Weekly Diabetes Drugs: FAQs

By Kathleen Doheny
WebMD Health News

Reviewed by Michael W. Smith, MD

Sept. 26, 2014 -- The recent FDA approval of Trulicity (dulaglutide), an injectable type 2 diabetes drug, gives people a third option when it comes to once-a-week diabetes medication.

The agency approved Bydureon (exenatide) in 2012 and Tanzeum (albiglutide) earlier this year.

About 26 million people in the U.S. have type 2 diabetes.

WebMD asked two doctors and a pharmacist familiar with the new medications to answer some commonly asked questions about the weekly options.

How do the three weekly injected medications work?

All three drugs are in a class known as GLP-1 receptor agonists. They mimic the effects of a natural hormone (not insulin) that helps keep blood sugar levels normal.

The GLP-1 drugs help your body release its own insulin when you eat. In type 2 diabetes, your body doesn't use insulin properly to maintain normal blood sugar levels.

All three drugs have three similar advantages, says Osama Hamdy, MD, PhD. He's the director of the inpatient diabetes program at Joslin Diabetes Center.

They don't cause abnormally low blood sugar, he says, which can be a problem with some diabetes medicines. "They don't cause weight gain" either, he says. "Most of them are causing weight loss, although they are not approved for that indication."

GLP-1 drugs "have a lot of extra benefits, besides blood sugar management," says Peter Galier, MD, attending physician at Santa Monica UCLA Medical Center. Those benefits include keeping food in your stomach longer, so you feel full longer, which may help you maintain a healthier weight or lose weight, he says.

Are they used alone or in combination?

All three weekly drugs are approved by the FDA to be used alone or in combination with other diabetes medicines such as metformin. They are meant to be used with diet and exercise.

How well do the weekly medicines work, and is there a front-runner?

While some experts have predicted one of the three will become more popular than the others, it's simply too soon to tell, says John Galdo, PharmD. He's a clinical pharmacy educator at Barney's Pharmacy, Augusta, GA..

There are no head-to-head comparisons of the three, but here are some results on how well each worked, when compared in different ways.

In clinical trials Trulicity, when used alone at the higher dose (1.5 milligrams), reduced a measure of blood sugar control called hemoglobin A1C by .8%, while the standard diabetes drug metformin reduced it .6% over 26 weeks.

Bydureon lowered A1C by 1.6% over 24 weeks when used with one or more oral medicines.

Tanzeum reduced A1C .9% over 52 weeks, compared to a .2% increase in A1C with placebo.

Eli Lilly and Company, the maker of Trulicity, says it's easier to use, as it requires no mixing by the person taking it. Those taking Bydureon need to refrigerate it, then tap it up to 80 times to mix up the drug. People using Tanzeum must also mix the solution in the injection pen before use.

What are the pros and cons of the new weekly medicines?

None can be used for type 1 diabetes.

Thryoid tumors have been found in animal studies. People with a family history of medullary thyroid cancers and certain other related conditions should not be given the drugs, the FDA says.

Nausea is a common side effect of GLP-1 drugs. "Fortunately, this is sometimes mild and goes away quickly," Hamdy says.

Some people prefer the daily GLP-1 drugs -- such as Byetta (exenatide), injected twice daily, and Victoza (liraglutide), injected once a day-- over weekly injections because of the mild nausea, Galdo says. These people say the nausea means they tend to eat less -- a plus if they're trying to lose weight.

SLIDESHOW

Type 2 Diabetes Diagnosis, Treatment, Medication See Slideshow

What do the medicines cost?

Trulicity is expected to be available later this year, according to Lilly. A 28-day pack, with four injection pens, will be $488.32.

That cost is similar to that of the other two weekly injectables.

Candace Johnson, a spokeswoman for Eli Lilly and Company, declined to comment about whether insurance plans would be covering Trulicity. The other two drugs typically are covered by insurance, Galdo says.

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References
SOURCES: Peter Galier, MD, attending physician, Santa Monica UCLA Medical Center, Santa Monica, CA; and professor of medicine, UCLA David Geffen School of Medicine, Los Angeles. Press release, FDA. John Galdo, PharmD, clinical pharmacy educator, Barney's Pharmacy and clinical assistant professor, University of Georgia, Augusta. Osama Hamdy, MD, PhD, medical director, Obesity Clinical Program, and director, inpatient diabetes program, Joslin Diabetes Center, and assistant professor of medicine, Harvard Medical School. Candace Johnson, spokesperson, Eli Lilly and Company, Indianapolis.

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