Diabetes

Medication for diabetes

03/01/2000

Question:

What is the latest available diabetes medication?

Answer:

Because there has been a large number of new drugs released and in the development "pipeline," this seemingly simple question has a large number of answers. There are drugs which work by different mechanisms which may be more suitable to one type of diabetes than the other.
In general, we can classify drugs as those that a) replace insulin; b)increase insulin release from cells in the pancreas (called beta cells); c)improve the sensitivity to insulin (which is a hormone or signalling molecule) at its target tissue; d) reduce release of glucose from the liver; and e) block conversion of starch to simple sugars in the intestine. Insulin is used in people wth both type 1 and type 2 diabetes while the other classes of drugs are approved for use only in people with type 2 diabetes.
a) Drugs that replace insulin: We have had human insulin available for almost 20 years now. My understanding is that those few people who are still taking beef or pork insulin will need to switch in the near future because production of the beef and pork insulins is slated to stop. Both of those insulins are mixed in different ways to alter how long the action lasts. Modern methods now allow making small changes in the insulin molecule itself to see whether those alter how long it takes for the insulin to enter and then disappear from the system. Lispro insulin is a recent variation with an onset and duration of action shorter than "regular" insulin. Other variations are being developed for both short and long durations of action. Changing from one to another should be undertaken in a planned way with enough time to adjust the new treatment so that you get full benefit. Some of those changes can offer advantages you may not have thought of. Primary care physicians are familiar with some of these but sometimes it may be necessary to see a diabetes specialist/endocrinologist to get the most up-to-date strategies and the most experience with these insulin preparations.
b)Drugs that increase insulin release by cells in the pancreas (called beta cells): We have had drugs in this class for many years and many people with type 2 diabetes are likely to take glipizide, glyburide, chlorpropamide or long-acting versions of those. Repaglinide is a new drug in this class that has a very short duration of action. Some people use a dose of a short-acting insulin secretion stimulator before each meal rather than a longer-acting drug less frequently because it keeps the tissues from being exposed to insulin at times they don`t need it. This may improve the effectiveness of the insulin the pancreas is still able to produce but that is not proven.
c)Drugs that improve the sensitivity to insulin at its target tissue: We have only recently had drugs available in this class. They are called thiazolidinediones (or "glitazones"). Troglitazone has been available for several years and rosiglitazone and pioglitazone have become available within the past year.
d) Drugs that reduce release of glucose from the liver: The liver ordinarily releases glucose into the blood stream to keep the blood sugar from getting too low. Metformin reduces abnormally high glucose release seen in type 2 diabetes. Some people think of this drug in the insulin sensitizer class but the liver action seems to be the most important. A longer-acting version of metformin is under development. e) Drugs that block conversion of starch and certain other complex sugars (like sucrose or table sugar) to simple sugars in the intestine and prevent them from being absorbed into the blood: Drugs in this class include acarbose and miglitol. I am not aware of any new drugs expected in the United States in this class.
Please keep in mind that this is a very simple overview of some of the new and existing options. Whether any given drug is likely to be both safe and effective in a person needs to be decided in the setting of a great deal of additional personal information.

For more information:

Go to the Diabetes health topic, where you can:

Read articles on this topic
Browse the previously asked questions
Ask your own question.

Response by:

Robert M. Cohen, MD
Associate Professor
Division of Endocrinology and Metabolism
Department of Internal Medicine
College of Medicine
University of Cincinnati