By: Daniel Trecroci
It seemed that every time we gave something a tryand it didn’t quite work out, Mom and Dad alwayshad a cliché at the ready to cushion the blow.
But what would Mom and Dad have to sayabout the AtLast alternate-site meter?
Or the GlucoWatch?
Or those needleless “jet” injectors?
For Every Good Innovation, There’s a Clunker
There is no doubt that the diabetes industryhas yielded many new devices and productsthat have made living with diabetes easier.
Ask any long-term diabetic what having the disease used to be like, and you’ll hear a laundry list of anecdotes that will make you look with a whole new light at your rapid-acting insulin, your designer type 2 drug or your meter that requires only a tiny speck ofblood.
But not every innovation has been aboom.
In fact, there has been a fair share of busts.
We asked Diabetes Health readers to tell us what they thought were some of the biggest disappointmentsin the world of diabetes. Their responses were asinteresting as they were varied.
The American Diabetes Association’s(ADA) Exchange Diet
For many people with diabetes, this was, and still is, the first dieting concept introduced to themupon diagnosis.
The ADA Exchange Diet advocates a diet low in fat, limited in protein and higher in carbohydrates.
“This is a recipe for unstable bloodsugars,” says Carl Hanson of Grantham,New Hampshire.
Ann Armstrong, a reader with type 2 fromZionsville, Indiana, agrees. “Now, as we know,carb counting is far more important than wasonce thought, and diabetics used to be told to eatway more carbs per day than is now acceptablefor good blood glucose control.”
Phil Snell, a type 2 from Salt Lake City, Utah, says that prescribing a diet of 180 to 200carbohydrate grams per day is “the biggestdisservice being done to those of us withdiabetes.”
“If I did that, my blood glucose would be much higher than it is, and I would undoubtedly have to be on insulin.”
Vicki Abbott of Portland, Oregon, says the ADA exchange plan has caused more harm to people withdiabetes than practically anything else shecan think of.
“All this [diet plan] does is make BGs rise,with the need for more medication to stay in control.”
Only a few years ago, Cygnus’s GlucoWatch was supposed to be the greatest thing to hit the diabetesindustry since the sliced bread recommended by theADA exchange plan.
At diabetes conferences, lines to the Cygnus boothran out the door as curious diabetics and healthcareprofessionals tried to get a glimpse of the wristwatchdevice that would measure blood glucose in theinterstitial fluid and alert users to lows and highs withits alarms.
Then, in May 2002, the GlucoWatch was granted FDAapproval, but there was also a hefty price tag for thewatch and pads. In addition, reports of inaccuraciesand skin irritation came out of the woodwork.
One reader calls the GlucoWatch “too cumbersome,irritating, expensive, inaccurate, painful and overhyped.”
People seemed to stop caring about the GlucoWatch,and Cygnus is rarely represented at diabetes conferencestoday.
The GlucoWatch is still sold, however, and onAugust 13, 2004, the Cygnus financial reportstated that the company had only $47,000 in total revenuesfor the fiscal quarter ending June 30, 2004. Cygnus also posted a net loss of $2.4 million for the same time frame.
Needleless “Jet” Injectors
Designed for needle-phobic people, these jet injectors force a tiny stream of insulin through the skin by pressure rather than puncture.
The devices were large and cumbersome and sometimescaused bruising at the injection site. Even though the devices were needle-free, jet injector users would sometimes wonder if the pain of inconvenience was better than thepain of a syringe.
Daniel Barcus of Chicago, Illinois, says the jet injectors of the early 1980s needed to be wound up to be pressurized, loaded with insulin and pressed against the skin, where insulin would shoot in a very thin stream through the skin with almost no pain.
“Yeah, right,” says Barcus. “And if there was any little problem, such as not holding the device (which wasreally heavy) at a perfect 90-degree angle, then only some of the insulin would go in to you. The rest would spray all around the room. There was also no way to know how much insulin had been deliveredand how much sprayed.”
Barcus adds that often the insulin from the needleless injector would make it only past the top layer of skin, and it would form a visible bubble right below the skin.
