New Medications for Type 2 Diabetes
Recent developments in diabetes treatment
Researchers are constantly working on ways to better control type 2 diabetes, and as they learn more about how it works, they’re able to develop new medications, such as the ones listed below.
Gliptins (DPP-4 Inhibitors)
Most often, you’ll hear gliptins referred to as DPP-4 (or DPP-IV) inhibitors. DPP-4 inhibitors are one of the newest classes of drugs used for type 2 diabetes.
The DPP stands for dipeptidyl peptidase IV, and it’s an enzyme that’s supposed to stop a certain hormone called glucagonlike peptide-1 or GLP-1. GLP-1 tells the beta cells to release insulin.
How they work: DPP-4 inhibitors lower blood glucose levels by allowing more insulin to be released in the body. There are hormones in the digestive tract that are released when you eat; they go to your pancreas and tell your beta cells to produce insulin. One of those hormones, GLP-1, is quickly destroyed by the enzyme DPP-4, which is fine for someone without diabetes.
For someone with type 2 diabetes, though, this prevents them from getting more insulin into their blood. A DPP-4 inhibitor, therefore, prevents the enzyme from destroying the GLP-1 hormone.
Example of DPP-4 inhibitor:
- Right now, there is only one DPP-4 inhibitor with FDA approval—sitagliptin (Januvia).
- Combination medication with metformin (Janumet)
GLP-1 Mimetics (Incretin Mimetics)
GLP-1 mimetics (also called incretin mimetics) focus on the effects of the GLP-1 hormone that the digestive tract releases when you eat. Researchers found a way to get around the fact that the DPP-4 enzyme destroys the GLP-1 hormone: they created a synthetic (manmade) version that mimics (hence the word mimetic) the GLP-1 hormone. Oddly enough, researchers found that the saliva of a Gila monster (a type of lizard) contains a hormone that mimics GLP-1, so they created a synthetic version using that.
How they work: The DPP-4 enzyme doesn’t attack the GLP-1 mimetic because it doesn’t recognize it as the same thing as the naturally-occurring GLP-1 hormone. Therefore, your body produces more insulin because the GLP-1 mimetic tells the beta cells to produce insulin; it works just like the natural hormone.
Special notes: GLP-1 mimetics also make you feel fuller faster—and you may feel fuller longer. When taking a GLP-1 mimentic, then, you may not eat as much, and you may lose weight.
Example of GLP-1 mimetic:
- Exenatide (Byetta) is an injectable medication that’s FDA-approved to treat type 2 diabetes.
An amylin analog is a synthetic (man-made) version of the hormone amylin. Amylin is released when insulin is released in the pancreas, so if your body is having trouble producing insulin, it’s probably also having trouble producing amylin. The hormone amylin helps lower blood glucose levels.
How it works: An amylin analog is injected before you eat. It works just like the naturally-occurring hormone amylin—it reduces how much glucagon you have in your body. Glucagon is a hormone that causes the body to release or produce glucose. So by reducing the glucagon level, an amylin analog reduces the blood glucose level.
Special notes: An amylin analog can be taken with insulin. If your body doesn’t produce much insulin any more—and you have to take insulin—taking an amylin analog at the same time can be another way to get better blood glucose control. Amylin cannot be mixed with insulin, so it needs to be taken as a separate injection.
Example of amylin analog:
- Pramlintide (Symlin) is an example of an FDA-approved amylin analog.
As you can see, there are many medication options if you have type 2 diabetes. All these medications help you control your blood glucose level, but they do it in different ways. Discuss which medication or medications might be right for you with your healthcare professional.
- American Diabetes Association. Standards of Medical Care in Diabetes—2009. Diabetes Care. 2009;32:S13-61.
- Becker G. Type 2 Diabetes: An Essential Guide for the newly Diagnosed. 2nd ed. New York, NY: Marlowe & Company; 2007.
- McCulloch D. Patient information: Diabetes type 2: Overview. UpToDate Web site. January 30, 2009. Available at: http://www.uptodate.com/patients/content/topic.do?topicKey=~n0K0MIfI1iZs.&selectedTitle=5~150&source=search_result. Accessed April 20, 2009.
- McCulloch D. Patient information: Diabetes mellitus type 2: Overview. UpToDate Web site. December 4, 2008. Available at: http://www.uptodate.com/patients/content/topic.do?topicKey=~X0jjLnBn4._ko&selectedTitle=4~150&source=search_result. Accessed April 20, 2009.