New Type 2 Diabetes Medications
The only inhaled insulin on the market is Afrezza. It's fast acting, so you take it only at mealtimes. It comes in 4-unit and 8-unit cartridges that you pop into a small gadget, like the ones people with asthma use. Those with asthma, COPD or who smoke should not use this medication.
"I think Afrezza has a potential role, but a small one, in people with type 2 because of dose requirements," says Zach Weber, PharmD, clinical associate professor of pharmacy practice at the Purdue College of Pharmacy. "If you have to take 20, 30, or 40 units for your dose, it could be impractical." That could mean using as many as 10 cartridges for a single dose.
"For people who are more sensitive to the effects of insulin, where 1 or 2 units makes a difference to you, my concern is that the lowest dose is 4 units," he adds. If you take more insulin than you need, you could lower your blood sugar too much and cause hypoglycemia.
For people who don't have good diabetes control with their longer-acting maintenance insulin, it's an option, Buse says, although he considers it more of a last resort. "But it's all about individual patient decisions. If a patient thinks it's meaningful or finds it helpful, I would support it."
When you eat, your gut releases a hormone called GLP-1 that tells your body to make more insulin. The effects of natural GLP-1 last only a few minutes. The effects of medications called GLP-1 receptor agonists are similar, but they work much longer.
You need shots of earlier kinds of these drugs, such as exenatide (Byetta) and liraglutide (Victoza), at least once a day. They can last up to 10 hours.
Newer drugs last for 7 days:
- Albiglutide (Tanzeum)
- Dulaglutide (Trulicity)
- Extended-release exenatide (Bydureon)
"The once-a-week doses have an advantage because you take fewer shots," Weber says. The drawback? You could end up with side effects like nausea, vomiting, and diarrhea for a whole week.
A 2014 report by the Pharmaceutical Research and Manufacturers of America notes that drugmakers are working on at least 100 drugs for type 2 diabetes. Many of them are in very early stages of research. Some might be ready in a few years.
Researchers are close to improving drugs called DPP-4 inhibitors, so you only have to take them once a week. They work by allowing your body to keep making insulin. They block an enzyme that breaks down hormones including GLP-1. DPP-4 inhibitors include medications with:
- Alogliptin (Nesina)
- Alogliptin and metformin (Kazano)
- Alogliptin and pioglitazone (Oseni)
- Linagliptin (Jentadueto)
- Linagliptin and metformin (Tradjenta)
- Saxagliptin (Ongylza)
- Saxagliptin and metformin (Kombiglyze)
- Sitagliptin (Januvia)
- Sitagliptin and metformin (Janumet)
Delayed-release metformin is also on the horizon. It targets the gut so people with kidney disease, who shouldn't take metformin, can use it.