Can Victoza favorably disrupt the unholy trinity of obesity, type 2 diabetes and heart disease? Since most type 2 diabetics die of cardiovascular disease rather than elevated blood sugar, this question significantly impacts survival.
Advertising claims suggest advantages for the injectable anti-diabetic drug Victoza in protecting the heart, stimulating weight loss and reducing the likelihood of death from cardiac events. Are these based in reality or merely commercial entreaties from the drug maker looking to ensnare more customers?
Among the results emphasized by the company are a statistically significant fall in death from cardiovascular causes from 1.6 in 100 patient-years down to 1.2. Regarding death from any cause Victoza reduced the toll from 2.5 deaths in 100 patient-years to 2.1.
While statistically significant, the clinical importance of these findings remains less than obvious especially in view of many shortcomings of the study’s design, implementation and entanglements of the author’s finances with the company.
This and other studies reveal limited cardiovascular benefit with a tiny reduction some critical outcomes. Victoza did not limit non-fatal heart attacks or stroke; neither did it improve the rate of hospitalization for heart failure.
Victoza functions by slowing stomach emptying which often leads to reduced appetite and loss of body weight. Not uncommonly patients lose 5-6 pounds over the course of a year. Unfortunately by itself this miniscule amount of weight loss fails to favorably alter the metabolism.
Another activity of Victoza involves stimulating the body to produce more insulin while at the same time decreasing production of glucagon, a blood glucose elevating hormone. Together these actions reduce blood sugar and lower the glycosylated hemoglobin by about 0.8-1.1%. Among those receiving the standard dose of Victoza, only around half succeed in lowering the HbA1c to the goal of less than 7%.
Typical adverse reactions revolve around the gastrointestinal tract. More than 4 out of 10 people experience nausea, diarrhea, constipation or vomiting. Headache tends to be more of a nuisance than a major issue.
Other potential side effects include thyroid tumors often presenting with a lump in the neck, hoarseness or shortness of breath. Pancreatitis rarely occurs but may lead to severe abdominal pain or death. Those already with kidney disease may find their condition worsening with Victoza.
The cash price for one month of Victoza ranges between $900-1000. Realizing their sales would be minimal at these prices, the company offers co-pay cards to reduce or eliminate the out of pocket expense. This allows them to charge the insurance companies excessively burdensome amounts without fear of complaints from the insulated customers. This manipulation of the system ensures a never ending spiral of drug costs into the stratosphere.
Finally with appropriate attention to diet and exercise, the overwhelming majority of type 2 diabetics would not require expensive medications. Instead of focusing the general public toward the benefits of a wholesome lifestyle, we prize treatments with drugs that minimally improve diabetes while posing threats to overall physical and financial health.
Our system rewards the drug industry rather than diets that not only improve heart disease but also minimize the risk of stroke, kidney dysfunction, peripheral neuropathy, vision loss, dementia, cancer and more. Seems like we need to re-orient our priorities.