Diabetes Treatment (cont.)

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Liraglutide (Victoza)

When combined with a proper diet and exercise program, liraglutide (Victoza) is an injectable medicine that improves blood sugar (glucose) in adults with type 2 diabetes.

  • Liraglutide is not insulin, and it remains unknown if liraglutide is safe and effective when used with insulin.
  • Liraglutide is not for people with type 1 diabetes or with diabetic ketoacidosis (DKA).
  • Although the first study in adolescents with type 2 diabetes reported similar pharmacokinetics to those observed in adults, liraglutide is not yet recommended for use in children.
  • Liraglutide, like exenatide, belongs to a class of medicines known as GLP-1 receptor agonists, which enhance insulin release from the pancreas after a meal.

Long-acting exenatide (Bydureon)

Bydureon is a longer acting from of exenatide that is injected once weekly.

Albiglutide (Tanzeum)

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).

Dulaglutide (Trulicity)

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.

  • Dulaglutide 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).
  • Dulaglutide should also not be used as first-line therapy for type 2 diabetes patients who cannot be managed with diet and exercise.

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.

  • In 2006 the FDA approved the first drug in this class called sitagliptin (Januvia). Sitagliptin can be used in combination with certain other medications, but its dose must be adjusted in patients with poor kidney function.
  • In August 2009, a second drug in this class was approved called saxagliptin (Onglyza).
  • In 2011, another drug in this class, linagliptin (Tradjenta) was approved.

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.

Combination medications

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.

  • Glucovance combines glyburide with metformin in varying doses.
  • Avandamet is a combination of varying doses of rosiglitazone and metformin.
  • Actoplusmet is a combination of varying doses of pioglitazone and metformin.
  • Metaglip is a combination pill containing glipizide and metformin in varying strengths.
  • Janumet combines metformin and sitagliptin.

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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