Alex Berenson, the New York Times business reporter who covers the pharmaceutical industry, has a new article on how Pfizer’s Exubera inhaled insulin sales are “lagging.”

The analysis discovered that many Wall Street analysts have downgraded their earnings estimates for Pfizer’s diabetes sales.

This blog hazards a guess that some of those analysts have read the research and posts here, discovering that quite a few doctors, insurers, and diabetics do not support Exubera use.

Berenson cites a February 2007 study by Citigroup’s drug industry analyst team which found that after surveying some 35 doctors, “more than half said they were concerned about Exubera’s safety. They were also concerned about its price and the bulkiness of the Exubera inhaler.”

Last July, this blog reported that Harvard Pilgrim’s Health Care’s pharmacy director was shocked that insurers would cover Exubera’s increased cost.

“I don’t get who the target market is — people with unlimited drug coverage who like gadgets?,” said Dr. Neil Minkoff, the insurer’s pharmacy director.

The two largest health insurance companies in the country, Wellpoint (which manages many Blue Cross / Blue Shield plans) and Minnesota-based UnitedHealthcare, list “Exubera in the third tier of their drug formularies. Co-pays at that level run $40 to $50 per prescription at United-Healthcare.”

Berenson also notes that sales of Type-2 diabetes drugs like Byetta and Januvia have grown rapidly compared to Pfizer’s Exubera sales

A new report says that Pfizer India received necessary approval to launch Exubera.

According to Mint, India’s new business newspaper, Pfizer India’s Managing Director Kewal Handa reportedly discussed Pfizer’s diabetes drug push.

Marketwatch says that Mint estimates a diabetes drug growth-rate of 20-22% a year in the country.

Pfizer India will face competition from Eli Lilly & Co. (NYSE:LLY) and Merck KGaA (MRK.XE), two major diabetes drug companies expanding their efforts in the country.

In contrast to the hesitation by some endocrinologists to prescribing Pfizer, Inc.’s (NYSE:PFE) Exubera, a number of doctors say that they are already excited about Merck & Co., Inc. (NYSE:MRK) getting FDA approval for Januvia.

Just what are endocrinologists saying about the new Type 2 diabetes drug?

Here are just a few comments:

“I can’t wait to put people on the drug”

Dr. James Underberg, Clincial Assistant Professor at New York University, quoted in the New York Times.

“In the way the diabetes story is being played out, we are beginning to have agents that are allowing us to have some control over blood sugars without weight gain. That is the excitement about these products.”

Dr. Stuart Weiss, endocrinologist and Assistant Clinical Professor at New York University, quoted in an Associated Press story in USA Today.

Other doctors, while not critical, are showing caution about Merck’s Januvia getting FDA approval. One of them is Dr. John Buse, Director of the Diabetes Care Center at the University of North Carolina-Chapel Hill, and the American Diabetes Association’s newly elected president.

Dr. Buse says that:

“There are many patients and — maybe, even more doctors — who are relatively reluctant to use a new drug in the first six months or year after it’s released…There are so many options. And this isn’t going to be the most powerful agent available.”

Is Exubera one of those diabetes drugs that doctors are “reluctant” to prescribe? Some have expressed real concern over the inhaled insulin’s pulmonary risks when used by diabetics who have chronic pulmonary disorders, but haven’t even been diagnosed with them yet. Others have also expressed caution, saying that they they’re going to take a wait-and-see approach over using Pfizer’s inhaled insulin.

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The FDA approved Januvia, a drug for Type 2 diabetes made by Merck & Co., Inc. (NYSE:MRK). Januvia’s approval is a new threat to Exubera, the inhaled insulin developed by Pfizer, Inc. (NYSE:PFE) and Nektar Therapeutics (NASDAQ:NKTR).

Merck sales reps are already looking forward to selling the drug.

One alleged plus: in contrast to Exubera’s safety risks, Merck says that Januvia was not associated, in the company’s clinical studies, with the common side effects, like weight gain and increased incidence of hypoglycemia (excessively low blood sugar), which can occur with some current diabetes treatments.