New Research Designs Focus on Safe and Effective Add-On Therapy for Diabetes Control

There is little doubt that metformin is the first drug of choice for most patients with Type 2 Diabetes. But for some, even the maximum dose of metformin is not adequate to control blood sugar. So what should be added when this is the case? Some say insulin. Some say sulfonylureas like glipizide or glyburide. Others favor a TZD drug, such as pioglitazone (Actos) or the DPP4 Inhibitors, such as Januvia, Onglyza, or others. The fact of the matter is that we have lots of choices nowadays. And 

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there are more options in the research pipeline that will eventually make it to the market place before too long. And this is especially good news because more help in managing diabetes is desperately needed. According to the American Diabetes Association, there are over 30 million people with diabetes in the US today, with about 1.5 million new cases being diagnosed per year. It is the 7th leading cause of mortality in the US, causing or contributing to more than 250,000 deaths per year. The total cost of diabetes to our society/economy is over $300 Billion per year and growing!

Research shows that tighter sugar control is associated with better health outcomes. So in the instance where

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 metformin isn’t enough, the choice of an add-on medication can be complicated. Some of the better treatments are more expensive and are therefore not utilized greatly. But maybe they should be if there are clear benefits over less expensive choices. This could be the case for the class of drugs called GLP-1 agonists (brand names are Byetta, Victoza, Saxenda, Bydureon, Trulicity, and Ozempic), commonly pronounced “Glip One’s”. Insulin and sulfonylureas are effective at controlling sugars either alone or added to metformin, but they may cause weight gain and dangerous drops in blood sugar, or hypoglycemia. But the GLP-1 drugs are different. They tend to actually cause substantial weight loss (great for diabetes management) and are not particularly associated with hypoglycemia. They work to improve insulin production with meals. They hinder a hormone called glucagon that causes sugar elevation. And they substantially decrease appetite. The result is better diabetes control without weight gain. So besides cost, what is the down-side for GLP-1’s? The main thing is that all of the currently available ones are administered by injection and that’s a turn off to some. Side effects may include nausea and prolonged feelings of fullness after meals. Patients who have gastric emptying problems, have had gastric bypass or other weight loss surgeries, or who have a history of pancreatitis could have problems with the drug class and should avoid it. Fortunately, three of the GLP-1 drugs are only administered once a week which makes the prospect of self-administering an injection easier to handle. So there is a case to be made for GLP-1 drugs being ideal for add-on therapy to metformin. But the debate will continue as many scientist, doctors, and researchers still favor other drugs instead. And more research is clearly needed.
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Studymetrix does have a research interest in the GLP-1 drugs as add on therapy to metformin in Type 2 diabetes and also as a weight loss agent in non-diabetics. Ongoing and future studies will be looking at these scenarios carefully and we need volunteers to get involved. We can be contacted by phone at 636.387.5100 or by email at recruitment@studymetrix.com. You can also get more information or contact us through our website at www.studymetrix.com. Or you can find us, follow us, and message us on Facebook as well. Let us hear from you soon if you are interested in doing a telephone pre-screen or maybe even coming in for a free, no-obligation pre-screening visit with us. Thanks for following us and please share with others who might be interested.

And remember, without volunteers, we would have no medications at all. So get involved! Volunteer!

Timothy R Smith, MD, RPh

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