ere you just diagnosed with
type 2 diabetes?
Or are
you thinking about switching to a new, more powerful medication? The good news is that
nowadays you have a big choice in the oral medications you can use to control diabetes.
As recently as 1995 your only choices were in one family or
class of drugs
(called sulfonylureas).
It was a little like buying one of the first automobiles in the color you
liked—as long as you liked black.
Now the pharmaceutical
companies have introduced a wide range of oral hypoglycemic agents. Currently, we have
well over a dozen different options to choose from.
Some of them have Web sites.
Oral hypoglycemic agents are pills that help to you
reduce your
blood glucose
levels. They are not oral insulin. But they do give some people
with diabetes normal glucose levels when diet and exercise aren't enough for them to
control their diabetes.
These pills work only when your pancreas is producing
insulin. They aren't for people with
type 1 diabetes,
because their pancreases don't
produce enough insulin for the pills to work.
We now have five (or six) classes of oral medications, each of which
work in a different way, plus various combination pills. Furthermore, your doctor may prescribe for you to take more than
one class of these medications at the same time.
Classes now available are:
[Top]
Sulfonylureas
Sulfonylureas squeeze more insulin out of the beta cells of
your pancreas and improve insulin's ability to get glucose into the rest of your body.
Cost and how long they work are the major differences among the many drugs in this class.
Brand names for
the sulfonylureas
in the U.S. include
Amaryl® (glimepiride), Dymelor®
(acetohexamide),
Diabinese®
(chlorpropamide), Glucotrol® and Glucotrol XL®
(glipizide),
Diaßeta®
(glyburide), Glynase® (glyburide), Micronase® (glyburide), Orinase®
(tolbutamide), and Tolinase®
(tolazamide).
Glyburide is also called glibenclamide in most of the world.
There are other sulfonylureas that are not marketed in the United States, including
gliclazide.
Websites:
Amaryl is the only sulfonylurea to have
its own Web site, www.amaryl.com.
Hoechst Marion Roussel (now Aventis) created the Amaryl site in June 1999.
Pfizer has registered the names
www.glynase.com
and
glucotrolxl.com
but as of March, 2004, these sites link to the main Pfizer site without giving specific information on these products.
[Return to classes]
Biguanides
In the 1970's, a biguanide called phenformin (sold under the names D.B.I., Meltrol-50 capsules, and others) had been available in the United States, but phenformin was associated
with a life-threatening side effect of lactic acidosis, and phenformin
was withdrawn from the U.S. market on November 15, 1978.
(Further information is available at the FDA website).
The explosion of drugs available
in the United States
for controlling blood
glucose really began in 1995. In that year, metformin, another drug in the biguanide class, became
available in the U.S.
after demonstrating much less likelihood of provoking lactic acidosis. Glucophage® (metformin hydrochloride) was developed in France by Lipha
S.A. and has been used for decades in Europe. It has quickly become the most prescribed
diabetes pill in the U.S..
Glucophage works differently from the sulfonylureas. It
increases the sensitivity of your liver and muscle to insulin rather than increasing
insulin secretion from your pancreas.
Websites:
Bristol-Myers Squibb Company has lots of information
about
metformin
on the Glucophage
website,
http://www.glucophagexr.com.
[Return to classes]
Alpha-glucosidase inhibitors
The third class of drugs approved for diabetes has a
mouthful of a name, alpha-glucosidase inhibitors. Drugs in this class delay the digestion
of carbohydrates, causing glucose to enter the blood more slowly.
The Food and Drug Administration approved the first drug in
this class, Precose® (acarbose), in late 1995. The FDA approved GlysetTM
(miglitol)
the next year, but it wasn't until early 1999 that this drug actually became available
here.
Websites:
Bayer has a website for Precose, using the alternate (non-U.S.) brand name of Glucobay, at
http://www.precose.com
and
http://www.glucobay.com (both URLs seem to lead to the same content).
Pfizer has registered the name
www.glyset.com
but as of March, 2004, this site links to the main Pfizer site without giving specific information on these products.
[Return to classes]
Thiazolidinediones
The first thiazolidinedione, troglitazone (Rezulin®) was introduced to the U.S. and Japanese markets in 1997.
Unfortunately, the drug could cause liver damage, and it
was voluntarily withdrawn from the market by the manufacturer on March 21, 2000. In mid-1999 the FDA approved
two new drugs in the class called thiazolidinediones (TZDs). They are Avandia®
(rosiglitazone maleate) and ActosTM (piaglitazone hydrochloride). These new
"glitazones" make your body more sensitive to its insulin.
Websites:
SmithKline Beecham's Avandia site is at www.avandia.com. An Actos site at www.actos.com is in the works.
[Return to classes]
Meglitinides
The first medication in the fifth class of drugs,
meglitinides, hit the market in 1998.
Repaglinide
(PrandinTM in the U.S.; NovoNormTM elsewhere)
works by stimulating
insulin secretion from the beta cells of the pancreas. Prandin's quick onset and short
duration of action concentrate its effect around the meal time glucose load. Consequently,
it needs to be taken just before each meal.
Another similar drug, nateglinide (Starlix™) (from Novartis) was approved by the U.S. FDA in December, 2000.
Websites:
Repaglinide:
www.prandin.com/
and
/www.novonorm.com
Nateglinide:
http://www.starlix.com
[Return to classes]
Orlistat
Orlistat (Xenical®)
(Roche) is approved by the FDA for weight loss, including use by people with obesity and
diabetes.
Orlistat works in the digestive system to block about one-third of the fat in the food that is eaten from being digested.
Orlistat attaches to lipase enzymes in the gut,
and blocks these lipase from breaking down some of the fat; the undigested fat cannot be absorbed and is eliminated in the bowel movements.
Since type 2 diabetes is frequently accompanied by obesity, and since weight loss can help improve glucose tolerance, it might be considered that orlistat be considered a "diabetes pill."
Roche has a page devoted to this topic on the Xenical website, at
Health befnefits of weight loss: Type 2 diabetes.
Websites:
Orlistat: www.xenical.com
[Return to classes]
Combination pills
Many of the diabetes pills can be combined to get increased effect to control blood sugar levels.
The manufacturers have now developed several combinations, using products from two of the five different classes
of diabetes pills.
Using fixed-combination pills offer less flexibility in diabetes management: if the dose of one ingredient needs to be adjusted, both would end up being adjusted if a combo pill is being used.
Also, the combination pills are presently available only by brand name.
They are more expensive, but the benefits of an easier routine may make the added cost worthwhile, if the combination is able to control your diabetes. For example, there may be less pills to swallow, and for people who have insurance for their medications, it's only a single copayment for the combination product.
Combination pills for diabetes that are available in the U.S. include
- GlucoVance
(combination of glyburide and metformin, from Bristol-Myers Squibb)
(Approved by FDA July 31, 2000.)
- Avandamet
(combination of rosiglitazone and metformin, from GlaxoSmithKline)
(Approved by FDA October 10, 2002.)
- Metaglip
(combination of glipizide and metformin, sold in the U.S. by Bristol-Myers Squibb)
(Approved by FDA October 22, 2002.)
Websites:
GlucoVance: www.glucovance.com;
Avandamet: www.avandamet.com
Metaglip: www.metaglip.com
[Return to classes]
Summary
That's
quite a few
different medications
in five
or six classes of drugs,
plus combinations!
One or more of these are likely to work for you.
By David Mendosa
Last modified: March 28, 2004
Reproduced with permission.
