New Diabetes Medications

A Healthier You

New Diabetes Medications

Staci NormanContributor: Dr. Staci-Marie Norman, PharmD, DCES

Do you watch commercials? I know this is a weird question, especially now with so many people streaming to avoid commercials. However, my husband and I are little geeky about watching medication commercials. Being a pharmacist, I’m always interested in how medications are portrayed to potential patients. My husband, who is a pharmaceutical rep, is always interested in seeing if he can pick out how drugs in the same “family” are different by what is emphasized. And we both love laughing as the spokesperson talks a million miles a minute about side effects. Listening to the list might make you think the medications are worst than the condition. I also find drug commercials helpful to keep me up to date on new and exciting things in the world of medicine, especially in areas I’m not as familiar with, like oncology or autoimmune disorders. One thing is for sure - diabetes has a lot of commercials! That’s exciting because it means many new medications are coming to market, or medications that have been around a little while have been found to help improve or prevent other health issues while managing diabetes.

One such medication is Ozempic (semaglutide is its generic name). Perhaps you've seen the commercial, "oh, oh, oh, Ozempic" (I love the jingles)! Now Ozempic is not brand new, it has been around a few years, and it is one medication in the drug class we call incretin mimetics or GLP-1s. The GLP-1 family mimics intestinal hormones called incretins. Incretins are responsible for signaling the pancreas to produce insulin when food is present and help to regulate the rate that the stomach churns up food and releases it into the intestines. It has been found that the incretin hormones are less than average in people with type 2 diabetes, causing less insulin release and increased speed of stomach motility, so food passes through much faster than it should. This can lead to a lack of satiety and overeating. Because GLP-1s are "hormones," they do not fare well in the stomach's acidic environment, so like insulin, they have had to be injected. Over the past 10 or 12 years, we have gone from Byetta (exenatide), which was the first GLP-1 and injected twice daily, to once daily Victoza (liraglutide), to once weekly formulations like Bydureon (exenatide), Trulicity (dulaglitide), and Ozempic (semaglutide). So, there have been significant improvements in the ease of administering these medications.

But have you seen the commercial "rise and shine with Rybelsus"? Surprise, Rybelsus is semaglutide in tablet form! Rybelsus must be taken first thing every morning to help get it through the hostile stomach environment, but if you're willing to put off your first cup of coffee for thirty minutes in the morning, you can get away from injections to gain the benefits from a GLP-1. There are also other benefits of the GLP-1 family that researchers are finding. One is that they can be protective of your heart. This isn't brand new information, but the American Diabetes Association feels it is important enough to make it one of the criteria when picking medications for blood glucose management. Newer research is also showing that these medications may help with the prevention of kidney disease. There can be some weight loss with this drug class. The more we learn, the more I love this class of medications for people with diabetes.

Have you seen the commercial for Farxiga? "Need to lower your blood sugar? Ask your doctor about Farxiga" or "My doctor prescribed Farxiga for my heart failure." Wait, is Farxiga used for two different conditions? The answer is YES! Farxiga (dapagliflozin) is a medication in a newer drug class called SGLT-2 inhibitors. These work in the kidneys to lower the threshold where glucose is dumped into the urine by the kidneys and eliminated from the body. Usually, our blood glucose must be around 180 mg/dL before finding sugar in the urine, but these medications lower that to around 120 mg/dL. We have seen that people using SGLT-2 inhibitors not only have lower blood glucose, but they also tend to lose weight because sugar is being eliminated and not stored. Another nice "side effect" of these medications is that salt and water follow the sugar out in the urine, so blood pressure also decreases. But the new commercial for the use of Farxiga in heart failure is due to the decreased blood volume because more water is passed as urine. The decreased volume makes the heart's pumping job easier. Farxiga is the first in this drug class to have the FDA indication for heart failure, but this effect is also seen with the other medications in this class, such as Jardiance (empagliflozin) and Invokana (Canagliflozin). There is also some evidence that the SGLT-2 inhibitors can help prevent kidney disease, and they have been proven to decrease the risk of heart disease. The ADA has also put SGLT-2 inhibitors at the top of their medication therapy algorithm with GLP-1s because of these benefits.

Bet you never thought you’d get so much from those drug commercials! I hope you all have “a lovely day, lovely day, a lovely dayyyyyy.”

Dr. Staci-Marie Norman, PharmD, DCES received her bachelors from Purdue University (’94) and her Doctor of Pharmacy from the University of Oklahoma (’96). In 2000 Dr. Norman added to her credentials by becoming a Certified Diabetes Care and Education Specialist. She is currently the Clinical Coordinator and staff pharmacist for Martin’s Pharmacy. Dr. Norman is a national faculty member for the American Pharmacist Association, teaching certificate programs in both diabetes and cardiovascular disease. She serves on the advisory board that oversees development and revision of these programs. Along with teaching and development responsibilities for APhA, Dr. Norman serves as a peer reviewer for research grants and publication submission. Dr. Norman has also spoken for Abbott, Bayer, Lilly, Mannkind, and Lifescan as a diabetes specialist.