Best medicines for Diabetes

Are You at Risk for Type 2 Diabetes?

Diabetes and prediabetes are two of the top pressing health issues in the nation. Recent estimates from the American Diabetes Association (ADA) state that about 1.5 million Americans are diagnosed with diabetes every year.

Prediabetes occurs when the blood sugar levels are higher than normal but not yet high enough to be classified as type 2 diabetes. Weight loss and increased exercise can help prevent a type 2 diabetes diagnosis.

Even more concerning is the number of Americans who are at risk for these conditions: it was reported by the ADA that of the 34.2 million adults with diabetes, 26.8 million were diagnosed, and 7.3 million were undiagnosed.

Treatment for Type 2 Diabetes

There’s no cure for type 2 diabetes, but patients may be able to manage their condition by eating healthy, staying active through regular exercise, and maintaining a normal weight. But sometimes this just isn’t enough.

Medication treatment for type 2 diabetes often begins with oral metformin, a drug that is the backbone of oral diabetes treatment regimens. From there, different drug classes may be added to metformin, and for some patients, the use of injectable insulin may be necessary.

  • Insulin is a hormone the body needs to utilize the glucose (sugar) from food to provide energy for the body.
  • In type 1 diabetes, the pancreas makes no insulin and it must be replaced. In type 2 diabetes, either the pancreas either doesn’t make enough insulin, there is resistance to the effects of insulin, or both.

A1C Levels

Diabetes treatments are monitored using a blood sugar target called hemoglobin A1C (HbA1c or just A1C) that gives average blood glucose levels over the past 3 months.

For adults, the American Diabetes Association (ADA) recommends a target HbA1C of below 7%; however, in March 2018, the American College of Physicians (ACP) issued new guidance, suggesting targets between 7% and 8%. Part of the ACP reasoning is to adhere to a more individualized approach to type 2 diabetes treatment. For example, in the elderly, very low blood sugars can be linked with serious health issues, including confusion and fainting.

High blood sugar levels can increase the risk for serious complications due to diabetes such as:

  • vision loss
  • peripheral nerve damage
  • kidney impairment
  • hard-to-treat infections
  • impotence
  • heart disease

However, the latest diabetes news is encouraging. Newer drugs with a positive outcome on heart disease and death, improved monitoring devices and an understanding of how diet and exercise impact diabetes is adding up to a gain in outcomes for patients.

The vast majority of people with type 2 diabetes are living longer lives due to better medications, and a better understanding of the disease and the numerous complications that result from this chronic disease.

In response to the type 2 diabetes epidemic, the U.S. Food and Drug Administration (FDA) continues to approve and improve type 2 diabetes medications and ease dosing regimens for patients.

Here is a selection of some top type 2 diabetes treatments and the latest breakthroughs:

Bydureon BCise (exenatide)

AstraZeneca’s Bydureon BCise (exenatide extended-release) is a once-weekly treatment approved for type 2 diabetes. Bydureon BCise is a long-acting form of exenatide, the same active ingredient found in Byetta, but Byetta is given twice-a-day instead of once-a-week.

The Bydureon BCise injection is used with diet and exercise in people on one or more type 2 diabetes medicines to improve blood sugar control. It is not used as a first-line agent. Bydureon is a glucagon-like peptide 1 (GLP-1) agonist, or incretin mimetic, that binds to GLP-1 receptors to help the pancreas produce more insulin in response to an increase in blood sugar. It is in the same class of drug as Trulicity, Victoza, Rybelsus and Ozempic, among others.

Bydureon BCise consists of a novel, continuous-release microsphere delivery system that is designed to provide consistent therapeutic levels of exenatide. Bydureon BCise comes as a single-dose autoinjector pen. The Bydureon and Bydureon Pen brand are now discontinued in the U.S.

In April 2018, the FDA approved exenatide as an add-on to basal insulin in adults who need extra blood sugar control. In the 28-week study, Bydureon or placebo were evaluated as add-on therapy to insulin glargine, with or without metformin, in adults with type 2 diabetes. Blood sugar control, as measured by the HbA1c, was reduced by 0.9% in the Bydureon group compared to 0.2% in the placebo group. Over 32% of patients in the Bydureon group reached an HbA1c of <7.0% compared to 7% of patients in the placebo group, a significant effect.

Low blood sugar (hypoglycemia) can be a problematic side effect when Bydureon BCise is used with insulin or insulin secretagogues like glyburide, glipizide or glimepiride. The dose of these agents may need to be reduced when combined with Bydureon BCise.

Symptoms of low blood sugar include a headache, sweating, shaking, anxiety, fast heartbeat, irritability, rapid breathing, or a confused state. Patients should learn to recognize these effects so they can treat low blood sugar with a carbohydrate source.

Other common side effects with exenatide have included:

  • nausea
  • vomiting
  • diarrhea
  • injection site itching
  • injection site nodules

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