The number of medicines approved to treat diabetes has grown tremendously recently, with several new classes of drug debuting within the past few years. This interview with diabetes drug expert Joshua Neumiller, PharmD, CDE, CGP, FASCP, provides an overview of medicines that have recently become available for diabetes management, including how these medicines work, common side effects, and the best candidates for their use.
New Diabetes Drugs
My name is Dr. Joshua Neumiller. I’m a Pharmacist. I’m on faculty at Washington State University and I am also a Certified Diabetes Educator.
What are SGLT2 Inhibitors
It’s really been an explosion, as of lately, for the amount of drugs we have available to people with diabetes. And so, the SGLT2 Inhibitors, they work in the kidney, and now we actually have three drugs in this drug class available for the patients.
Invokana is one, Farxiga is another, and Jardiance is another. And these drugs, they work a little different. They actually work in the kidney. So, the kidneys actually filter the blood, and actually filters glucose. And normally the kidneys actually reabsorb all that sugar back into the bloodstream. And what these drugs do, they actually inhibit the major transporter, that recovers the sugar. So, with people with type 2 diabetes, for which these are approved, use these medications. They actually release sugar through the urine, that helps lower blood glucose. And the other potential benefit of this, that people realize when they are treated with these drugs, is that they loose calories in the form of sugar through their urine. So, people actually loose weight with these medications.
Because they work in the kidney and they require the kidney to be filtering that sugar, they’re not a good option for people with chronic kidney disease. And because these drugs do increase the amount of sugars in the urine. Some of the main side effects are genital fungal infections, particularly women can get some yeast infection with these medications. There is a small increase risk of Urinary Tract Infections with these drugs as well. And something that’s also good that people be aware of when they use these medications is, because they are causing glucose to be, or sugar to be spilled through the urine, is they work a little bit like a diuretic or water pill.
What is Toujeo Insulin?
So, with SGLT2 inhibitors, the average H1C reduction that people can achieve with these is about 0.7 to 0.8 percent. Toujeo, this is a new longer acting insuman, for people who need long acting basal insulin. There was another product that many people are aware of named, called Lantus. And what Toujeo is, actually a more concentrated insuman, that uses the same drug, the same form of insuman, but most insuman comes in what we call, 100 units per milliliter, and this particular drug is 300 units per milliliter. So, its more concentrated. And in concentrating this long acting insuman, in a couple potential benefits to that, it works longer than 24 hours. And so, some people who use other long acting insuman, it tends to wear off before the day runs out. Whereas, with this insuman, it tends to last a little bit longer. And the other advantage of that, is for people who take very high doses of insuman, because this is a concentrated insuman, they can get away with smaller injection sizes. So, they can have less injection site pain.
Its approved for people with both type 1 and type 2 diabetes. And really, similar to all insuman products, the main thing people have to be aware of is low blood sugar, hypoglycemia risks. The nice thing about this particular long lasting insuman, its very flat in terms of its action. So, relatively low risk of hypoglycemia.
And in terms of H1C, lowering with Toujeo, as is with most insumans, the nice thing about insuman, we get to tight rate it, which is we want to get peoples H1C low. So, for people who have quite elevated H1Cs, insuman is our go to medication. The very nice thing about Toujeo, was that the manufacturers of this insuman, make it only available on the pen device, where the patient doesn’t even have to worry about any conversion. They just dial it to the dose they need.
What is Afrezza Insulin?
So, Afrezza is a new inhaled insuman for mealtime use. So, for people who need a little bit of insuman with their meals. This is a new option, and it is an inhaled product, which is, really something we haven’t had for a while in the insulin space. So, the insuman is, it comes, it has a small inhaler where they put cartridges into this device and inhale their mealtime insulin dose. Approved for people with type 1 and type 2 diabetes. People who shouldn’t take Afrezza, it is a little different, this insuman product, because it is inhaled. And so, particularly for people who have long disease, they have asthma, COPD, or people who smoke, they are not good candidates for using this particular product.
Afrezza Insulin Side Effects
So, side effects with Afrezza, similar to other insuman, hypoglycemia. We have to be aware of that, as really any insuman product, that’s one of our main concerns is hypoglycemia. The very nice thing about this product, is its our most rapid-acting insuman we have currently available. So, it works very quickly, and its out of the body fairly quickly. So, compared to some other insumans, people taking it at mealtime, probably has less of a hypoglycemia risk if you use the appropriate doses.
And there are many, many drugs in the pipeline, and so, over the next several years, patients and their caregivers, and prescribers will see a lot more agents to pick from.