Spotlight on New Diabetes Treatments

Over the years, three diabetes treatments with entirely new modes of action were approved: exenatide injection (Byetta®, for people with type 2 diabetes), pramlintide injection (Symlin®, as an add-on to insulin therapy for people with type 1 or type 2 diabetes) and Sitagliptin (Januvia® also for people with type 2 diabetes). "New is not necessarily better, but these are additional weapons in the armament," says Nora Saul, MS, CDE, RD, LDN, Manager of Education Services at Joslin Diabetes Center. Saul educates Joslin Diabetes Center patients on blood glucose management.

Some diabetes medications help the pancreas release more insulin (if you have type 2 diabetes), others help cells use insulin better, and others keep the liver from releasing too much glucose. The three new treatments focus action on hormones called incretins. The two given by injection—Byetta and Symlin—have an added bonus of promoting weight loss.  “These three medications led the way for others being added to the list of available diabetes medications. Since then, many other additional medications have been added,” says Saul, “New to the list are Victoza, Bydureon, Tradjenta and Onglyza.”

With more options, treatments can be better tailored to an individual. Since type 2 diabetes is progressive, what works for some people for a period of time may lose effectiveness. For example, some people with type 2 diabetes may start treating the chronic disease with oral medications, and then subsequently discover that insulin would give them more control.

The following are the five new medical options that enhance blood glucose control for people with type 1 or type 2 diabetes:

1. Exenatide injection (Byetta®)

Exenatide injection:

• is injected twice a day at mealtime
  
• is for those with type 2 diabetes who have been unable to control blood glucose with oral medicines
  
• improves blood glucose control by mimicking incretin hormones, stimulating insulin and slowing stomach-emptying
  
• leads to weight loss because patients will feel full faster and stop eating
  
• can cause nausea

2. Exenatide extended release (Bydureon®)

Exenatide extended release is:

• injected once per week
  
• similar action and side effects listed above for Byetta

3. Liraglutide (Victora®)

Liraglutide is:

• injected the same time once a day

4. Pramlintide acetate (Symlin®)

Pramlintide acetate:

• is intended for those with type 1 or type 2 diabetes who use insulin
  
• is injected at mealtime
  
• is to never mix with insulin in one syringe; which creates the need for an additional injection for the patient
  
• used for better glucose control, reduction in blood glucose spikes, reduction in food intake, whichleads to weight loss
  
• can cause nausea or hypoglycemia (dangerously low blood glucose)

5. Sitagliptin (Januvia®); saxagliptin (Onglyza®); and linagliptin (Tradjenta®)

All three of these pills:

• are taken once a day
  
• are for type 2 diabetes
  
• do not promote weight gain
  
• are often used in combination with metformin
  
• have very little, if any, side effects
  
• Should be taken with caution for patients with renal disease (dose should be decreased)
  
• slows the breakdown of incretins, so insulin is released over a longer period of time

Click here for more information about Patient Education at Joslin Diabetes Center.