3. Diabetes Mellitus
A disease in which the body’s ability to produce or
respond to the hormone insulin is impaired, resulting in
abnormal metabolism of carbohydrates and elevated
levels of glucose in the blood
Muhammad Nauman Khalid
4. Types Of Diabetes
Diabetes
Type 1 diabetes, once known as juvenile diabetes or
insulin- dependent diabetes, is a chronic condition in
which the pancreas produces little or no insulin.
Type 1 Diabetes
Type 2 Diabetes
Diabetes mellitus Type 2 is a long-term
metabolic disorder that is characterized by high
blood sugar, insulin resistance
Gestational Diabetes
Gestational diabetes mellitus (GDM) is
defined as any degree of glucose
intolerance with onset or first
recognition during pregnancy Muhammad Nauman Khalid
5. Role of Pancreas
Beta cells (β cell)
Alpha cells (α cell)
Delta cells
PP cells
Pancreas
1 to 2 million Islets of Langerhans,
Diabetes
Muhammad Nauman Khalid
6. Decreases blood glucose
levels
Beta cells
High levels of blood
glucose
Low levels of blood
glucose
Released by
Action
Secreted in
response to
Secretion
inhibited by
Increases blood glucose
levels
Alpha cells
Low levels of blood
glucose
High levels of blood
glucose
Insulin Glucagon
The Pancreatic Islets
Hormones released
Diabetes
Muhammad Nauman Khalid
7. Released by
Action
PP cells
Somatostatin Pancreatic Polypeptide
Delta cells
Suppresses Insulin
and Glucagon
slows intestinal motility
Not Known
Diabetes
The Pancreatic Islets
Hormones released
Muhammad Nauman Khalid
8. Blood Glucose regulation, fasting state
Role of liver
Glycogenolysis:
Conversion of
glycogen to glucose
Gluconeogenesis:
Conversion of fat to
glucose
Muhammad Nauman Khalid
9. Increase in glucose concentration
Liver performs 2 functions
After a meal
Function 1: Conversion of glucose to Glycogen : Glycogenesis
Blood Glucose regulation, fed state
Role of liver
Function 2: Conversion of glucose to triglycerides
Muhammad Nauman Khalid
10. Galvus(Vildagliptin)
Best in Class DPP4 Inhibitor,
Incretin Based Therapy with low Risk of
Hypoglycemia and Wait Gain
Muhammad Nauman Khalid
11. What are Incretins?
Hormones produced by the gastrointestinal tract in response to
incoming nutrients, and have important actions that contribute to
glucose homeostasis.
Two hormones:
- Gastric insulinotropic polypeptide (GIP)
- Glucagon-like peptide-1 (GLP-1)
Muhammad Nauman Khalid
12. Half-Lives of GLP-1 and GIP
GLP-1 Inactive compounds
1 to 2 min
DPP-4
DPP-4
Inactive compounds
GIP
7 min
Muhammad Nauman Khalid
14. Role of Galvus for Glycemic Control
Incretins
GIP &GLP1
Stimulate
insulin
release
Inhibit
Glucagon
Release
DPP-4
Enzyme
inactivates
Incretins
Lowering of
Blood
Glucose
Galvus Blocks
Muhammad Nauman Khalid
15. DPP-4=dipeptidyl peptidase-4; T2DM=type 2 diabetes mellitus
Adapted from Unger RH. Metabolism 1974; 23: 581-593. Ahrén B. Curr Enzyme Inhib 2005; 1: 65-73.
Insulin
Glucagon
Improved
glycemic control
Incretin
activity
prolonged
Improved islet
function
DPP-4 inhibitor
Glucagon
Hyperglycemia
Incretin
response
diminished
Further impaired
islet function
Insulin
Blocking DPP-4 Can Improve IncretinActivity and Correct
the Insulin:Glucagon Ratio in T2DM
T2DM
Muhammad Nauman Khalid
16. Pharmacology of Galvus
Mechanism of Action
Vildagliptin a member of islet enhancer class, is a
potent and selective DPP-4 Inhibitor that improves
glycemic control. Galvus inhibit DPP-4 results in
increased fasting and postprandial endogenous levels
of incretin hormones GLP1 and GIP.
Pharmacodynamics
In patients with type 2 diabetes , administration of
Vildagliptin led to inhibition of DPP4 enzyme activity
for 24- period.
The enhanced insulin/glucagon ratio during
hyperglycemia due to increase incretin hormones
levels results in a decrease in fasting and
postprandial hepatic glucose production, leading to
reduce glycemic levels. Muhammad Nauman Khalid
17. Pharmacology of Galvus
Characteristics Details
Half life 2-3 Hours
Bioavailability 85%
Protein Binding 9.3%
Elimination Urine 85% Feces 15%
Peak Plasma Level 1.7 to 2.5 Hours
Muhammad Nauman Khalid
18. ♦ Known hypersensitivity to vildagliptin or to
any of the excipients
♦ Patients with creatinine clearance <30 ml/min
♦ Congestive heart failure
♦ Acute or chronic metabolic acidosis including
lactic acidosis or diabetic ketoacidosis with or
without coma
♦ Should be temporarily discontinued
in patients undergoing radiologic studies
involving intravascular administration of
iodinated contrast materials.
