The way doctors treat diabetes is changing.
For years, people with type 2 diabetes who needed medication to lower their blood sugar started with an old drug called metformin. New guidelines now recommend patients start with one of the new diabetes drugs, which can also reduce weight and protect the heart and kidneys.
This change could help the many people with diabetes who also struggle with conditions such as hypertension, kidney disease and obesity, while addressing the high blood sugar that is a hallmark of their diabetes.
“It’s a fundamental shift from the classic approach of trying to fix blood sugar, which we used to focus on because that’s all we could really do,” said Dr Marie McDonnell, director of the diabetes program at Brigham and Women’s Hospital. in Boston, which has received research funding from some diabetes drug makers.
These new diabetes drugs belong to two classes known by the acronyms SGLT-2 and GLP-1 for their mode of action.
The goal of the changes was to make treatment more patient-specific rather than drug-focused, said Dr. Nuha Ali El Sayed, an endocrinologist at the Joslin Diabetes Center in Boston, vice president of healthcare improvement at the American Diabetes Association. .
THE However, the new drugs cost more than metformin and some patients might not be able to afford the costs and have to switch to metformin, the doctors said. Ozempic, for example, lists nearly $900 per month, and Jardiance costs around $590 per month.
In contrast, patients can get the typical monthly supply of metformin, which is generic, for $25.72 without insurance or discounts, according to data from GoodRx Holdings. Inc.,
which provides coupons for drug discounts.
“I think these drugs work very well; it bothers me that they’re so expensive and out of reach for a lot of people who benefit most from them,” said Dr. Rozalina McCoy, who treats diabetes patients at the Mayo Clinic in Rochester, Minnesota.
Novo Nordisk A/S, which sells Ozempic, and Jardiance maker Eli Lilly & Co., said insured patients don’t pay the list price for their drugs, and the companies have programs to help people pay their own costs, sometimes including covering the full cost of the patient.
Some doctors also said that most studies evaluating the new drugs did not test them without metformin, which obscured whether the heart, kidney and weight benefits were due solely to the new drugs. Additionally, the studies tested the drugs SGLT-2 and GLP-1 in patients at high risk for heart or kidney problems, not everyone who could get them under the new guidelines.
Supply could be an issue. Some diabetic patients have struggled to fill prescriptions for Novo Nordisk’s Ozempic, as well as Lilly’s Mounjaro and Trulicity, as they have become popular weight-loss aids, despite drug regulators not having them. not approved for such use. The companies said they were taking steps to help people with diabetes get the drugs.
August Bellardine, a retired Navy electronics officer from Winder, Georgia, said he took metformin starting around 2000 after he was first diagnosed with type 2 diabetes. last year, a doctor prescribed him Ozempic in part to help him lose weight. He lost 5 pounds in the first three weeks of treatment. After two months on Ozempic, however, he switched to a GLP-1 pill called Rybelsus due to supply issues.
“I’m on the right track. What I am doing is good, it makes me feel good, ”said Mr. Bellardine, 65.
Diabetes is a chronic disease that affects the ability to control blood sugar, causing it to build up and eventually leading to heart, kidney, and other health problems. Some 37 million people in the United States have diabetes, most of them with the type 2 form, according to the Centers for Disease Control and Prevention.
Long-standing ADA guidelines recommended that people with diabetes who had not been able to control their disease through diet and exercise should start drug therapy by taking metformin.
Studies have shown that metformin, which was first approved in the United States in 1995, reduced high blood sugar levels. Yet many people with type 2 diabetes also suffer from heart, weight, and kidney problems, which often require treatment with other medications.
The ADA changed its guidelines last December, adding new diabetes drugs to its recommendations for first-line treatments.
SGLT-2 inhibitors, which stands for sodium-glucose cotransporter-2, lower blood sugar by preventing the kidneys from reabsorbing it. Instead, blood sugar is released through urine.
Pills include Farxiga from AstraZeneca PLC, Jardiance from Boehringer Ingelheim GmbH and Lilly, Johnson & JohnsonIt is
Invokana and Steglatro from Merck & Co.
GLP-1 agents copy the body’s natural reaction to eating, producing a hormone called glucagon-like peptide 1 that stimulates insulin production. It is insulin that helps lower blood sugar levels. The drugs also suppress people’s appetites, doctors say.
The class includes Byetta and Bydureon from AstraZeneca PLC, Lilly’s Trulicity and Adlyxin from Sanofi HER,
as well as Ozempic, Victoza and Rybelsus from Novo Nordisk. All are injected except the Rybelsus pill. Lilly’s Mounjaro targets GLP-1, as well as another gut hormone.
The Food and Drug Administration began approving drug classes years ago. In 2008, the agency recommended drugmakers test their diabetes drugs to make sure they didn’t dangerously increase heart risks, after researchers linked the diabetes drug Avandia to heart attack.
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In 2021, the FDA approved a GLP-1 drug that Novo Nordisk calls Wegovy for chronic weight management; the drug had earlier been approved to treat type 2 diabetes under the brand name Ozempic. The FDA is considering whether to approve Lilly’s Mounjaro, currently licensed for diabetes, for the treatment of obese adults.
According to new ADA guidelines, doctors must consider whether a diabetic has a higher risk of heart and kidney disease and their weight, as well as their blood sugar levels, when deciding which medication to prescribe.
“This ushers us into an era of what I might call precision pharmacology for diabetes, which is currently in its infancy, but didn’t exist at all 10 years ago,” Dr Suneil said. Koliwad, who heads the division of endocrinology and metabolism at the University of California, San Francisco and has consulted for several pharmaceutical companies.
Dr. Koliwad said he prescribes metformin first to most of his patients, in part because it’s cheaper than newer drugs. He prescribes the newest agents if they’re best for the patient, he said, though he sometimes has to deal with health insurance paperwork and steep out-of-pocket costs.
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