"There are two problems with diabetes," explains Ronald Goldberg, MD, associate director of the Diabetes Research Institute at the University of Miami Medical Center. "Your body doesn't make enough insulin. And your organs are resistant to using insulin that is produced."
About two years ago, when Anne Tierney learned she had type 2 diabetes, it galvanized her. “My diagnosis came as a shock,” says Tierney, who was then about 40 pounds overweight. “I used to eat chocolate all the time. The day I was diagnosed, I quit.” She also consulted a nutritionist and hired a personal trainer. “I knew I had to take action,” recalls Tierney, 51, director of corporate gifts for Halls Crown Center in Kansas City, Mo. Her action plan was in keeping with the latest research on...
If lowering high blood sugar is the primary goal, today's diabetes drugs do their job "but only to a limited extent," Goldberg tells WebMD. "Even when patients respond to one drug, they will need more and more drugs over time, as the pancreas deteriorates."
Type 2 Diabetes Treatments: New OptionsFortunately for many, advances in treatment are helping to make a difference, giving people with type 2 diabetes a growing list of options, including:
- Complex new drugs, like Byetta, which is taken by injection but is not insulin. It attacks high blood sugar from multiple angles and suppresses appetite. "Byetta is a real advance," says Stephen Davis, MD, chief of Diabetes, Endocrinology, and Metabolism at Vanderbilt Medical Center in Nashville.
- Victoza is another new drug that is taken by injection but is not insulin that may improve blood sugar levels in adults with type 2 diabetes. This drug helps the pancreas release the right amount of insulin.
- Januvia and Onglyza are novel drugs that work with gut hormones, natural enzymes, and the body's own insulin to control blood glucose. Tradjenta is another drug in the same class.
- Several two-drug combination pills have been approved by the FDA in the past two years -- reducing the number of pills people must take. The well-known drugmetformin is now available in an extended-release, once- or twice-a-day dosage -- without bothersome intestinal side effects.
- Symlin a synthetic form of a hormone made and secreted from the pancreas which help lowers blood sugars after meals.
He says metformin is good at controlling glucose. "And it's a drug that does not cause weight gain. Also, the generic version is less expensive for patients. For all those reasons, metformin is usually the medication we start patients on."
However, because of side effects -- gas, bloating, and diarrhea -- some people have trouble tolerating metformin in its standard form, says Davis.
Extended-release metformin takes care of that problem. The drug has fewer side effects, says Davis, "and is absolutely an advance ... much better tolerated."
New Combination Drugs for DiabetesThe new combination medications join metformin with other well-known diabetes drugs. Sulfonylureas like Amaryl and Glucophage help stimulate the pancreas to make more insulin. Thiazolidinediones (TZDs) like Actos and Avandia help "sensitize" fat and muscle cells, making them more responsive to the body's natural insulin, thus overcoming insulin resistance. However, the FDA has restricted Avandia for use in new patients only if they can't control their blood sugar on other medications and are unable to take Actos. Current users can continue Avandia if they choose to do so. All patients using Avandia must review and fully understand the cardiovascular risks. Meglitinides like Prandin help your body make more insulin for a short period of time right after meals. DPP-4 inhibitors lower your blood glucose by helping your body make more insulin when it's needed, especially right after meals. It also helps keep your liver from putting stored glucose into your blood
- Glucovance (metformin and glyburide, a sulfonylurea)
- Metaglip (metformin and glipizide, a sulfonylurea)
- Avandamet (metformin and rosiglitazone, a TZD)
- Actoplus Met (Metformin and Actos, a TZD)
- Avandaryl (glimepiride, a sulfonylurea and rosiglitazone, a TZD)
- PrandiMet (metformin and repaglinide, a meglitinide)
- Kombiglyze (metformin and saxagliptin, a DPP-4 Inhibitor)
- Duetact ( Glimepiride, a sulfonylurea and Pioglitazone, a TZD)
However, the two-in-one drugs have a downside, Davis says. "If there are side effects with one drug, you cannot change the dosage to reduce them. The patient may have to quit the drug altogether."
Combination drugs are not appropriate for people with advanced diabetes, he adds. "Their glucose is more difficult to control, and they are less able to tolerate side effects. I would not prescribe them for those patients."
Sophisticated New Treatment Options for Type 2 DiabetesThe two-pronged mission of Byetta -- a drug derived from lizard spit -- has generated lots of interest, says Goldberg. The drug stimulates insulin production after a meal, but only when blood glucose is high. It also represses glucagon, a hormone that increases blood sugars. The drug is given by injection and is not insulin but a type of medication that mimics the action of a natural hormone called an incretin.
Victoza is a non insulin injection that mimics a natural blood sugar-lowering hormone made in the gut (GLP1), Goldberg says.
Symlin is used along with insulin injections in those with type 1 and type 2 diabetes. It is a synthetic form of a hormone made and secreted from the pancreas along with insulin. This medication help lowers blood sugars after meals. It works by slowing gastric emptying, repressing glucagon, and suppressing appetite. Symlin is given by injection.
The Future of Diabetes Drugs: Beyond Blood Sugar ControlSide effects may not always present a problem. For example, research has revealed positive "side effects" of many other already available diabetes drugs:
- Metformin and Precose can reduce the risk of developing type 2 diabetes in at-risk individuals, when combined with a healthy diet and exercise.
- Actos may reduce the risk of heart attack, stroke, and premature death among people with type 2 diabetes.
Januvia (sitagliptin), Onglyza (saxagliptin), and Tradjenta (linagliptin) belong to a novel class of diabetes drugs called DPP-4 inhibitors. By inhibiting this natural enzyme, these medicines significantly increase the levels of incretin-a hormone, which helps regulate blood sugars. They also increase the synthesis and release of insulin.
Don't Forget: Treatment With Exercise, Healthy DietTo get the most benefit from any diabetes medications, you must stick to a healthy lifestyle, Davis says. He doesn't advise patients to follow extreme diets, like low-carb or vegan diets -- even though one study by the American Diabetes Association found that a vegan diet can reduce the need for diabetes medications.
"I certainly wouldn't recommend a vegan diet. You can get nutritional deficiencies," Davis tells WebMD. "I advise a well-balanced, nutritious diet that includes protein, fat, and carbohydrates."
Exercise prompts your body to use insulin efficiently -- if you eat a sensibly-sized meal, Davis says. "However, if you eat a very large meal, the medications may not be able to cope with the excess blood sugar. So yes, diet and exercise are important. Exercise controls insulin, blood pressure, weight, and well-being."