Contraindications
Muhammad Nauman Khalid
19. Rare cases of angioedema. Rare cases of
hepatic dysfunction (including hepatitis)
Adverse reactions:
Common:
Dizziness
Uncommon:
Headache, Constipation, Edema peripheral.
Muhammad Nauman Khalid
21. Worldwide prevalence of diabetes is high and is expected to
increase to 592 million in approximately 20 years
International Diabetes Federation Diabetes Atlas 6th edition. www.idf.org/diabetesatlas/6e/ (Accessed September 2014)
Regional estimates for the number of people aged 20‒79 years with diabetes, in millions
Number of people with diabetes 2013: 382 million
Estimated number of people with diabetes in 2035: 592 million (~55%)
24.1 38.5
LatAm
+60%
North
America
+37%
36.8 50.4
Europe
+22%
Africa
+109%
19.8 41.5
Middle East &
North Africa
+96%
34.6 67.9
South-East
Asia
+71%
72.1 123.0
Western
Pacific
+46%
138.2 201.8
56.3 68.9
Muhammad Nauman Khalid
22. Prevalence in Pakistan
According to latest survey there is 35.3 Adults
are diabetic patients in our country.
IDF also confirmed there are more than 25%
adult population in Pakistan is Diabetic.
Muhammad Nauman Khalid
23. • Diabetes is a serious public health concern which places a great
burden on the individual, on the society and on the health
services.
• Number of people suffering from diabetes is increasing all over
the world.
• There are currently an estimated 143 Million people with
diabetes world wide.
• The figure is projected to rise to 300 Million by the year 2025.
• In Pakistan diabetes is on the rise.
Facts about Diabetes
Muhammad Nauman Khalid
24. • Diabetes is the fourth leading cause of death by disease
globally.
• In our country it is the most common cause of blindness and
end stage renal disease in adults.
Facts about Diabetes
Muhammad Nauman Khalid
25. Vision of Galvus
Our Vision is to Become the leader
in Anti Diabetic Market
Muhammad Nauman Khalid
26. Total Anti Diabetic Market Size 9 billion Rs
30%
45%
25%
Market Analysis
Sus DPP4 Others
Muhammad Nauman Khalid
29. Smart & Effective Customer List
• Wise Customer Selection for targeted product.
• T1 to ST Conversion.
• Expand and Explore new Customers and
Institutions.
• Untapped Opportunities
• Sound Knowledge of Prescribers and non
Prescribers
Muhammad Nauman Khalid
30. Key Factors to Achieve Leadership in
Anti Diabetic Market
Maintain our Leadership DPP4
Market
SU’s Market Share
Generics Share
Muhammad Nauman Khalid
31. Maintain our Leadership DPP4 Market
• Continuous Chamber Excellence & Engagement with
Leading Diabetologist and Physicians.
• Focus on Early Treatment Intensification.
• Cross Territory or within territory KOL’s engagements
with quality participants “SLP”
• Strong follow-up of activities about to or executed.
• Family Physicians forum quality engagements.
Muhammad Nauman Khalid
32. SU’s Market Share / Generics Share
• GP Awareness program in each territory 2 to 3 “G & G”
Programs per Quarter. Speaker: Associate/Asst Prof,
Audience: GP’s
• Patient Screening Camps with Gp’s
• MO’s SMO’s PG’s and Registrars will be engaged in
program “One 2 One”
• Find SU’s prescribers and share studies on Galvus
accordingly.
• Field Force Trainings and Skill development.
Muhammad Nauman Khalid
33. Summary
The biggest activity and investment is
Chamber Presence, Performance and
Excellence.
Muhammad Nauman Khalid
Editor's Notes
Diabetes is one of the most common diseases worldwide:1
In 2013, the world prevalence of diabetes was 382 million, this is projected to increase by almost 55% to 592 million by 20351
Prevalence is high globally and is increasing to epidemic proportions, especially in emerging economies1,2
Prevalence data by area (including the Middle East and North Africa, Africa and Asia) are shown on this slide
Type 2 diabetes accounts for approximately ~90% of all cases of diabetes2
The emerging global epidemic of diabetes has been attributed to poor diet, obesity and physical inactivity.1,2
In most countries, diabetes has become one of the major causes of premature illness and death.2
Complications, such as coronary artery disease, peripheral vascular disease, stroke, diabetic neuropathy, renal disease, blindness and amputations, not only translate into reduced life expectancy and quality of life, but also generate an enormous health burden.1,2 In 2013, more than 548 billion USD was spent on healthcare for diabetes.1
In summary: diabetes is one of the most challenging health problems of the 21st Century.1
References:
International Diabetes Federation. Diabetes Atlas 6th edition (www.idf.org/diabetesatlas/6e/. Accessed September 2014)
WHO 10 Facts About Diabetes (www.who.int/features/factfiles/diabetes/facts/en/index.html; Accessed March 2013)