Type 2 diabetes: how to know which drug is best for you

If you live with type 2 diabetes, you are certainly not alone. According to the CDC, 1 in 10 people in the United States has diabetes. However, despite significant advances in diabetes treatment over the last two decades, less than half of diabetics actually reach their target blood glucose levels.

In part, this may be because doctors can take time to change a patient’s treatment plan, even if the patient’s treatment goals have not been met. One reason for this may be the overwhelming number of drugs currently available. Still, if it takes too long to coordinate treatment for type 2 diabetes, it can have long-term adverse effects on the body that can increase the risk of heart and kidney disease. Other complications..

What is Type 2 Diabetes?

Type 2 diabetes is a chronic condition that impairs the body’s ability to use glucose or sugar as fuel. Our body produces a hormone called insulin. This allows sugars from the carbohydrates of the foods we eat to reach the cells and be used as energy.

In type 2 diabetes, the ability of insulin to do its job is impaired, and over time, the body actually reduces insulin production. This means less intracellular sugar for fuel and more sugar in the unusable blood. Having high levels of blood sugar over time can damage important organs such as the heart, kidneys, nerves, and eyes.

Some risk factors that predispose you to developing type 2 diabetes, such as genetics and age, cannot be changed. Other risk factors such as overweight and obesity may change. This is why losing 5% to 10% of baseline body weight through a healthy diet and physical activity remains the backbone of type 2 diabetes management.

Most drugs effectively lower blood sugar

The target for blood glucose levels in most adults with diabetes is A1C below 7%. (A1C is a measure of average blood glucose over a period of about 3 months.) For many people, diet and exercise alone may not reach this goal and may require one or more medications. Metformin is a proven drug that has been used for decades in the treatment of type 2 diabetes and is recommended as first-line treatment by most professionals. It’s affordable, safe, effective, and well tolerated by most people.

If metformin does not properly control blood sugar levels, another drug may need to be added. It is at this point that doctors and patients have to choose from the many drugs and drug classes available to treat type 2 diabetes. In general, for people with a low risk of heart disease or no history of diabetic nephropathy, most diabetes treatments added to metformin effectively lower blood sugar levels and lower A1C to less than 7%. I can.

So how do you choose your medicine? People with diabetes have their own goals, needs and preferences. Before choosing a drug, it is important to ask a few related questions: Is my blood sugar a goal? Is this medicine affordable? Do you have heart or kidney disease? What are the side effects? Is it a pill or an injection, and how often is it taken?

Regardless of which treatment is selected American Diabetes Association Standard Treatment It is advisable to reassess diabetes management every 3-6 months and change treatment as needed.

Weigh the benefits and risks

Recently, new treatment options for type 2 diabetes, glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT2) inhibitors, have been widely touted. These new drug classes lower blood sugar levels and also have cardiovascular and kidney benefits.

GLP-1 receptor agonists are drugs that lower postprandial blood sugar levels by helping the body’s insulin function more efficiently. All drugs in this group are self-injected under the skin daily or weekly, except for one. Some of them, such as liraglutide (Victoza), semaglutide (Ozempic), and duraglutide (Trulicity), It is shown To reduce the risk of cardiovascular disease in people who are at high risk for cardiovascular disease or who have existing cardiovascular disease. They also promote weight loss. Some people taking GLP-1 receptor agonists have side effects such as nausea and vomiting, and in rare cases pancreatitis may occur.

SGLT2 inhibitors such as empagliflozin (Jardiance), canagliflozin (Invokana), dapagliflozin (Farxiga), and ertzgliflozin (Steglatro) also work by blocking the kidneys from reabsorbing sugar into the body. It is a class drug.They also provide cardiovascular benefits, especially in people suffering from heart failure, and It is shown To slow the progression of diabetic nephropathy. Other benefits include lowering blood pressure and promoting weight loss. The use of these drugs may increase the risk of genital yeast infections, especially in women. A rare but serious consequence of SGLT2 inhibitors is diabetic ketoacidosis. This is an emergency treatment that can be avoided before major surgery or by consulting a doctor and discontinuing these medications in case of illness or fasting.

While these diabetes medications do provide more than an improvement in blood sugar levels, they are expensive and remain unavailable to many. This is why it is imperative to have a frank and honest conversation with your doctor about what is most important to you and what suits your goals and preferences. Managing complex illnesses like diabetes requires an entire team and you are a key team member.