to use those first. We look at the patient's coverage — hopefully, they have that.
That's all part of the individualization of the treatment, and I think if we can address this, and have the time to address it, we really have the tools now to customize to the patient's needs. And we can hopefully get the best glycemic control, the best reduction of cardiovascular disease risk, prevention of first or recurrent cardiovascular events, we can have the best method for addressing kidneys, hypertension, obesity, other elements that are part of the story of type 2 diabetes. It's an exciting time when you can do all of this, also with an eye to the cost for the patient.
It's very complicated, but also very exciting that we have so many different ways of understanding the individual patient and their own type of diabetes they have, and the way we can appropriately treat this.