Updates on Treatment Options in the Modern Management of Diabetes

The standard treatment paradigm for newly diagnosed patients with diabetes is counseling the patient about diet and exercise and starting them on an oral agent. Over time, initial pharmacologic therapies prove inadequate to achieve optimal glycemic control, necessitating use of other agents, combination therapies, and eventually insulin.

New agents may help overcome major barriers to improving control, including weight gain and hypoglycemia. Byetta (exenatide) is a twice-daily injectable incretin mimetic that stimulates the pancreas to produce more insulin and signals satiety to the stomach. In addition to reducing postprandial and fasting glucose, as well as glycohemoglobin levels, use of Byetta results in dose-dependent weight loss. However, some patients are unable to endure the side effects, especially nausea, which can occur with doses as low as 5 mcg.

Januvia (sitagliptin), an oral DPP-4 inhibitor, breaks down glucagon-like peptide-1 (GLP-1), which leads to reduced postprandial glucagon release. Januvia also breaks down gastric inhibitory peptide (GIP). It is weight-neutral and not associated with hypoglycemia.

Insulin continues to be part of the long-term treatment paradigm in patients with diabetes. Long-acting insulins, such as Novolog, or the new agent Levemir (insulin detemir [rDNA origin] injection), can be used in conjunction with short-acting insulins or inhalable insulins to achieve euglycemic control. New agents, including new insulin formulations, are an important adjunct to the management of type 2 diabetes.

In this conversation, two diabetes experts, Dr. Brian Tulloch and Dr. Naveed Iqbal, join Dr. Carlos Hamilton to discuss the role of these new therapies in the management of diabetes.

Related References/Reading:

1. Buse JB, Henry RR, Han J, et al. Effects of exenatide (exedin-4) on glycemic control over 30 weeks in sulfonylurea-treated patients with type 2 diabetes. Diabetes Care. 2004;27:2628-35.
2. Gallwitx B. Exenatide in type 2 diabetes: treatment effects in clinical studies and animal study data. International Journal of Clinical Practice. 2006;60:1654-1661.