Diabetes Self-Management Articles

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Type 2 Diabetes Drugs
A Growing Number of Options

by Joshua J. Neumiller, PharmD, CDE, CGP, FASCP, and Sally To, PharmD

Alpha-glucosidase inhibitors
Digestive enzymes in the small intestine break down complex carbohydrates (found in grains, fruits, and vegetables) into simple sugars — such as glucose — that can be absorbed and used for energy. Alpha-glucosidase inhibitors, namely acarbose (Precose) and miglitol (Glyset), are drugs that block the enzyme alpha-glucosidase and thus slow the breakdown of complex carbohydrates. This delays the absorption of glucose from the digestive tract, resulting in less of a rise in blood glucose level following a meal. To be effective, these drugs should be taken with the first bite of a meal. Because of the way they work, alpha-glucosidase inhibitors commonly cause abdominal pain, bloating, gas, and diarrhea. These drugs can lower HbA1c by about 0.5%, a benefit often deemed too small to justify the unpleasant side effects they tend to cause. However, if the dose of these drugs is increased slowly from a low level, they can be well tolerated by some people.

Colesevelam (Welchol) is a cholesterol-lowering drug that was recently approved to help lower blood glucose in people with Type 2 diabetes. It can lower HbA1c by about 0.5% and also lowers LDL (low-density lipoprotein, or “bad”) cholesterol. This drug is believed to work by reducing the absorption of carbohydrates by the digestive system. Colesevelam is taken once or twice daily with meals; common side effects include constipation, indigestion, and nausea. While colesevelam can lower LDL cholesterol, it may increase the blood triglyceride level, so this drug is generally not a good fit for people with very high triglycerides. A major concern with colesevelam is that it can interact with several other drugs. It is therefore very important to let your health-care providers know about all drugs you take prior to starting colesevelam.

Bromocriptine (Cycloset) was used to treat neurological conditions such as Parkinson disease before being approved to treat Type 2 diabetes in 2009. Studies of this drug have shown that it leads to improved blood glucose control as well as some weight loss. While the exact mechanism of its action is unknown, it is believed that bromocriptine helps regulate the circadian rhythm (the normal cycle of hormones and other physiological processes throughout the day) of people with Type 2 diabetes. Cycloset is normally taken with food within two hours of waking up. Common side effects include hypotension (low blood pressure), fainting, nausea, vomiting, diarrhea, and constipation.

What’s right for you
There are more options for treating Type 2 diabetes than most people could have imagined 20 or even 10 years ago. And while the American Diabetes Association recommends only certain treatments and the order in which they should be prescribed, its guidelines also recognize that people with diabetes have individual needs to which therapies should be tailored. The course of treatment should take not just blood glucose, but also factors such as body weight, risk of hypoglycemia, and the cost of drugs into account. Whether you’ve been recently diagnosed or have had diabetes for years, talk to your doctor, pharmacist, or diabetes educator if you have any questions or doubts about your current treatment. If your blood glucose control is not where you want it or you’re troubled by side effects, there may be something else on the menu of options that’s right for you.

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