Diabetes Treatment (cont.)
Robert Ferry Jr., MD
Robert Ferry Jr., MD
Robert Ferry Jr., MD, is a U.S. board-certified Pediatric Endocrinologist. After taking his baccalaureate degree from Yale College, receiving his doctoral degree and residency training in pediatrics at University of Texas Health Science Center at San Antonio (UTHSCSA), he completed fellowship training in pediatric endocrinology at The Children's Hospital of Philadelphia.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
In this Article
Long-acting exenatide (Bydureon)
Bydureon is a longer acting from of exenatide that is injected once weekly.
During April 2014, FDA approved albiglutide as an injectable monotherapy for adults with type 2 diabetes. Liraglutide and albiglutide share the same mechanism of action and similar side effect profiles. Eight clinical trials involving over 2,000 participants with type 2 diabetes showed improved HbA1c with albiglutide. Albiglutide has been studied as monotherapy and in combination with metformin, glimepiride, pioglitazone, or insulin.
Albiglutide should not be used in patients with type 1 diabetes and those with risk for, family history of, or personal history of medullary thyroid cancer (MTC) or multiple endocrine neoplasia syndrome type 2 (which predisposes to MTC).
During September 2014, FDA approved dulaglutide as an injectable monotherapy for adults with type 2 diabetes. Liraglutide, albiglutide, and dulaglutide are all GLP-1 receptor agonists and share similar side effect profiles. Dulaglutide improved HbA1c level in 6 clinical trials involving over 3,300 participants with type 2 diabetes. Dulaglutide has been studied as monotherapy and in combination with metformin, sulfonylurea, thiazolidinedione, or prandial insulin.
DPP-IV inhibitors (sitagliptin, saxagliptin, linagliptin)
The body breaks down GLP-1 by an enzyme called DPP IV. Logically, one could make either a synthetic GLP-1 that cannot be broken down by this enzyme (for example, exenatide), or try to stop the enzyme that breaks down natural GLP- The latter approach yielded the new class of drugs called DPP IV inhibitors. This approach allows native GLP-1 already in the blood to circulate longer. Many companies are working on this new drug class.
These drugs have essentially the same side effect profile as exenatide; however, they are administered orally in pill form. While exenatide has a significant weight loss profile, DPP-IV inhibitors to date have displayed no effect on weight.
Glyburide/metformin (Glucovance), rosiglitazone/metformin (Avandamet), glipizide/metformin (Metaglip), pioglitazone/metformin (Actoplusmet), and metformin/sitagliptin (Janumet) are five relatively new combination pills on the market to treat type 2 diabetes.
These combination drugs carry the benefit of taking fewer pills, which hopefully improves compliance. While they work well, most health-care professionals initiate individual medications to optimize dosing, before switching to a combination pill once the patient has been stable on individual medications for a while.
Medically Reviewed by a Doctor on 5/7/2015
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