By: Keith Campbell
To successfully treat diabetes, you must take charge of your own diabetesmanagement. You need to know your medications, and you need to know yourpharmacist. But that kind of intimate knowledge has become a lot more complex inthe past decade.
Just 12 years ago, we had only two types of drug to treat diabetes: insulin andthe sulfonylureas like glyburide, glimepiride and glipizide. Now there are ninedifferent classes of drugs available to manage blood sugar.
With this full toolbox of medications, healthcare providers can work with theirpatients to develop a specific treatment plan that normalizes blood sugars asmuch as possible. But this requires a comprehensive knowledge of the entireselection of medications. Oral anti-diabetes agents differ widely in how theywork, time of onset, peak and duration of effect, A1c lowering ability, sideeffects, cost, and tolerability.
Not only that, but often a combination of several classes or types ofmedications must be used to normalize A1c's. And anti-diabetes drugs are alsoused along with other medicines to normalize lipids and blood pressure. Youshould know that diabetes equals heart disease, so in addition to medications totreat high blood sugars, you may also need to take aspirin and be aggressivelytreated for high blood pressure and for abnormal lipid (fat) levels.
Traditional oral anti-diabetes agents consist of those that enhance insulinsecretion from the pancreas (sulfonylureas like glyburide and glimepiride, andglinides like nateglinide and repaglinide); those that enhance insulinsensitivity (glitazones like pioglitazone (Actos) and rosiglitazone (Avandia);those that decrease insulin resistance in the fat and muscle cells; metformin,which reduces the sugar going from the liver into the blood; and those thatinhibit intestinal carbohydrate metabolism (the a-glucosidase inhibitors likeacarbose and miglitol).
A new oral agent, the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin(Januvia), was recently FDA approved for use. It is taken orally and enhancesthe activity of an incretin called glucagon-like peptide 1 (GLP-1), which causesglucose-dependent insulin secretion and also blocks the effect of glucagon.
Common drawbacks of traditional therapies include hypoglycemia, weight gain, andpoor tolerability. Oral DPP-4 inhibitors, however, can offer significantimprovement in glycemic control without hypoglycemia or weight gain. They alsoprovide the possible benefit of improving or maintaining beta cell function.Sitagliptin is often used in combination with metformin to create a greaterglucose-lowering effect and decrease A1c levels. Another recent populartreatment for diabetes is called exenatide, or Byetta. It's also an incretin, soit acts like GLP-1 to improve management of high blood sugars. It is injectedtwice daily, and many patients are able to lose weight while taking it.
The last class of drugs to treat diabetes consists of pramlintide, or Symlin,which restores a hormone called amylin in patients who use insulin, therebyhelping decrease blood sugars. It is injected before each meal and is nowavailable in an easy-to-use pen device.
All of these drugs work better if you follow a good nutrition plan and exerciseat least 30 minutes a day for at least five days a week. But along with thisgood nutrition and exercise, medications can help you near normalize bloodsugars and live a more productive life, with fewer acute and chroniccomplications. So learn all you can about your medication regimen. You will feeland do better.