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Dear Dr. Fox • My "grandbaby," a 12-year-old female German shepherd/husky-mix, has been diagnosed with renal/kidney failure.

She was losing weight, her fur was clumping in mats, and she was generally being cranky for at least six months before my daughter took her to the vet last month.

I just found out from another family member that Kachina has about three weeks to live because her kidneys are giving out.

I had been living with my daughter and all the grandbabies until several months ago. We parted on unfriendly terms. Kachina was crated most of the time — except when I was there or my daughter was home — sometimes with very little or no water. She was let out several times a day and night to do her business.

But there were times when I was not there, and my daughter would come home late from work and then go out very late at night. The poor dog was crated for hours and hours.

The dog did not like dry food only. Dinner was usually dry and canned.I am convinced that going without water, being crated for such long periods of time and being forced to eat dry food that wasn't good for her all led to this sad diagnosis.

Is there anything that can be done to help make my precious grandbaby more comfortable and maybe slow down or halt this disease? — P.B., Fairfax, Va.

Dear P.B. • I wonder, as you do, how a caring person such as yourself could have a daughter who mistreats a poor old dog as yours does.

If the dog were a human child, you would call the state child protection services.

But, regrettably, animal protection laws are inadequate and poorly enforced.

There is a man in Minnesota (where I live) who neglected several horses he owned or was boarding for other owners. Not until the horses were close to death from starvation were the local animal protection authorities able to seize them and put the poor animals into protective custody.

After a trial on misdemeanor charges for this repeat offender — who should have been prosecuted for felony animal cruelty — the judge allowed this man to keep the horses. Animal protection laws are trumped generally by business interests.

In the case of your poor Kachina, is it possible for you to make peace with your daughter and convince her that the dog should be living with you? If that is not feasible and she refuses to provide the dog with appropriate veterinary care, I would call the police and animal control and file a complaint, or at least threaten her with this if you think it might lead to her giving you the dog.

I am sure that Kachina's saga is not unique, and in many instances there is no family member like you to intervene.

twobitdog.com/DrFox Write to: Dr. Michael Fox in care of Universal Uclick, 1130 Walnut St., Kansas City, Mo. 64106.

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Feroz Khan's toothy smile is infectious and his courage, awesome. For the past seven years, he has been in and out of hospitals, determined to fight a disease that saps the energy out of him.

At the age of 12, Feroz began falling ill frequently. He was diagnosed with systemic lupus erythematosus (SLE), ordinarily referred to as lupus. It is an inflammatory, auto-immune disease that affects nearly every organ in the body, and the central nervous system. It could lead to kidney failure, if the patient is prescribed strong antibiotics and painkillers frequently.

Feroz's father, I. Razik Fareeth is an auto rickshaw driver and his mother, Mumtaz, takes tuition to support his treatment cost.

“We hail from Kizhakarai in Ramanathapuram. We were rich then but the treatment cost has made us poor,” Feroz said. His older brother is a final-year engineering student in a city college.

In 2009, he developed chronic kidney disease and was admitted to the Government General Hospital. Doctors suggested renal transplant but finding a donor was tough. “The only course left was dialysis until I could find a donor.”

His family could not afford dialysis in private hospitals. He had to drop out of school. Then, they were directed to TANKER Foundation for subsidized dialysis in December 2010. It was turning point for him. Feroz gained confidence and health, and returned to school to finish class XI.

But the disease returned the next year and he was on a twice-a-week dialysis regimen. Between December '11 and February '12, he was coached at home and scored 75.1 per cent in class XII.

“I want to do B.Com and then do a CA. It will take eight more years of study, but I will make it,” 19-year-old Feroz said.

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INGELHEIM, Germany & INDIANAPOLIS--(BUSINESS WIRE)--

“In this analysis, patients treated with linagliptin showed improvements in blood glucose levels and reduction of albumin in the urine, a sign for renal dysfunction. We will continue to further investigate this area as we recognise the importance of considering declining renal function when treating type 2 diabetes patients.”

EX US & UK.
Medical Media Only.

