Diabetes medications: new kids on the block

For all of you looking for the next sexy agent in diabetes, or if you are just a nerd like me, it’s always exciting when newer agents hit the market. Exciting and also nerve wracking actually. The promise of newer medications often brings with it possibilities of fewer pills, stronger effects and sometimes less side effects, or even side effects you might want.{{more}}

The nerve-wracking part is that because they are new, often there is no long-term safety information. So most companies and universities will have done studies to say this medication is safe for, say, 1 or 2 years. But often no one knows how safe it is after 10 years, and many folks with diabetes are on their medication for a long period of time. So it is with cautious hope that I introduce some of the newest agents on the market for treatment of diabetes, not including the new insulins (that will come later):

Januvia, otherwise known as Sitagliptin, has been on the market for just a few years. It is very unique in its method of action. Without hammering you with complicated diagrams and descriptions of chemical pathways, I will just say that it works by stopping one of the signals that can interfere with insulin action. It also helps decrease the amount of glucose that your liver makes on its own. This oral medication has also been combined with Metformin in one pill called JanuMet, to make it easier to give take medications at once. It can be used with other medications also, like Glipizide and Amaryl in the Sulfonylurea group but you should be cautious of low blood sugars when combining the pills. Januvia is not currently approved for use when also taking insulin, so those of you with Type 2 diabetes and on insulin, or those with Type 1 cannot take this medication. The big selling point of Januvia right now is that it causes limited side effects, and most notably does not frequently cause low blood sugars.

Symlin(Amylin) is another new and interesting agent that recently hit the market and is slowly creeping up in popularity. Similarly to Januvia, it is an injection(yes, another one) and the exact pathways are somewhat intricate so I will not go into them here, but it does not make any new insulin and thus the chances for having low blood sugars while taking this medication are very low. It decreases the amount of sugar that your liver makes on its own, helps slow the rate of absorption of food and also decreases appetite. It is approved for use in both those taking insulin or on pills only, but the doses of insulin may need to be decreased while taking this medication to avoid having low blood sugars. There are not many serious side effects known at this time in regard to Amylin-mainly the usual warnings of rash, upset stomach and low sugars. It is still relatively expensive as it is a new agent but be on the lookout for it.

We’ll continue next week with some of the new agents, then on to the mega-topic of insulins. Until then, take care Vincies!

Anita Ramsetty, MD
endodocs@endocrinehelp.com
Medical Director Endocrine Care Group
www.endocrinehelp.com
Tel: 843-798-4227