This drug for type 2 diabetes came on the market in 1997 and was hailed by type 2s and healthcare professionals for its ability to lower blood glucose and A1Cs by decreasing insulin resistance in the muscle cells.
Then, in 1998, reports began to surface that Rezulin(troglitazone) was causing liver damage in some users. Afterintense media scrutiny and more deaths as a result of liver failure, Rezulin was pulled from the market in March 2000.
Constance Etter of Winchester, California, callsRezulin the biggest diabetes bust.
“It kept my blood glucose perfectly in line, but it could have killed me eventually,” she says. “What a letdown, after almost a year on it, and feeling good.”
Melissa Ford calls Rezulin the biggest diabetes bust for63 reasons: “63 deaths!”
While Rezulin was the first drug in the new class ofthiazolidinediones (TZDs, glitazones) to be approvedby the FDA, it was then followed by the two currentlyapproved TZDs, Actos (pioglitazone) and Avandia(rosiglitazone), which offer the benefits of decreasinginsulin resistance without the high risks associatedwith Rezulin.
In the works for many years now, several companies arechampioning inhalable insulin. At present, there exists muchfavorable data demonstrating its ability to lower BGs in people withtypes 1 and 2 diabetes.
Unfavorable data, however, have surfaced in the past.
The December 2002 issue of Respiratory Medicinefound that children with type 1 have an increase inairway resistance, and that “progressive abnormalitiesin lung function might interfere with the promisingresults of treatment with intrabronchial administrationof insulin.”
Scott Strumello of New York City considers inhalableinsulin to be a bust.
“How much money has been [wasted] away onthis concept?” asks Strumello. “It is not better fortreatment, it is merely designed to sell insulin tomillions of type 2 patients who refuse to take insulinbecause they’re afraid of needles. Above all, at leastin the first versions being studied, it does not provide basal coverage, so millions will still need to rely on shots.”
Strumello argues that if the money allotted to inhalableinsulin research had been spent on “legitimate”research, “we would have a cure by now.”
Flawed Terminology for Diabetes
Pat Shermer of Livingston, Montana, offers a differenttake on the diabetes bust concept. She thinks that ourdiabetes terminology is a bust.
“I believe that the biggest wrong is that type 1 andtype 2 diabetes are called by the same name,” saysShermer. “They are two very different diseases withsome similarities. Very few people, in this world, evenknow there is a difference.”
Promises of a Cure
Surprisingly, many readers felt the biggest diabetes bustis the endless promises of a cure that have come downover the years.
The list, it seems, goes back as far as there has been adiagnosis for diabetes:
- Pancreas transplants
- The artificial pancreas
- Islet transplantation/the Edmonton Protocol
Gail Trenhaile of Omaha, Nebraska, was diagnosedwith type 1 in 1980 and has been told ever sincethat time that a cure is “just around the corner” or“only 10 years away.”
“Do the math,” says Trenhaile. “Holdingout false hope is cruel, especially for families withchildren with diabetes, and it is very defeating forfundraising purposes.”
Toni Fraser of Saint Regis Falls, New York, is theparent of two sons with type 1. She, too, agrees thatpromises of a cure are a bust.
“Diabetes is a mega-money-maker for the healthcareand pharmaceutical industry,” says Fraser. “Why wouldthey want to cure it? They come up with more and more devices because those things can be sold. A cure will put an end to the cash flow.”
The 17 Biggest Diabetes Busts According to Diabetes Health Readers
- The ADA Exchange Diet
- The AtLast Meter and Alternate-site testing
- Promises that a cure is “just around the corner”
- The Diabetes Control and Complications Trial (DCCT)
- The Dream Beam
- The GlucoWatch
- The idea that eating sweets causes diabetes
- Inhalable insulin
- Islet transplantation
- Liposuction to “cure” type 2
- The terminology for diabetes
- Needleless injectors
- Noninvasive testing
- Sugar alcohols that make foods “sugar-free”
- Urine testing
Tell Us Your Diabetes Busts
Okay, we know you’re going to read this and ask, But what about . . .? and what about . . ?
We would love to hear your “what abouts.” Drop us a line and let us know. We’ll publish some of them in a future article.