Over the past decade, the list of type 2 diabetes medications has grown -- helping people gain better blood sugar control. But the drugs' side effects -- plus taking several pills every day -- can be frustrating.
"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."
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."
Fortunately 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, Tenn.
Januvia is a novel drug that works with gut hormones, natural enzymes, and the body's own insulin to control blood glucose.
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 drug metformin 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.Metformin has long been the workhorse of the oral diabetes drugs. Metformin "mostly works by preventing the liver from releasing too much sugar," Goldberg explains.
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."
The 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.
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