Published: June 15, 2011
Updated: June 15, 2011
By Ron Sha, MD, PhD, and Elisabetta Politi, MPH, RD, LDN
It took more than 40 years after the discovery of insulin in 1921 before a new medication for the treatment of diabetes became available.
Then, over the next 40 years, several additional diabetes medications appeared on the market.
Unfortunately, as recently as a decade ago, almost all of these medications caused weight gain, and many could cause dangerous low blood sugar reactions as well.
Fortunately, over the past 10 years, several new diabetes drugs have appeared on the scene -- drugs that don’t lead to weight gain and rarely cause low blood sugar reactions, so they are much safer to take than their predecessors.
We humans have a number of ways by which we can control our blood sugar (glucose) levels. The main one is with the hormone insulin, which allows glucose to leave our bloodstream and enter our body’s cells, thereby lowering our blood glucose level.
Our intestines also produce hormones called incretins that help us control our blood glucose level. Unfortunately, the incretins we produce naturally are destroyed fairly rapidly in our bloodstream.
However, we now have two medications that mimic the glucose-lowering actions of our natural incretins: exenatide (Byetta) and liraglutide (Victoza).
In fact, Byetta and Victoza are even more effective than our natural incretins for lowering glucose, and they are associated with weight loss! However, Byetta and Victoza are proteins, and since proteins are destroyed by our stomach acid, these two medications must be given by injection.
Currently, Byetta is given twice a day and Victoza once a day, but rumor has it that Byetta may soon have a once-a-week injection available.
In addition, we now have new medications that keep our naturally produced incretins in our bloodstream for a longer period of time and at a higher level, so they can be more effective at lowering our blood glucose levels.
These medications, sitagliptin (Januvia) and saxagliptin (Onglyza), are taken as once-a-day pills -- much more convenient than the injections, and most people can take them with few or no side effects. Moreover, unlike most other diabetes medications, they are not associated with weight gain.
It is not uncommon for obese or overweight individuals to find their fasting blood glucose to be elevated.
A recent survey of Duke Diet & Fitness Center clients found that about 21 percent have diabetes (fasting blood glucose over 125 mg/dl on two different occasions), and 30 percent have pre-diabetes or increased risk of diabetes (fasting blood glucose between 100 and 125 mg/dl).
Between one third and one half of pre-diabetics will develop type 2 diabetes within five to ten years.
The good news is that the landmark Diabetes Prevention Program (DPP), a major multicenter clinical research study, showed that people with pre-diabetes can greatly reduce their risk for developing diabetes by making changes in their diets and increasing their physical activity. They may even be able to return their blood glucose to normal range.
Recommendations to prevent diabetes include following these steps:
Ronald Sha, MD, PhD, is the medical director of the Duke Diet & Fitness Center.
Elisabetta Politi, RD, MPH, CDE, is the nutrition director of the Duke Diet & Fitness Center.