Thiazolidinedione
Another family of type 2 diabetes drugs are thiazolidinediones (TZDs), which help control blood sugar and improve the body’s insulin resistance, according to StatPearls.
Although using TZDs early in the course of the disease may benefit the pancreas, long-term side effects such as heart failure, weight gain, and decreased bone density may need to be monitored.
Pioglitazone (Actos) and rosiglitazone are the only TZDs approved in the United States.
TZDs can affect the liver, so liver function is closely monitored while taking these drugs.
DPP-4 inhibitor
Another group of drugs is known as DPP-4 inhibitors.
DPP-4 inhibitors block the production of an enzyme called dipeptidyl peptidase 4. According to a paper published in 2018, reduced production of this enzyme allows the body to release more insulin. diabetes treatment.
Examples of DPP-4 inhibitors currently on the market in the United States include sitagliptin (Januvia) and saxagliptin (Onglyza), according to the FDA.
According to the aforementioned 2018 study, these drugs do not cause hypoglycemia or weight gain, and are thought to have important additional benefits in the management of type 2 diabetes. According to previous research, it may even have a positive impact on cholesterol levels..
GLP-1 and dual GLP-1/GIP receptor agonists
These families of drugs are among the newest options for diabetics. Experts agree they can be very effective, but they are also expensive compared to other type 2 diabetes drugs.
Glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are hormones that stimulate postprandial insulin secretion. According to StatPearls, in people with type 2 diabetes, “this process may be slowed down or even eliminated,” leading to elevated blood sugar levels. GLP-1 receptor agonists are drugs that mimic the effects of the first hormone. Dual GLP-1/GIP receptor agonists mimic both hormones. The ADA now recognizes that these two families of drugs are some of the most effective drugs available to lower blood sugar levels and improve other markers of metabolic health.
One of the features of these drugs that attracts attention from experts and patients alike is how they effortlessly lead to weight loss. All drugs in this family are associated with at least moderate weight loss, but research suggests that certain formulations, particularly semaglutide (Ozempic, Rybelsus) and tirzepatide (Mounjaro), may have unprecedented effects. Experts claim that weight loss can have dramatic positive effects on both glycemic control and cardiometabolic health. of lancet Note.
Studies have shown that GLP-1 receptor agonists may also protect against cardiovascular and kidney disease. (The FDA approved the first dual GLP-1/GIP receptor agonist in 2022, but it is too early for scientists to know whether it will have the same long-term effects as GLP-1 receptor agonists.)
The ADA’s latest recommendations identify GLP-1 and GLP-1/GIP receptor agonists as the most effective agents for patients with type 2 diabetes seeking weight loss. Additionally, GLP-1 receptor agonists have been cited as one of the best options for people with or at high risk for atherosclerotic cardiovascular disease.
This family of drugs is usually injected daily or weekly. Examples of GLP-1 receptor agonists include liraglutide (Victoza), dulaglutide (Trulicity), semaglutide (Ozempic), lixisenatide (Adrixin), exenatide (Bydureon), and exenatide (Byetta), the FDA notes. Semaglutide (Rybelsus), a GLP-1 receptor agonist, is available as a daily pill.
There is only one dual GLP-1/GIP receptor agonist available: tirzepatide (Mounjaro).
According to past reviews, common side effects of GLP-1 receptor agonists include nausea, vomiting, diarrhea, and other gastrointestinal discomfort. More serious risks include a drop in blood sugar levels, which usually only occurs if you are also taking another drug that lowers blood sugar levels, such as a sulfonylurea or insulin.
Tirzepatide, the only dual GLP-1/GIP receptor agonist available, is associated with abdominal pain, according to the Mayo Clinic. Less commonly, side effects may occur, such as skin problems, difficulty breathing or swallowing, and increased heart rate.
SGLT2 inhibitor
According to the National Kidney Foundation, sodium-glucose cotransporter 2 (SGLT2) inhibitors help lower blood sugar levels by blocking the kidneys from reabsorbing sugar that the body produces. This excess sugar is excreted from the body through urine.
The latest ADA guidelines indicate that SGLT2 inhibitors have “moderate to high” hypoglycemic efficacy. Studies have shown that these pills can lower A1C by an average of 0.5 to 0.8 percent.
Although SGLT2 inhibitors are not the most potent hypoglycemic agents, they may have other important benefits. Reviews published in 2021 Creus They point out that SGLT2 inhibitors can help prevent the onset and progression of cardiovascular and kidney diseases. As a result, the ADA now considers SGLT2 inhibitors to be one of the preferred drug treatments for patients with type 2 diabetes who have the following characteristics:
- High risk of atherosclerotic cardiovascular disease
- atherosclerotic cardiovascular disease
- heart failure
- chronic kidney disease
Articles published in 2019 drugs Please note that SGLT2 inhibitors can cause moderate weight loss.
According to StatPearls, these pills are typically taken daily. There are currently four SGLT2 inhibitors on the U.S. market.
- Canagliflozin (Invokana)
- Dapagliflozin (Faciga)
- Empagliflozin (Jardiance)
- Ertugliflozin (Steglatro)
Additionally, some combination tablets are available that combine an SGLT2 inhibitor with another diabetes drug, such as metformin.
The FDA warns that SGLT2 inhibitors may increase the risk of ketoacidosis and serious urinary tract infections. Other side effects include dehydration, kidney problems commonly associated with dehydration, increased cholesterol, and yeast infections.
combination therapy
Many of the type 2 diabetes drugs mentioned above are prescribed together to produce an even more potent hypoglycemic effect. Many of the most common combinations are also available in combined form, such as glyburide and metformin (Glucovance) and sitagliptin and metformin (Janumet).
“There are many combination therapies that incorporate most classes of hypoglycemic drugs,” Dungan says.
She says the combination therapy is highly effective and can help reduce drug costs for people with diabetes.
But Dungan points out that one drawback of combination therapy is that the doses of each drug cannot be adjusted individually. Additionally, if side effects occur, it may be difficult to determine which drug is to blame.
