New Type 2 Diabetes Treatment Options

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 a MD. "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.

Future medications. Other classes of medication are in development. One type doesn't affect insulin, unlike most diabetes drugs. It blocks the body from re-absorbing glucose from urine, says a Dr. While the FDA has not approved any drug from this class, it could in the future.

Despite the advances, Dr. points out that many people with diabetes have probably not changed their prescriptions much over the last decade. "In some ways, there's been a lot of consistency," . "Metformin and the sulfonylureas [such as Amaryl, DiaBeta, Diabenese, Glucotrol, Glynase, and Micronase] and metformin are still the most commonly prescribed drugs for diabetes and they've been around for a long time."

While the new drugs may not have replaced the old, they have added options for people who had problems controlling blood sugar with standard drugs.

Problems with older drugs also emerged in recent years. In 2010, the FDA severely restricted the use of Avandia. Studies showed that it was linked with cardiovascular risks. In 2011, the FDA added a new warning to Actos, a drug from the same class, because it may increase the risk of bladder cancer.

Type 2 Diabetes Treatment: Glucose Monitoring and Insulin Pumps

Experts say that there have been great strides in glucose monitoring and insulin pumps. Continuous glucose monitors work with a tiny sensor that a doctor implants in the skin. The sensor sends data about current glucose levels to a wireless device that looks like a pager. The sensors need to be replaced every three to seven days.

"Once, people had to urinate on a strip of paper to get even a rough idea of their glucose levels," says a Dr. "Now, they can get a precise update every few minutes with a continuous glucose monitor. It's amazing."

For people with type 2 diabetes who need injected insulin, insulin pumps are now more refined.  The devices give smaller and more precise doses.

Many companies are working on technology that will fully automate the interaction between a continuous glucose monitor and a pump. You would not have to press the button on your pump when your monitor alerts you. Instead, the monitor would trigger the pump to give the insulin dose directly.  The two would operate without your input -- creating what many experts call an "artificial pancreas."

We've known for a long time that lifestyle -- such as diet and exercise -- play a key role in controlling type 2 diabetes.She says that the last decade of research has only made the connection more clear.

Studies show that aggressively controlling glucose with lifestyle changes can reduce heart risk in people with diabetes. Experts generally recommend that people with diabetes get at least 150 minutes of aerobic activity each week coupled with strength training.

When it comes to food choices, Dr. says that there is no one-size-fits-all diabetes diet. "You have to be flexible and creative in developing a meal plan," he says. He says that many people -- but not all -- do well on low-carb and Mediterranean diets. The key is to work with an expert, such as a dietitian with experience treating diabetes. You need a custom plan. It has to be something that you can stick with for the long haul.

While research over the last decade has shown just how well lifestyle changes work for diabetes, there's a catch. We also have a clearer understanding of the drawbacks. It's hard to make big changes to your diet and lifestyle that stick, she says.

For that reason, she says that many diabetes doctors are now quicker to get people onto drugs than they were in the past. Given the importance of glucose control, doctors may be less likely to wait while a person keeps trying, without real success, to adopt healthier habits.

Type 2 Diabetes Treatment: Getting Control

One of the biggest changes in diabetes management has not come from a medication or a device. Instead, it's a different approach. Diabetes doctors are much more aggressive in treating the disease.

"There's much more emphasis on catching diabetes early and treating it earlier," says a Dr. "We have strong evidence of how poorly controlled diabetes can have serious complications later. We're acting faster in doing something about it."

More important than any specific treatment, experts say, is good control of your condition and regular medical care.  

"If you're getting the right support, managing diabetes is very straightforward," says the Dr. "With good treatment, anyone with diabetes can learn how to control this disease. It doesn't have to control you."

ps- this is only for information, but always consult you physician before having any particular food/ medication.

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