Diabetes Self-Management Articles

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Tools of the Trade 2011

by Alwa A. Cooper

Availability: The GlucoPouch is currently available online from American Diabetes Wholesale (www.americandiabeteswholesale.com), Western Diabetic (www.westerndiabetic.com), and from the GlucoBrands Web store (http://buy.glucobrands.com).


Product: Acarbose

Manufacturer: Mylan
(724) 514-1800

What it does: Acarbose is one of two drugs (the other is miglitol [Glyset]) in the class known as alpha-glucosidase inhibitors, which work by slowing the breakdown of carbohydrate in the digestive system. The drug has been available since 1995 under the brand name Precose, but this year Mylan Pharmaceuticals won approval of a generic version. Acarbose can be taken alone or with other diabetes drugs, including sulfonlyureas (such as glipizide, glyburide, and glimepiride), metformin, and insulin. The drug should be taken three times a day, with the first bite of every meal. Acarbose carries no risk of hypoglycemia. It has been shown to lower HbA1c by about 1 percentage point.

Availability: Acarbose is available in 25, 50, and 100-mg tablets.

Product: Linagliptin (Tradjenta)

Manufacturer: Boehringer Ingelheim
(800) 243-0127
(317) 276-2000

What it does: Tradjenta joins sitagliptin (Januvia) and saxagliptin (Onglyza) in the DPP-4 inhibitor class. These drugs block the action of an enzyme called DPP-4. That in turn prolongs the effects of the hormone GLP-1, which are to stimulate the release of insulin, slow stomach emptying, restrict the body’s production of glucose, and protect the pancreas’s remaining beta cells. Tradjenta has not been studied in combination with insulin, and has not been approved for children, for people with Type 1 diabetes, or to treat diabetic ketoacidosis. Tradjenta’s effectiveness is reduced by certain medicines called CYP 3A4 inducers, which include phenobarbitol, modafinil (Provigil), and St. John’s wort, among others. In clinical studies, pancreatitis (inflammation of the pancreas) was reported more often in people taking Tradjenta than in people taking a placebo. Cold-like symptoms were the most commonly reported side effect. Tradjenta can be taken once a day, at any time of day, with or without food.

Availability: Tradjenta is available in 5-mg tablets.

Product: Saxagliptin and metformin extended-release (Kombiglyze XR)

Manufacturer: Bristol-Myers Squibb
(800) 332-2056

What it does: The FDA has approved a combination pill containing combined saxagliptin and extended-release metformin for the treatment of Type 2 diabetes. The two drugs work in different ways — saxagliptin (Onglyza) is a DPP-4 inhibitor, which works in the same way as Tradjenta (see earlier explanation), and extended-release metformin (Glucophage XR and others) works by decreasing the amount of glucose produced by the liver and by improving insulin sensitivity.

People with metabolic acidosis (excessive acidity of the blood) or who drink alcohol excessively should not take Kombiglyze XR. The drug is not recommended for people with liver problems. Metformin in any formulation raises a person’s risk of developing lactic acidosis, a rare but potentially fatal side effect.

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