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An estimated 13% of adults in the United States have diabetes. As the 7th leading cause of death in the country, it is responsible for almost 80,000 fatalities each year. Considering that the disease costs approximately $322 billion in healthcare costs each year in the U.S.A., it is understandable that pharmaceutical companies are continually striving to improve on existing diabetes medications and create new drugs to help treat this condition..
However, the number of drugs currently available can be overwhelming and confusing. This article is meant to help clarify the diabetes disease process and introduce the best diabetes medications to combat the disease.
What Is Diabetes?
Diabetes is a disease that affects how the body converts food into energy. In healthy adults, the body uses glucose, a form of sugar that comes from food, as a primary source of fuel. When we first eat a meal, the body breaks it down into glucose and other substances, which enter into the bloodstream following digestion. Insulin is an important hormone that helps take the glucose out of the bloodstream and puts it into other cells of the body so that it can be used for energy.
With diabetes, this process becomes faulty for various reasons. The result is that the glucose remains in the blood, which eventually builds up and causes high blood sugar. The reason this occurs depends on the type of diabetes.
Type 1 Diabetes
Type 1 diabetes is an autoimmune disorder in which the body attacks the cells of the pancreas for unknown reasons. Cells in the pancreas, called beta cells, make the hormone insulin. The eventual result of Type 1 diabetes is a total lack of insulin. This leads to the build up of glucose in the blood, also known as high blood sugar.
Type 2 Diabetes
Type 1 diabetes is an autoimmune disorder in which the body attacks the cells of the pancreas for unknown reasons. Cells in the pancreas, called beta cells, make the hormone insulin. The eventual result of Type 1 diabetes is a total lack of insulin. This leads to the build up of glucose in the blood, also known as high blood sugar.
Unlike type 1 diabetes, in Type 2 diabetes the body does still make insulin. However, for various reasons, the body becomes resistant to the insulin, and does not react to the hormone in the usual way. Without the ability to use insulin properly, the body cannot transfer glucose from the blood into the cells. The result, again, is high blood sugar. Some common risk factors for tType 2 diabetes include family history, certain ethnicities, age, being overweight or obese, high blood pressure or cholesterol, and physical inactivity.
Diagnosing Diabetes
Symptoms of diabetes can include increased thirst, frequent urination, and increased hunger along with unexplained weight loss. However, many people will exhibit no symptoms of diabetes before diagnosis. The best way to diagnose diabetes is through a blood test. Most commonly this includes either a glucose test or a Hemoglobin A1C test. The glucose tests measures your blood sugar at the time the test is take while Hemoglobin A1C measures your average blood sugar over the past 3 months.
Risks Of High Blood Sugar
Uncontrolled high blood sugar can cause damage to the blood vessels over time. This can potentially lead to a variety of issues including vision problems, heart disease or stroke, nerve problems including neuropathy (pain due to nerve damage,) or kidney disease. Although there is no treatment to cure diabetes, keeping blood sugars in good control can help prevent these complications from occurring.
What Do Diabetes Medication Do?
The good news about diabetes is that it can be managed. This most often involves a combination of diet, exercise, and medications. Diabetes medications help lower blood sugars via a variety of methods. Most medications target different areas of the body, including the pancreas, liver, kidneys, and digestive system, to help the body rid itself of excess glucose. Additionally, some diabetes medications can help with weight loss or protect the heart from diabetes related damage.
Best Diabetes Medications
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Diabetes is a very individualized disease, meaning that the best diabetes medications will vary from person to person. It is important to work with your healthcare provider on finding the best diabetes medications for you. Your doctor will need to consider many factors such as the type of diabetes and any other health conditions present before deciding on a medication. He or she may also factor in your health insurance coverage, as the cost of medications can vary.
1. Alpha-Glucosidase Inhibitors
This class of diabetes medication helps slow the rate at which the body digests your food into glucose. The result is that less sugar gets absorbed into the bloodstream. Instead, some glucose from food can pass through the digestive system unabsorbed. The two most common diabetes medications within this class include acarbose (Precose) and miglitol (Glyset.)
