Type 2 diabetes treatment has come a long way in the last 10 years, experts say, with new drugs and devices adding up to better lives for patients.
"In the last decade, I think that we've transformed the way we manage diabetes," says Aaron Cypess, MD, PhD, assistant professor at Harvard Medical School and staff physician at Joslin Diabetes Center. He points to new classes of drugs, better devices, and a fuller understanding of how exercise and diet can treat the condition.
The Diabetes Prevention Program (DPP) was a major clinical trial, or research study, aimed at discovering whether either diet and exercise or the oral diabetes drug metformin (Glucophage) could prevent or delay the onset of type 2 diabetes in people with impaired glucose tolerance (IGT).
The answer is yes. In fact, the DPP found that over the three years of the study, diet and exercise sharply reduced the chances that a person with IGT would develop diabetes. Metformin also reduced risk, although...
Doctors have also become much more aggressive in treating diabetes. People with type 2 diabetes are getting diagnosed and treated earlier than they once did -- and having better outcomes.
Type 2 Diabetes Treatment: New Medications
"We've seen several new, exciting classes of drugs in the past decade," says Cypess. New drugs and types of insulin have made treatment better. In some cases, it's simpler, too.
DPP-4 inhibitors include the oral drugs Januvia, Nesina, Onglyza, and Tradjenta. These protect a natural compound in the body -- GLP-1 -- from breaking down. GLP-1 helps lower blood glucose.
Incretin mimetics or GLP analogs include the injected drugs Byetta and Victoza. They use the body's own signaling system to boost insulin after meals.
Sodium-glucose co-transporter 2 (SGLT2) inhibitors work by blocking glucose from being reabsorbed by the kidneys. That raises the amount of glucose urinated, and lowers the amount of glucose in the blood. Currently, Invokana (canaglifozin) is the only drug in this class that's approved by the FDA. More SGLT2 inhibitors are being developed.
Other drugs include Symilin, an injectable synthetic hormone. It helps lower blood sugar after meals in people with diabetes who use insulin.
Combination drugs have made a difference. They join different medications in one pill -- often metformin and a sulfonylurea, a meglitinide, a DPP4 inhibitor, a thiazolidinedione, or a thiazolidinedione in combination with a sulfonylurea. This cuts down the number of pills a person has to take. Combination drugs include Actoplus MET, Avandamet, Duetact, Glucovance, Metaglip, Kazano, Oseni, and PrandiMet. There can be drawbacks. They tend to cost more than generic drugs. They can also make it harder to fine-tune the treatment. "When you have a combination drug, you can't adjust the dose of one drug without adjusting the other too," says Rita Kalyani, MD, assistant professor of medicine at Johns Hopkins University. "There is less room for precision."
New types of insulin allow some people to take just one injection of a long-acting insulin each day. That can be much easier than multiple injections of standard insulin, says Cypess.
Future medications. Other classes of medication are in development. One type doesn't affect insulin, unlike most diabetes drugs. It blocks the body from reabsorbing glucose from urine, says Kalyani. While the FDA has not approved any drug from this class, it could in the future.
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