How three ‘small’ changes in diabetes and obesity care may have gigantic long-term effects

This month I’d like to talk about small changes. You know: waking up 15 minutes earlier for a daily head start, taking deep breaths when stressed, using public transit instead of driving, or taking the stairs more often than the elevator. The kind of changes that sound simple (but inevitably require time and focused effort) and that seem minor (but often bring dramatic, long-lasting benefits). We’ve recently seen several examples of these ‘small’ changes in the world of diabetes and obesity treatment, and I’m excited to see what big effects will follow.

One of February’s biggest medical stories was the FDA Advisory Committee’s recommendation to approve Qnexa, a new anti-obesity drug. One could argue that Qnexa represents a small change, since it is simply two existing medications (phentermine for short-term weight loss and topiramate for migraine/epilepsy) combined in a single, once-daily pill. But bringing such a change to the real world is a big process with big implications – clinical development has involved thousands of patients over several years, and the FDA’s review (which began in early 2010) will continue until at least this April. The FDA has been especially cautious so far because so many people might want to try Qnexa; in one-year trials, patients on average lost nearly 10% of their body weight when they used Qnexa along with a diet-and-exercise program.

Another recent example is Bydureon, which uses the same active ingredient as Byetta – except in a once-weekly injection instead of twice-daily. Thanks to this small change (which also decreases the nausea associated with the drug), many people, including me, think that Bydureon’s launches in the US (this month) and in Europe (last summer) could be “game-changing” moments in diabetes care.

One area of still-ongoing changes is the quest to build an insulin pump controlled directly by a continuous glucose monitor – sometimes called a closed-loop device or an artificial pancreas. Progress here has been positive (as seen in this month’s Conference Pearls), though not fast as we’d want. For example, Medtronic’s pump/CGM combination that stops delivering insulin during hypoglycemia – known as the Veo and available internationally since 2009 – is just the first step toward the artificial pancreas, and it will likely not come up for US approval until 2014. Still, as we highlight in this month’s Trial Watch, the pivotal study to approve the device is now recruiting participants. We anticipate that the benefits of closing the loop – fewer lows, ‘smarter’ devices, and less time spent thinking about diabetes – will be worth the wait.

Although many more examples of small, positive changes are happening every day in diabetes care, I’ll close with just one more. Since we began publishing diaTribe in November 2006, we’ve made many tweaks: switching to a once-monthly format with longer issues, founding dQ&A to give you a direct voice to diabetes companies (write richard.wood@d-qa.com if you’d like to be part of this multi-thousand person panel), and expanding to platforms like Twitter (if you don’t already, follow us at @diaTribeNews). After 40 issues, diabetes has become a bigger worldwide problem than ever, and we are still just one small team working against the tide. But we hope that diaTribe has been a small change for the better in your own life, with many more small changes to come.

Sincerely,