indexAs diabetes affects millions of people worldwide and the disease has no cure but can only be managed and treated, there is constant ongoing research in finding new treatment options.  Type 1 diabetes is when no insulin is produced by the body and it often affects young people, including children. However, Type 2 diabetes is more common and 90 percent of those diagnosed in the U.S. suffer from this form of the disorder. Diagnosed by a simple blood test, this form of diabetes, in its very early stages may be managed by dietary changes and exercise. If that is not sufficient to control sugar levels, it is treated by different medicines, sometimes singly, sometimes in combination.  When not managed and treated, uncontrolled diabetes can lead to serious problems including diabetic neuropathy, blindness, and gangrene and can even be fatal.

How conventional drugs work

Conventional drugs work by lowering blood sugar in different ways – that’s why different people may require a varied combination of drugs. Treatment and medicine combinations may have to be specifically tailored to the patient’s requirements. Some drugs affect the say the sugar is metabolized and some drugs help the production of insulin in the body. These drugs include:

  • Alpha-glucosidase inhibitors (like Acarbose) – reduces the absorption of carbohydrates
  • Biguanides (Metformin) – work by decreasing the amount of glucose released by the liver
  • Injectable medicines (including Exenatide, Mitiglinide, Pramlintide) – improves blood sugar control via multiple actions
  • Meglitinides (including Repaglinide and Nateglinide) – stimulates the pancreas to release more insulin
  • Sulfonylureas (like Glimepiride, Glyburide, and Tolazamide) – work by getting the pancreas to produce more insulin
  • Thiazolidinediones (such as Rosiglitazone and Pioglitazone) – helps make the body more sensitive to the insulin present
  • DPP4 inhibitors (like Sitagliptin) – reduces glucose made by the body and enhances insulin levels at the same time
  • Bile acid sequestrants (like Colesevelam) – helps lower blood glucose levels when taken with other medicines

There is no one standard treatment for diabetes, especially since newer drugs keep entering the market – doctors may try different drugs in various combinations and monitor the patient till the sugar levels return to normal. Once stabilized, the patient still has to undergo regular blood tests at fixed intervals, depending on the medicines taken and the sugar levels. Over time, many people especially those with poor control or those in whom drugs don’t work may need to take insulin via injection. As diabetes is a lifelong disease it needs to be carefully managed and, if any symptoms of complications develop, these need to be treated as well.

New category of treatment

The FDA has approved a new drug to treat diabetes. Farxiga (Dapagliflozin), made by Bristol-Myers Squibb and AstraZeneca has a novel approach to treating the disease. It belongs to a class of medicines called sodium-glucose co-transporter 2 or SGLT2 drugs. Farxiga eliminates the extra sugar in the body via the urine. A drug with a similar mode of action, previously launched by Johnson & Johnson, is Invokana. The SGLT2 drugs work by not allowing the glucose to the re-absorbed by the kidney, increases the elimination of glucose in the urine and so lowers blood glucose levels.

The required clinical trials showed that the drug is effective in controlling blood sugar levels. However the trials also revealed a link between bladder cancer and the drug and so the FDA has asked for six different post-marketing studies on the drug. Side effects include increased risk of bladder cancer, dehydration, fungal infections and decline in renal functions. People with bladder cancer, risk of bladder cancer or renal impairment can only take the drug under medical advice.



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