By Sean Williams
A whopping 25.3 million people in the U.S. right now are diabetic, with an additional 79 million Americans in the pre-diabetes stage. Those figures, according to research firm PhRMA, are downright scary, because diabetic patients come with a growing list of health complications and could place an incredible human and financial burden on our health-care system. The American Diabetes Association’s latest study in March, for instance, estimated that the total cost of care related to diabetes jumped to $245 billion last year from $174 billion in 2007.
In the U.S., diabetes is currently the leading cause of new cases of blindness, kidney failure, and amputations of the feet and legs not related to accidents, according to the Centers for Disease Control and Prevention. In addition, life-threatening complications such as cardiovascular disease, nerve damage, and possibly Alzheimer’s disease have been associated with this disease.
What’s truly worrisome about diabetes mellitus — a condition in which the body is either unable to produce insulin (type 1 diabetes), or the body’s cells don’t know how to use the insulin produced to establish a proper glycemic balance in the body (type 2 diabetes) — is that many of the risk factors are often preventable. Unfortunately, as the following graph from the CDC demonstrates, few people are heeding the seriousness of diabetes’ risk factors as the number of diagnosed cases has jumped dramatically over the previous three decades.
Source: Centers for Disease Control and Prevention.
Today, I propose examining the three primary factors that lead to diabetes and see what’s being done to treat each factor.
Obesity/lack of physical exercise
It really shouldn’t be a surprise that not taking care of your body by eating poorly or electing not to exercise is the primary cause of diabetes. This isn’t to say that all of the people who are overweight or obese will develop diabetes, but there’s statistical evidence in the numbers that 80% of those people who are diagnosed with diabetes tend to be overweight or obese.
Certain factors of obesity are unavoidable, such as genetics and socioeconomic status, which can play a role in how the body reacts to what you eat and exactly what quality of food you can afford to buy. However, more obesity cases than not can be improved through a lifestyle change of choosing to eat healthier foods and exercising regularly.
In cases where this isn’t an option, or a little extra help is needed, there are always the two newly approved chronic weight management drugs — Qsymia by VIVUS (NASDAQ: VVUS ) , and Belviq by Arena Pharmaceuticals (NASDAQ: ARNA ) . It’s a bit early to tell which drug could ultimately prove to be the go-to drug in weight loss, with Qsymia providing a bigger weight loss in trials and Belviq delivering a marginally better safety profile, but the treatment group that could benefit from either drug is certainly growing, not shrinking. Assuming both drugs attract adequate nationwide insurance coverage (since consumers very much dislike out-of-pocket costs), they both have a chance at being blockbusters.
Smoking
Feel free to add diabetes to the growing list of health complications that smoking will bring to the table. A study conducted over 14 years of 1.3 million South Korean adults were who part of the Korean Cancer Prevention Society, and presented on the ADA’s website, notes that incidences of diabetes were higher in those who smoked, and that risk rose proportionately with the amount of cigarettes smoked daily. If there were ever a risk factor that could be easily eliminated from the equation, it would be to stop smoking.
In the U.S., the Food and Drug Administration and CDC are certainly doing their best to increase public awareness about the dangers of smoking. In March of last year, the CDC unveiled an aggressive and graphic $54 million advertising campaign across TV, radio, and online mediums aimed at reducing the number of smokers — particularly young smokers. The FDA followed just weeks later with its request for the quantity levels of some 20 harmful ingredients found in cigarettes, with the plan of releasing that data to the public sometime this year.
While these agencies might appear to be making little progress, the effect is certainly hitting home with tobacco producer Altria (NYSE: MO ) . In response to declining sales, Altria has turned to raising prices and cutting 15% of its workforce to reduce its expenses. In addition, a proposed 93% increase in the federal cigarette tax in President Obama’s 2014 budget proposal to $1.94 per pack from $1.01 could further cramp tobacco sales.
Genetics
Understandably, genetics also plays a big role in whether a person develops diabetes. If a person’s parents have diabetes, then they could be genetically at a higher risk of developing the disease — especially with regard to type 2 diabetes. However, genes alone aren’t enough to trigger diabetes, as a multitude of other risk factors, including obesity and smoking, are the triggers that push these high-risk people into pre-diabetic or diabetic territory.
For patients who have diabetes and who have a family history that supports preventative treatment based on a history of obesity or other complications, there are numerous medications available. None, however, is more exciting than a new class of type 2 diabetes drugs known as SGLT2 inhibitors. Instead of working via the liver and pancreas as previous diabetic treatments have, SGLT2 inhibitors work in the kidneys and allow patients to excrete excess glucose through their urine. Even more, this class of drugs has also been shown to cause modest weight loss in patients, although it isn’t indicated for such use.
Johnson & Johnson‘s (NYSE: JNJ ) Invokana is one such treatment that received FDA approval in late March to treat type 2 diabetes after lowering A1C levels in trials and helping provide better glycemic balance. Bristol-Myers Squibb (NYSE: BMY ) andAstraZeneca also have an SGLT2 candidate known as Forxiga, which was approved in Europe last year but failed to get past the FDA because of elevated concerns about breast and bladder cancer in January 2012. It seems only a matter of time until Forxiga gets the FDA nod of approval and diabetic patients gain another therapeutic option.
The two key takeaways
There are two primary takeaways from the top three causes of diabetes. First is that many of these risk factors are preventable. By choosing to live a healthier style, eating right, exercising, and not smoking, you could be dramatically reducing your chances of getting diabetes in your lifetime. It’s true we can’t do anything about our genes or about getting older (age has been shown to slightly increase our risk of diabetes as well), but focusing on putting good things in our body and keeping the bad things out is a big step toward avoiding unwanted health complications.
The other takeaway is that the therapies available to treat diabetes are rapidly improving. SGLT2 inhibitors could completely replace DPP-4 and other classes of diabetes drugs by the end of the decade as the gold standard in care. Also, weight-loss drugs such as Qsymia and Belviq offer investors a growing pool of potential patients. Really, any of the health-care companies I’ve mentioned here have a shot at becoming a leader in treating diabetes symptoms in the coming years.
