Type 2 diabetes: Which medication is best for me? – Harvard Health Blog

If you live with type 2 diabetes, you are definitely not alone. One in 10 people in the United States has diabetes, according to the CDC. However, despite tremendous advances in the treatment of diabetes over the past 20 years, less than half of people with diabetes actually reach their blood sugar target.

This may be explained in part by the fact that doctors can be slow to change a patient’s treatment plan, even when a patient’s treatment goals are not being met. One of the reasons for this may be the sheer number of drugs currently available. And yet, waiting too long to adjust treatment for type 2 diabetes can have lasting negative effects on the body that can increase the risk of heart and kidney disease and other complications.

What is type 2 diabetes?

Type 2 diabetes is a chronic disease in which the body’s ability to use glucose or sugar for fuel is impaired. Our body produces a hormone called insulin that allows the sugar from the carbohydrates in the food we eat to reach the cells and be used for energy. In type 2 diabetes, the ability of insulin to do its job is compromised, and over time the body makes less of it. This means less sugar in the cells for fuel and more sugar in the blood where it cannot be used. Having high blood sugar levels over time can damage vital organs like the heart, kidneys, nerves, and eyes.

Some risk factors that predispose people to developing type 2 diabetes, such as genetics and age, cannot be changed. Other risk factors, such as overweight or obesity, can be changed. That is why losing 5% to 10% of your basal weight through a healthy diet and physical activity remains the backbone of type 2 diabetes management.

Most diabetes medications effectively lower blood sugar

The blood sugar target for most adults with diabetes is an A1C below 7%. (A1C is a measure of a person’s average blood sugar over a period of about three months.) In many people, diet and exercise are not enough to achieve this goal and one or more drugs may be necessary. Metformin is a proven drug that has been used for many decades to treat type 2 diabetes and is recommended by most experts as a first-line treatment. It is affordable, safe, effective, and well tolerated by most people.

When metformin does not adequately control blood sugar, another drug should be added. It is at this point that physicians and patients must choose from the many drugs and classes of drugs available to treat type 2 diabetes. Usually, for people at low risk of heart disease or who have no heart disease. For a history of diabetic kidney disease, most diabetes drugs added to metformin effectively lower blood sugar and can reduce A1C to less than 7%.

So how do you choose a drug? Each person with diabetes has their own goals, needs and preferences. Before choosing a medication, it is important to ask yourself some relevant questions: is my blood sugar at its target? Is this drug affordable? Do I have heart or kidney disease? What are the side effects? Is it a pill or an injection and how often is it taken?

Regardless of the treatment chosen, the American Diabetes Association’s standards of care recommend re-evaluation of diabetes control every three to six months, followed by changes in treatment if necessary.

New diabetes drugs: weighing the benefits and risks

Recently, new treatment options for type 2 diabetes – glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose-2 co-transporter inhibitors (SGLT2) – have been investigated. ‘strong publicity. These newer classes of drugs lower blood sugar and also have cardiovascular and kidney benefits.

GLP-1 receptor agonists are drugs that lower blood sugar after you eat by helping your body’s insulin work more efficiently. All drugs in this group except one are self-injected under the skin, daily or weekly. Several of these, such as liraglutide (Victoza), semaglutide (Ozempic), and dulaglutide (Trulicity), have been shown to reduce the risk of cardiovascular disease in people at high risk or with pre-existing heart disease. . They also promote weight loss. Some people who take GLP-1 receptor agonists may have side effects such as nausea and vomiting and, in very rare cases, pancreatitis.

SGLT2 inhibitors like empagliflozin (Jardiance), canagliflozin (Invokana), dapagliflozin (Farxiga), and ertugliflozin (Steglatro) are also a new class of drugs that work by preventing your kidneys from reabsorbing sugar in your body. . They also have cardiovascular benefits, especially in people with heart failure, and have been shown to slow the progression of diabetic kidney disease. Other benefits include lowering blood pressure and promoting weight loss. Using these medicines may increase the risk of genital yeast infections, especially in women. A rare but serious consequence of SGLT2 inhibitors is diabetic ketoacidosis, which is a medical emergency that can be avoided by stopping these drugs in consultation with your doctor before major surgeries, or if you are ill or on an empty stomach.

While these diabetes medications certainly have more to offer than just improvements in blood sugar, they are still expensive and inaccessible to many people. This is why it is essential to have an open and honest conversation with your doctor about what is most important to you and what matches your goals and preferences. Managing a complex disease like diabetes requires an entire team, with you being the key member of the team.

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Jothi Venkat

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