Boehringer Ingelheim and Eli Lilly and Company (NYSE:LLY) today announced results from a post-hoc analysis that showed linagliptin is associated with improvements in glucose levels and a significant reduction in urinary albumin-to-creatinine ratio (UACR) of 33% (p<0.05) from baseline in patients with T2D and at high risk of declining renal function (some degree of albuminuria at baseline). UACR is a measure of albuminuria in T2D patients with declining renal function.¹ Linagliptin is a once-daily tablet that is used along with diet and exercise either as monotherapy or in combination with other treatments, such as metformin or metformin + sulphonylurea, to improve glycaemic control in adults with T2D.^2,3

The post-hoc analysis included 227 T2D patients at high risk of declining renal function from four randomised, 24-week trials who were on stable treatment with one of two types of blood pressure medicines that are the standard treatment for diabetic renal disease – angiotensin-converting enzyme inhibitors (ACEs) or angiotensin receptor blockers (ARBs).¹ In addition to a reduction in glucose levels, as measured by a 0.71% change in haemoglobin A1c [HbA1c] versus placebo at 24 weeks, a 29% reduction in UACR was demonstrated with linagliptin versus placebo.¹ HbA1c is measured in patients with diabetes to provide an index of blood glucose control for the previous two to three months.

“This analysis is important because approximately 65% of patients living with type 2 diabetes are at risk of declining renal function, which can limit treatment options,” said Professor Per Henrik Groop, Division of Nephrology, Helsinki University Central Hospital, Finland. “In this analysis, patients treated with linagliptin showed improvements in blood glucose levels and reduction of albumin in the urine, a sign for renal dysfunction. We will continue to further investigate this area as we recognise the importance of considering declining renal function when treating type 2 diabetes patients.”

The primary endpoint in each of these four trials was the reduction in HbA1c levels from baseline at 24 weeks.

Linagliptin (5 mg, once daily) is marketed in the U.S. as Tradjenta™ (linagliptin), in Europe as Trajenta™ (linagliptin), and in other global markets as a once-daily tablet that is used along with diet and exercise either as monotherapy or in combination with other treatments, such as metformin or metformin + sulphonylurea, to improve glyceamic control in adults with T2D. Linagliptin should not be used in patients with type 1 diabetes or for the treatment of diabetic ketoacidosis (increased ketones in the blood or urine). Linagliptin is not approved in combination with insulin. With linagliptin, no dose adjustment is required regardless of declining renal function or hepatic impairment.^2,3

About the Albuminuria Post-hoc Analysis

In a post-hoc analysis, data from four randomised, double-blind, 24-week, placebo-controlled trials of linagliptin monotherapy, linagliptin with add-on to metformin, linagliptin with add-on to metformin and sulphonylurea and a factorial study of linagliptin in initial combination with metformin were pooled (n=2472) to explore the clinical effect of linagliptin on albuminuria in patients with T2D who are at high risk of declining renal function (including albuminuria at baseline). The primary objective of these four trials was to analyse the change in HbA1c from baseline at 24 weeks.¹

UACR was collected in the four trials as safety data. The endpoint was the percentage change in geometric mean UACR. In this analysis, 492 (19.9%) patients met UACR (30?UACR ?3000 mg/g creatinine) and estimated glomerular filtration rate (eGFR) thresholds (eGFR >30 ml/ min/1.73m²) of whom 46% received stable ACE/ARB therapy (linagliptin n=168; placebo n=59). Mean baseline HbA1c and median UACR were 8.2% versus 8.5% and 76 versus 78 mg/g creatinine for the linagliptin and placebo groups, respectively. After 24 weeks, placebo-corrected changes in HbA1c and FPG were -0.71% and -26 mg/dL respectively (both p<0.0001). Linagliptin significantly lowered UACR by 33% compared to baseline (p<0.05) with a between-group difference of -29% (p<0.05).¹

About Diabetes

An estimated 366 million people worldwide have type 1 and type 2 diabetes.⁴ Type 2 diabetes is the most common type, accounting for an estimated 90 to 95% of all diabetes cases.⁵ Diabetes is a chronic disease that occurs when the body either does not properly produce, or use, the hormone insulin.⁶

