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To successfully treat diabetes, you must take charge of your own diabetes management. You need to know your medications, and you need to know your pharmacist. But that kind of intimate knowledge has become a lot more complex in the past decade.
Just 12 years ago, we had only two types of drug to treat diabetes: insulin and the sulfonylureas like glyburide, glimepiride and glipizide. Now there are nine different classes of drugs available to manage blood sugar.
With this full toolbox of medications, healthcare providers can work with their patients to develop a specific treatment plan that normalizes blood sugars as much as possible. But this requires a comprehensive knowledge of the entire selection of medications. Oral anti-diabetes agents differ widely in how they work, time of onset, peak and duration of effect, A1c lowering ability, side effects, cost, and tolerability.
Not only that, but often a combination of several classes or types of medications must be used to normalize A1c's. And anti-diabetes drugs are also used along with other medicines to normalize lipids and blood pressure. You should know that diabetes equals heart disease, so in addition to medications to treat high blood sugars, you may also need to take aspirin and be aggressively treated for high blood pressure and for abnormal lipid (fat) levels.
Traditional oral anti-diabetes agents consist of those that enhance insulin secretion from the pancreas (sulfonylureas like glyburide and glimepiride, and glinides like nateglinide and repaglinide); those that enhance insulin sensitivity (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 that inhibit intestinal carbohydrate metabolism (the a-glucosidase inhibitors like acarbose 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 enhances the activity of an incretin called glucagon-like peptide 1 (GLP-1), which causes glucose-dependent insulin secretion and also blocks the effect of glucagon.
Common drawbacks of traditional therapies include hypoglycemia, weight gain, and poor tolerability. Oral DPP-4 inhibitors, however, can offer significant improvement in glycemic control without hypoglycemia or weight gain. They also provide the possible benefit of improving or maintaining beta cell function. Sitagliptin is often used in combination with metformin to create a greater glucose-lowering effect and decrease A1c levels. Another recent popular treatment for diabetes is called exenatide, or Byetta. It's also an incretin, so it acts like GLP-1 to improve management of high blood sugars. It is injected twice 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, thereby helping decrease blood sugars. It is injected before each meal and is now available in an easy-to-use pen device.
All of these drugs work better if you follow a good nutrition plan and exercise at least 30 minutes a day for at least five days a week. But along with this good nutrition and exercise, medications can help you near normalize blood sugars and live a more productive life, with fewer acute and chronic complications. So learn all you can about your medication regimen. You will feel and do better.
Feb 12, 2008
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.