It's been an exciting time for diabetes treatment - in the past year or so, several brand new medications have been approved to treat type 2 diabetes. These are not just new meds, they're completely new categories of drugs. What does that mean? These new medications work in completely different ways than the standard medications.
But does that mean that science is giving up on the old stand-by drugs? No, it doesn't. The oldies-but-goodies still do a good job, and coupled with the new kids on the block, blood glucose levels can stay even closer to normal and tighter control may be easier to maintain. Note: Scroll to end of page for a chart on diabetes medications.
New Classifications and Medicines
DPP-4 Inhibitors: These drugs block an enzyme (DPP-4) that normally deactivates a protein (GLP-1) that keeps insulin circulating in the blood. Slowing the deactivation process helps reduce sugar production, lowering blood glucose levels.
- Januvia (sitagliptin phosphate): The first of the DPP-4 inhibitors to be approved by the Food and Drug Administration. Januvia is an oral medication which is taken once a day, either alone with diet and exercise, or in combination with other oral diabetes medications.
Incretin Mimetics: These mimic the action of incretin hormones which help the body make more insulin. They also slow the rate of digestion so that glucose enters the blood more slowly. People on incretin mimetics feel full longer, which reduces food intake, which helps some people lose weight while on the medication.
- Byetta (exenatide): Byetta is an injectable medication that is used in combination with other oral diabetes medications. It is not an insulin and it does not take the place of insulin. It is used for type 2 diabetes only and cannot be given with insulin. Byetta comes in a pre-filled injector pen. The dose is 5 mcg. to start, twice a day within 60 minutes prior to your morning and evening meals. Your doctor may increase the dose to 10 mcg. based on your results.
Antihyperglycemic Synthetic Analogs: These are medications that are created as synthetic versions of human substances, in this case a human hormone called amylin, which is used by the pancreas to lower blood glucose levels.
- Symlin (pramlintide acetate): Symlin is an injectable medication which is used with insulin for tighter blood glucose control. Symlin can increase the risk of severe hypoglycemia, therefore patients who are put on Symlin are selected carefully and monitored closely by their healthcare providers.
Older Classifications and Medicines
Sulfonylureas: These medications are the oldest of the oral diabetes drugs, and until 1995 they were the only drugs available for managing type 2 diabetes. Sulfonylureas stimulate the pancreas to release more insulin into the blood stream. Hypoglycemia can be a side effect of these drugs. Sulfonylureas can also sometimes stop working after a few years.
There are several "generations" of this classification of medicines. Second and third generations are more widely prescribed today.
- First generation: Orinase, Tolinase and Diabinese
- Second generation: Glucotrol (glipizide), Glucotrol XL (extended-release glipizide), Micronase or Diabeta (glyburide)
- Third generation: Amaryl (glimepiride)
Biguanides: These lower the production of glucose that is made in the liver. It also makes the body more sensitive to insulin. Cholesterol levels may be lowered as well.
- Glucophage, Glucophage XR (metformin): There is very little risk of hypoglycemia when metformin is used alone. Lactic acidosis can be a rare but serious side effect.
Alpha-Glucosidase Inhibitors: These delay the conversion of carbohydrates into glucose during digestion. This prevents blood glucose levels from peaking too high.
- Precose (acarbose)
- Glyset (miglitol)
Thiazolidinediones: Sensitizes muscle and fat cells to accept insulin more easily.
- Avandia (rosiglitazone)
- Actos (pioglitazone)
As of May 21, 2007, the FDA has issued a safety alert regarding the possibility of heart attacks or other fatal cardiovascular events when taking Avandia. Please call your physician to discuss alternative medications for managing your diabetes.
Meglitinides: These stimulate insulin production when there is glucose present in the blood. If blood sugar is low, the drug does not work as well.
- Prandin (repaglinide)
- Starlix (nateglitinide)
Hinnen, ARNP, BC-ADM, CDE, FAAN, Deborah, Nielsen PhD, Loretta L., Waninger BS, Amy, and Kushner MA, MD, Pamela. "Incretin Mimetics and DPP-IV Inhibitors: New Paradigms for the Treatment of Type 2 Diabetes." Journal of the American Board of Family Medicine Vol. 19 No. 6.Nov.-Dec. 2006 30 Jan. 2007.
"Patient Information Sheet - Sitagliptin Phosphate." Center for Drug Evaluation and Research. 04 Dec. 2006. U.S Food and Drug Evaluation and Research. 30 Jan 2007.
"Patient Information Sheet - Exenatide." Center for Drug Evaluation and Research. 27 May 2005. U.S Food and Drug Administration. 30 Jan 2007.
"Symlin (Pramlinitide Acetate) Injection." Center for Drug Evaluation and Research. Mar. 2005. U.S Food and Drug Administration. 30 Jan 2007.
Ketz Pharm.D., BCPS, Jeff. "A Review of Oral Antidiabetic Agents." Pharmacotherapy Update. May/June 2001. The Cleveland Clinic Center for Continuing Education. 30 Jan 2007.
Medication Reference Chart For Type 2 Diabetes
|MEDICATIONS FOR TYPE 2 DIABETES|
|Classification||Medication||Route||The way it works||Time and Dose|
|Sulfonylureas||Glimepiride (Amaryl) Glipizide (Glucotrol) Glipizide ER (Glucotrol XL) Glyburide||Oral||Increases insulin production||1 or 2 times a day|
|Biguanides||Glucophage (aka Metformin) Glucophage XR||Oral||Lowers glucose from digestion||2-3 times a day, XR once a day|
|Alpha-Glucosidase Inhibitors||Glyset and Precose||Oral||Slows digestion, slows glucose production||Take before each meal|
|Thiazolidinediones||Actos and Avandia||Oral||Lowers glucose production||Once daily with or without food|
|Meglitinides||Prandin and Starlix||Oral||Increases insulin production||5-30 minutes before meals|
|DPP-4 Inhibitors||Januvia||Oral||Lowers glucose by blocking an enzyme||100 mg. once a day|
|Incretin Mimetics||Byetta||Injectable||Helps the pancreas make insulin, slows digestion||10 mcg. Inject within an hour of AM and PM meals|
|Anti-hyperglycemic||Symlin||Injectable||Controls postprandial blood glucose||15 mcg. Inject before major meals|