According to American Diabetes Association there are 1.6 million new cases of diabetes are diagnosed in people aged 20 years and older every year. Traditionally, diet modification has been the cornerstone of diabetes management. Weight loss is more likely to control glycemia in patients with recent onset of the disease than in patients who are significantly insulinopenic.
What type of medications are available for those with type 2 diabetes? There are several actually.
Medications that induce weight loss may be effective in highly selected patients but are not generally included in the treatment of the average patient with type 2 diabetes mellitus.
Currently, patients who exhibit the symptoms may require treatment with insulin to reduce increased blood sugar levels which may reduce beta cell insulin secretion and worsen insulin resistance. They can also be treated with an insulin secretagogue to rapidly relieve symptoms such as polyuria and polydipsia.
Types of Insulin Drugs available for Diabetics
New drug classes and new drugs effectively treat type 2 diabetes mellitus, allowing glycemic control previously beyond the reach of medical therapy.
1. Sulfonylureas are time-tested insulin secretagogues and probably have the greatest efficacy for glycemic lowering of any of the oral agents.
2. Meglitinides are much more short-acting insulin secretagogues than sulfonylureas, with preprandial dosing potentially achieving more insulin release and less risk for hypoglycemia. Their glycemic efficacy is probably less than sulfonylureas.
3. Biguanides are old drugs that reduce hepatic glucose production and may have a minor effect on glucose utilization. Insulin must be present for biguanides to work. Metformin has proved effective and safe.
4. Alpha-glucosidase inhibitors prolong the absorption of carbohydrates. Their induction of flatulence greatly limits their use. Their effect on glycemic control is modest, affecting primarily postprandial glycemic excursions.
5. Thiazolidinediones. Glitazones are a newer class of drugs that reduce insulin resistance in the periphery. They activate a nuclear transcription factor that is important in fat cell differentiation and fatty acid metabolism. Their major action is probably actually fat redistribution. These drugs may have beta cell preservation properties. Their glycemic efficacy is moderate, between alpha-glucosidase inhibitors and sulfonylureas. They are also the most expensive oral agents.
6. The incretin-mimetic agent exenatide has a novel mechanism of action. It stimulates glucose-dependent insulin release as opposed to oral insulin secretagogues which may cause non–glucose-dependent insulin release and hypoglycemia, reduces glucagon, and slows gastric emptying. Studies have used exenatide in addition to metformin and/or a sulfonylurea. Patients may attain modest weight loss. Animal data suggest that this drug prevents beta cell apoptosis and may in time restore beta cell mass.
7. Dipeptidyl peptidase IV inhibitors. DPP-4 degrades numerous biologically active peptides, including the endogenous incretins GLP-1 and glucose-dependent insulinotropic peptide (GIP). Sitagliptin can be used as a monotherapy or in combination with metformin or a glitazone. It is given once daily and is weight neutral.
8. Insulin. Ultimately, many patients with type 2 diabetes mellitus become markedly insulinopenic. The only therapy that corrects this defect is insulin. Because most patients are insulin resistant, small changes in insulin dosage may make no difference in glycemia in some patients. Furthermore, because insulin resistance is variable from patient to patient, therapy must be individualized in each patient.
Ask your doctor about your condition so the right prescription can be given.