2. Biguanides
Biguanides are often one of the first class of medications prescribed for someone with diabetes. The most well known biguanide is Metformin, although there are other similar drugs within this class. These diabetes medications work by suppressing the release of glucose from the liver. In healthy adults, the liver helps store sugar in a form called glycogen.
These glycogen stores get released into the blood stream when the body senses that it needs more energy.: for example, if you went a long time without eating or if you used a sudden burst of energy for exercise. This process can become defective in diabetes, and so biguanides like Metformin help lower the amount of blood sugar released from the liver in these instances.
Dopamine Agonist
The action of this class of diabetes medication is not fully understood; however, it is believed that it may play a role in resetting the circadium rhythm (your natural sleep and wake cycle) to reduce the insulin resistance typically found in type 2 diabetes. Bromocriptine (Cycloset) is an example of a dopaine agonist.
4. Dipeptidyl Peptidase-4 (DPP-4) Inhibitors
DPP-4 inhibitors play a role in increasing the amount of time it takes for food to move through the digestive system. This helps lower blood sugar by decreasing the amount of food, or glucose, that the body needs to process in a given time. It also increases the amount of insulin made by the body to help make sure that the glucose can more easily be moved from the bloodstream and into other cells of the body to be used as energy.
There are many types of drugs within this class, but some more commonly known medications include sitagliptin (Januvia,) saxagliptin (Onglyza,) linagliptin (Tradjenta,) and alogliptin (Nesina.) It is also commonly combined with other classes of diabetes medications to help target multiple organ systems and more efficiently lower blood sugars.
5. Glucagon-Like Peptides (Incretin Mimetics)
Glucagon-like peptide medications are also known as "incretin mimetics" because they mimic the action of a hormone called incretin. Incretin is a hormone in the body that is naturally released after eating a meal, and glucagon-like peptides do the same. The result is a favorable slowing of digestion, which increases feelings of fullness. Additionally, more insulin is created by the pancreas after taking this medication.
Both of these actions help to lower blood sugar, and even promote weight loss in some individuals. This class of diabetes medications must be injected, as it does not come in pill form. Glucagon-like peptide medications come in many forms, including liraglutide (Victoza,) exenatide (Byetta,) and dulaglutide (Trulicity.) It is also available in an extended release form, known as exenatide extended-release (Bydureon.) which only needs to be injected once per week.
6. Meglitinides
These class of drug promotes a rapid burst of insulin in the body to help lower blood sugar. These powerful diabetes medications pose the risk of causing low blood sugar, also known as hypoglycemia, and so should not be taken on an empty stomach. Some commonly known meglitinides include nateglinide (Starlix) and epaglinide (Prandin.)
7. Sodium Glucose Transporter (SGLT) 2 Inhibitors
SGLT 2 inhibitors work by helping the kidneys get rid of execess glucose through your urine. Because of the increase in sugar moving through the urinary system, one of the most common side effects of these diabetes medications include urinary tract infections (UTIs.) Some specific drugs within this class include dapagliflozin (Farxiga,) canagliflozin (Invokana,) empagliflozin (Jardiance,) and ertugliflozin (Steglatro).
8. Sulfonylureas
This type of medication has been around for a long time. Sulfonylureas simply stimulate the pancreas to make more insulin. They do increase the risk of having low blood sugar, and so should be taken soon before eating. Glipizide (Glucotrol,) glyburide (DiaBeta, Glynase, Micronase,) and glimepiride (Amaryl) are all examples of sulfonylureas.
9. Thiazolidinediones
Sometimes abbreviated "TZD's", these diabetes medications help increase your body's sensitivity to insulin. While this process effectively lowers blood sugar, thiazolidinediones should not be used for anyone diagnosed with Congestive Heart Failure (CHF.) Two commonly know diabetes medications in this class include Pioglitazone (Actos) and rosiglitazone (Avandia.)
Conclusion
There is no "one size fits all" approach to managing diabetes. It is important to always include a trained healthcare provider when choosing the best diabetes medications for you. A doctor, pharmacist, or Certified Diabetes Educator (CDE) can help review your medical history to personalize the best treatment approach.
Always remember that a healthy diet and physical activity are just as important as even the best diabetes medications for good blood sugar control. There is no treatment for diabetes, but keeping your blood sugars within a good range can help prevent the unwanted consequences of the disease.
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