Boehringer Ingelheim and Eli Lilly and Company

In January 2011, Boehringer Ingelheim and Eli Lilly and Company announced an alliance in the field of diabetes that centres on four pipeline compounds representing several of the largest treatment classes. This alliance leverages the companies’ strengths as two of the world’s leading pharmaceutical companies, combining Boehringer Ingelheim’s solid track record of research-driven innovation and Lilly’s innovative research, experience, and pioneering history in diabetes. By joining forces, the companies demonstrate commitment in the care of patients with diabetes and stand together to focus on patient needs. Find out more about the alliance at www.boehringer-ingelheim.com or www.lilly.com.

About Boehringer Ingelheim

The Boehringer Ingelheim group is one of the world’s 20 leading pharmaceutical companies. Headquartered in Ingelheim, Germany, it operates globally with 145 affiliates and more than 44,000 employees. Since it was founded in 1885, the family-owned company has been committed to researching, developing, manufacturing and marketing novel medications of high therapeutic value for human and veterinary medicine.

As a central element of its culture, Boehringer Ingelheim pledges to act socially responsible. Involvement in social projects, caring for employees and their families, and providing equal opportunities for all employees form the foundation of the global operations. Mutual cooperation and respect, as well as environmental protection and sustainability are intrinsic factors in all of Boehringer Ingelheim’s endeavors.

In 2011, Boehringer Ingelheim achieved net sales of about 13.2 billion euro. R&D expenditure in the business area Prescription Medicines corresponds to 23.5% of its net sales.

For more information please visit www.boehringer-ingelheim.com

About Eli Lilly and Company

Lilly, a leading innovation-driven corporation, is developing a growing portfolio of pharmaceutical products by applying the latest research from its own worldwide laboratories and from collaborations with eminent scientific organizations. Headquartered in Indianapolis, IN, Lilly provides answers – through medicines and information – for some of the world's most urgent medical needs. Additional information about Lilly is available at www.lilly.com.

About Lilly Diabetes

Lilly has been a global leader in diabetes care since 1923, when we introduced the world’s first commercial insulin. Today we work to meet the diverse needs of people with diabetes through research and collaboration, a broad and growing product portfolio and a continued commitment to providing real solutions - from medicines to support programs and more - to make lives better.

For more information, visit www.lillydiabetes.com.

This press release contains forward-looking statements about linagliptin tablets for the treatment of type 2 diabetes. It reflects Lilly's current beliefs; however, as with any such undertaking, there are substantial risks and uncertainties in the process of drug development and commercialisation. There is no guarantee that future study results and patient experience will be consistent with study findings to date or that linagliptin will be commercially successful. For further discussion of these and other risks and uncertainties, please see Lilly's latest Forms 10-Q and 10-K filed with the U.S. Securities and Exchange Commission. Lilly undertakes no duty to update forward-looking statements.

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References

¹Groop P, Cooper M, et al. Linagliptin Lowers Albuminuria on Top of Recommended Standard Treatment for Diabetic Nephropathy. Poster No. 953-P. Presented at the American Diabetes Association^® (ADA) 72^nd Scientific Sessions. June 8-12, Philadelphia, PA.
² Trajenta™ (linagliptin) tablets. EMA Summary of Product Characteristics. Approval 25 September 2011. www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Product_Information/human/002110/WC500115745.pdf
³Tradjenta™ (linagliptin) tablets. Highlights of Prescribing Information. Initial U.S. Approval: 2011.
⁴ International Diabetes Federation. IDF Diabetes Atlas, 5th Edition: The Global Burden. 2011. http://www.idf.org/diabetesatlas/5e/the-global-burden. Accessed on: April 11, 2012.
⁵ Centers for Disease Control and Prevention.Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.
⁶ International Diabetes Federation. IDF Diabetes Atlas, 5th Edition: What is Diabetes? http://www.idf.org/diabetesatlas/5e/what-is-diabetes. Accessed on: April 11, 2012.

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