Treating type 2 diabetes with new medication

Diabetes is a metabolic disease which makes the body unable to regulate blood sugar levels. Type 2 diabetes occurs when the body stops responding to insulin, a hormone that controls blood sugar levels. In some instances, patients with Type 2 Diabetes require treatment with insulin, as well as medications that improve the body’s response to it. Renowned consultant endocrinologist Dr Nemanja Stojanovic, who treats patients in Warley, Redbridge, and London, discusses some of the newest medications available to type 2 diabetes patients.  

What are some of the newer type 2 diabetes drugs?

Over the past 20 years, there have been major developments in the treatment of patients with type 2 diabetes. Some of the medications that are now used, help both pre-diabetes and loss of weight. 

• GLP-1 analogues which are mostly injectables and can help with major weight loss.
• DPP-4 inhibitors, for example, sitagliptin and linagliptin, which are given as tablets are weight neutral.
• SGLT2 inhibitors help with the excretion of sugar through the kidneys. These can help patients with heart failure who may or may not have diabetes and can also be used in patients with advanced kidney disease to protect kidney function. 

How are they administered?

GLP-1 analogues, which include liraglutide, semaglutide, and dulaglutide among others are usually administered as injections. Some of these are given as a weekly injection, while one of the drugs in the class also exists as a tablet that is taken daily. DPP-4 inhibitors and SGLT-2 inhibitors are taken by mouth. 

What are the benefits of these newer medications?

These medications have shown quite a few surprising benefits after testing. Some of them are among the first medications that have been shown to positively impact mortality in diabetes, some of them can help with weight loss and others are very neutral. Quite a few of these medications have improved both treatments of diabetes and weight management. In my experience, some patients who have lost a significant amount of weight with these drugs found that their mobility has improved and those who have sleep apnoea may find themselves not needing treatment for it any longer.

Are there any side effects to be aware of?

Like most medications, there is a risk of side effects. GLP-1 analogues, which are injectables, can cause problems with the gastrointestinal system. These symptoms can be an upset stomach, diarrhoea, nausea, and/ or vomiting. This is now a less common occurrence due to the improvement in the formulation of these medicines. These drugs have been linked to pancreatitis, the inflammation of the pancreas. In rats, but not in humans, they have been shown to cause melullary thyroid cancer. This form of thyroid cancer is very rarely seen in humans. 

SGLT2 inhibitors, on the other hand, can increase the chance of infections (UTIs). In extreme cases, they can cause dehydration. In some patients with type 2 diabetes, they can cause diabetic ketoacidosis with normal sugars, which can be potentially life-threatening. Although rare, if a person on SGLT2 inhibitors develops relentless nausea and vomiting, they should seek immediate medical attention. 

What is the most effective medicine for type 2 diabetes?

It depends, really, on the patient. One of the jobs of an endocrinologist or a GP with a special interest in diabetes is to help the patient choose the most appropriate drug for him or her. For example, if someone has a high body mass index, they might be more suited to the GLP-1 analogues than a medication that can cause weight gain. It might also depend on the individual’s ability to secrete or respond to insulin as well, so it is truly determined on an individual case basis. 

Dr Nemanja Stojanovic is a revered consultant endocrinologist with over 30 years of experience, who sees patients in Warley, Redbridge, and London. If you want to book a consultation with Dr Stojanovic, you can do so by visiting his Top Doctor’s profile today.