Making Sense of New Medication Options for Diabetics

These days it is hard to watch television or read a magazine and not encounter an ad for diabetes medications. While it is great that manufacturers are working to inform the public of advances in treatment options, the ads often leave people who have diabetes with more questions than answers. The most pressing question of all being, “Should I be taking that?”

These new medications are real game changers for many people with diabetes. In addition to bringing diabetes under control, they can help with weight loss, which helps protect against heart attacks—the leading cause of death among diabetics.

However, transitioning from insulin to a new medication is not quite as easy as saying “sign me up!”

To begin with, the currently highly promoted medications fall into one of two classes: GLP-1 and SGLT-2.

Here is how they differ:

GLP-1 Inhibitors (popular brand names Ozempic, Trulicity, Victoza, etc.) These injectable drugs mimic the action of a naturally occurring hormone called glucagon-like peptide 1. When blood sugar levels begin to rise after eating, the drug stimulates the body to produce more insulin, which lowers blood sugar levels. In addition, GLP-1s slow digestion, which causes you to feel fuller longer and suppresses appetite.

SGLT-Inhibitors (popular brand names Jardiance, Invokana, Farxiga, etc.) This daily oral medication works to lower blood sugar by blocking sugars from being reabsorbed by the kidneys into the bloodstream. In addition to lowering blood sugar and contributing to weight loss, SGLT-2s reduce the risk of kidney disease, and may lower the risk of heart attack and stroke in people with a high risk of either condition. In fact, SGLT-2 is currently being prescribed for people with congestive heart failure. Note: this medication is not for use by Type I diabetics.

While the potential of these medications is exciting, there are a few cautions worth noting.

First, the process of getting onto the medications and seeing the benefits can take a bit of time. In the case of GLP-1s, weaning off insulin and increasing your medication level to full dose can take several months. Moreover, the medications are not a fit for everyone.

For example, people trying or planning to get pregnant should not use either class of medication. In addition, GLP-1s are not recommended for individuals with a family history of medullary thyroid cancer, anyone with a multiple endocrine neoplasia syndrome Type 2 or a family history of the condition, and anyone with a history of pancreatitis.

SGLT-2 is not recommended for individuals with stage 4 and 5 of chronic kidney disease or a history of urinary tract infections.

Potential side effects include:

GLP-1 Inhibitors

• Risk of pancreatitis
• Nausea
• Vomiting
• Diarrhea
• Abdominal pain
• Dehydration

SGLT-2 Inhibitors

• Genital yeast infection
• Urinary tract infection
• Constipation
• Dehydration
• Increased need to urinate
• Risk of gangrene

The decision to change your diabetes treatment plan should not be made lightly. You and your doctor need to consider your health, medical situation, lifestyle, and what your insurance will and will not cover. If you are prescribed a new medication, you need to remain realistic about what it can and can’t do. The closest thing to a “miracle medication” for diabetics since insulin, these options are no substitute for taking care of your health through a healthy diet and regular exercise.

For more information on what is right for you, talk to your provider or contact an SVMC Diabetes Educator (see box below).

Carolyn Goodwin, FNP-BC, CDE, is a family nurse practitioner with SVMC Endocrinology at Southwestern Vermont Medical Center.