Healthcare Social Network. Share Knowledge, Be Discovered, Find Opportunities. Join Now
Diabetes Mellitus Facts and Statistics
Diabetes is a health condition in which the body is unable to properly use glucose (sugar) for energy resulting in high levels of blood glucose (hyperglycemia). There are two types of diabetes. In Type 1 diabetes, the pancreas can no longer produce insulin and thus glucose is unable to enter the cells for use as energy. In Type 2 diabetes, either the pancreas does not produce an adequate amount of insulin or the body cannot respond properly to insulin. Type 2 diabetes is the most common form. Individuals with hyperglycemia usually experience signs and symptoms of frequent urination (polyuria), excessive thirst (polydipsia), and excessive hunger (polyphagia).
Newest Medications for Treatment of Type 2 Diabetes
Dipeptidyl Peptidase 4 (DPP-4) Inhibitors
Although DPP-4 inhibitors have been available for almost 8 years they are newer than sulfonylureas and metformin. The first DPP-4 inhibitor, sitagliptin (Januvia), was FDA approved in 2006 for use with diet and exercise and was later approved in 2007 for its use in combination with metformin or thiazolidinediones. The second DPP-4 inhibitor, saxagliptin (Onglyza), was approved in 2009 for monotherapy and in combination with metformin, sulfonylurea, or thiazolidinediones. The next DPP-4 inhibitor, linagliptin (Tradjenta), was approved in 2011 for both monotherapy and combination therapy with metformin, sulfonylureas, or pioglitazone. The latest DPP-4 inhibitor, alogliptin (Nesina), was FDA approved in 2013 as monotherapy or in combination with metformin, sulfonylureas, thiazolidinediones, and insulin.
DPP-4 inhibitors increase the amount of two proteins (incretin hormones) found in the body, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP). Incretin hormones tell the body to release insulin and lower blood glucose. GLP-1 also decreases the production of glucose and slows down the absorption of glucose.
Incretin hormones are removed from the body by an enzyme called dipeptidyl peptidase-4 (DPP-4). DPP-4 inhibitors block this enzyme resulting in GLP-1 and GIP to stay in the body longer and therefore decrease blood glucose levels.
Efficacy of DPP-4 Inhibitors
Side Effects of DPP-4 inhibitors
List of DPP-4 Inhibitors and their Average Wholesale Price (AWP) per Pill
Glucagon-Like Peptide-1 (GLP-1) Receptor Agonists
The first GLP-1 receptor agonist, exenatide (Byetta) was FDA approved in 2005. The latest GLP-1 receptor agonist, liraglutide (Victoza), was approved in 2010. The extended-release formulation of exenatide, Bydureon, was FDA approved in 2012. All three medications are used as monotherapy with diet and exercise or in combination with metformin, sulfonylureas, or thiazolidinediones.
GLP-1 receptor agonists activate the GLP-1 receptor which leads to insulin production and release when blood glucose levels are high. They also stop the liver from making too much glucose, reduce appetite, and slow down how much food and glucose leave the stomach and get absorbed into the blood, preventing hyperglycemia after meals.
Efficacy of GLP-1 Agonists
Side Effects of GLP-1 Receptor Agonists
List of GLP-1 Agonists and their Average Wholesale Price (AWP)
Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors
The first SGLT2 inhibitor, canagliflozin (Invokana), was FDA approved in 2013 and the second drug in this class, dapagliflozin (Farxiga), was approved in 2014. Both medications are used as monotherapy with diet and exercise or in combination with metformin and sulfonylureas.
SGLT2 inhibitors decrease blood sugar by blocking the kidney from reabsorbing it and removing excess sugar through the urine. They do this by blocking the sodium-glucose co-transporter-2 (SGLT2) in the kidney that is responsible for reabsorbing sugar back into the body.
Efficacy of SGLT2 Inhibitors
Side Effects of SGLT2 Inhibitors
List and Average Wholesale Price (AWP) of SGLT2 Inhibitors
Metformin remains the cornerstone of most type 2 diabetes treatment regimens. Many patients may require combination therapy in order to achieve glycemic goals. These latest drug classes are beneficial in patients not receiving adequate blood glucose control from other drug classes. They also offer additional benefits such as better tolerability, weight loss, and a greater efficacy when combined with other antidiabetic medications such as metformin. Although some drugs in these classes may be expensive, the price should be weighed against the benefit in decreasing the burden of the disease.
Astrup et al. (2012). Safety, tolerability and sustained weight loss over 2 years with the once-daily human GLP-1 analog, liraglutide. International Journal of Obesity. 36: 843-854.
Dicker, D. (2011). DPP-4 inhibitors. Diabetes Care. 34(2): 276-278.
Garber, A.J. (2011). Long-acting glucagon-like peptide 1 receptor agonists. Diabetes Care. 34(2): 279-284.
RED BOOK online
Grow your network while contributing to healthcare knowledge by joining and publishing an article.
More Articles by Jonah-Lynne Padigus, PharmD