Which meds are best for Type 2 diabetes?
If you are living with Type 2 diabetes, you certainly are not alone. One in 10 people in the U.S. has diabetes, according to the CDC.
However, despite considerable progress in diabetes treatment over the past 20 years, fewer than half of those with diabetes actually reach their target blood sugar goal.
In part, this may be because doctors can be slow to make changes to a patient’s treatment plan, even when treatment goals are not being met. One reason for this may be the overwhelming number of medications available.
And yet, waiting too long to adjust treatment for Type 2 diabetes can have long-lasting negative effects on the body that may raise the risk of heart and kidney disease and other complications.
Some risk factors that predispose people to developing Type 2 diabetes, such as genetics and age, are not modifiable. Other risk factors, such as being overweight or having obesity, can be altered. This is why losing 5% to 10% of one’s baseline weight remains the backbone of Type 2 diabetes management.
Most meds lower blood sugar
The blood sugar goal for most adults with diabetes is an A1C of below 7%. (A1C is a measure of a person’s average blood sugar over a period of about three months.)
For many people, diet and exercise are not enough to reach this goal, and one or more medications may be needed.
Metformin is a tried and tested medicine that has been used for many decades to treat Type 2 diabetes. Most experts recommend it as first-line therapy. It is affordable, safe, effective, and well tolerated by most people.
When metformin does not adequately control blood sugar, another medication must be added.
Benefits, risks of newer meds
Lately, newer treatment options for Type 2 diabetes — glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT2) inhibitors — have been heavily advertised. These newer drug classes lower blood sugar and also have cardiovascular and kidney benefits.
GLP-1 receptor agonists are drugs that lower blood sugar after eating by helping your body’s insulin work more efficiently. All drugs in this group except one are self-injected under the skin, either daily or weekly.
Several of them, such as liraglutide (Victoza), semaglutide (Ozempic) and dulaglutide (Trulicity), have been shown to lower the risk of cardiovascular disease in people who are at high risk for it or who have pre-existing heart disease. They also promote weight loss.
Some people who take GLP-1 receptor agonists may have side effects such as nausea and vomiting, and in very rare cases pancreatitis.
SGLT2 inhibitors are also a newer class of medications that work by blocking your kidneys from reabsorbing sugar.
They also have cardiovascular benefits, especially in people with heart failure, and have been shown to slow the progression of diabetic kidney disease. Other benefits include lowering blood pressure and promoting weight loss.
Use of these medications may increase the risk of genital yeast infections, especially in women. A rare but serious consequence of SGLT2 inhibitors is diabetic ketoacidosis, which is a medical emergency that can be avoided by stopping these medications in consultation with your doctor before major surgeries, or if you are ill or fasting.
While these diabetes medications certainly have more to offer than just improvements in blood sugar, they remain costly and inaccessible to many individuals.
This is why it is essential to have an open and honest conversation with your doctor about what is most important to you and what aligns with your goals and preferences. Management of a complex disease like diabetes takes an entire team, with you being the key team member.
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