When anyone receives a diagnosis of diabetes it will be obvious that the main aim of treatment is to lower blood glucose. There are various drug targets for this purpose and different ways to achieve the same aim.
Drugs such as acarbose (glucobay) reduce the absorption of glucose from the intestine into the blood. The medication group known as sulphonylureas such as gliclazide (diamicron) and the glinides, for example repaglinide (novonorm), help the pancreas release more insulin and thereby reduce blood sugar that way. Reducing the liver’s own production of glucose with metformin (glucophage) or making the body much more sensitive to the action of your own insulin with pioglitazone (actos) are other ways of achieving this objective.
We have recently added a new and novel way of lowering blood glucose. This is based on the action of a group of drugs that encourage the kidney to excrete glucose in the urine instead of its usual action, which is to retain glucose in the body. These are known as SGLT2 inhibitors and examples include the brands Forxiga (dapagliflozin), Jardiance (empagliflozin) and Invokana (canagliflozin).
A different class of medication entirely is based on the physiological action of a gut hormone called glucagon-like peptide (GLP-1). These are the so-called incretin hormone- based therapies. They rely on their ability to regulate a number of natural processes that happen after we eat. These therapies influences the way the stomach delivers food to the intestine, they increase pancreatic insulin production and the body’s sensitivity to insulin. They also reduce the liver’s release of glucose into the blood. The net result of all of these actions is to lower blood glucose and improves diabetes control.
Over the past few years, pharmaceutical companies have developed a number of GLP-1 based treatments. They include oral treatments based on the gliptin drugs and injectable treatments that mimic GLP-1 action. Well known tablet-based therapies include sitagliptin, also known by its brand name Januvia. Widely used injectable treatment include liraglutide, known by its brand name Victoza. It is used to treat diabetes but a higher dose of the same drug, known by the brand name Saxenda, is marketed as a weight reducing treatment. Many of this class of medicine can now be given on a weekly basis. Semaglutide, known also by its brand name Ozempic, is a recent addition from the Danish company Novo Nordisk. It is a commonly used weekly treatment used to lower both glucose and weight.
Because there is such a wide selection of possible drugs to use in diabetes treatment, the patients that we see in our clinic have typically tried a whole range of different combinations. No single diabetes treatment would be considered best or most appropriate for everyone. In fact what works for one person may not work so well for another. The choice of drug depends on a variety of physiological factors and the selection of the best drug for each patient never follows the theory that one size fits all. For each of the possible drug classes there is always the question of the relative benefits versus possible drug side effects.