A physicians’ group says weight loss drugs such as Ozempic can help manage type 2 diabetes.
- Researchers report that
GLP-1 and SGLT-2 drugs can help people with type 2 diabetes control blood
sugar.
- They note that the high cost
of drugs such Jardiance and Ozempic can be a barrier to treatment.
- DPP-4 drugs were not
recommended because researchers said they don’t appear to reduce morbidity
or mortality.
Medications such as Jardiance and Ozempic can
help people with type 2
diabetes who have trouble controlling their blood sugar when
the drugs are used in conjunction with the diabetes medication metformin as
well as interventions to improve diet and exercise.
That’s what the American College of Physicians (ACP)
is saying in their newly revised clinical
recommendations published today in the Annals of
Internal Medicine.
“ACP recommends adding a sodium-glucose
cotransporter-2 (SGLT-2) inhibitor or glucagon-like peptide-1 (GLP-1) agonist
to metformin and lifestyle interventions in patients with type 2 diabetes and
inadequate glycemic control,” said organization officials in updating their
diabetes treatment guidelines for the first time since 2017.
“The American College of Physicians’ updated guidelines
on pharmacological treatments for type 2 diabetes provides valuable
recommendations for physicians, particularly in highlighting the benefits of
SGLT-2 inhibitors and GLP-1 agonists for reducing serious complication
risks,” Dr. William Hsu, an endocrinologist and chief medical officer
at health nutrition firm L-Nutra, told Medical News Today.
“However, it’s crucial to recognize that medication alone is not sufficient for
optimal diabetes management. Type 2 diabetes is fundamentally a metabolic
disorder rooted in insulin resistance and beta cell fatigue driven by factors
like obesity, inactivity, a suboptimal diet, and aging. To achieve
transformative diabetes care, we must address these underlying root causes.
This is where innovative nutrition-based interventions can play a pivotal
role.”
Ozempic, Jardiance as type 2 diabetes treatments
The physicians’ group said using a SGLT-2
inhibitor such as Jardiance can reduce the risk of all-cause
mortality, major adverse cardiovascular events, progression of chronic kidney
disease, and hospitalization due to congestive heart failure. SGLT-2 inhibitors
help control diabetes by increasing excretion of glucose via urination.
GLP-1
agonists such as Ozempic help control blood sugar by
stimulating the pancreas to release insulin and suppressing the release of a
hormone called glucagon, which normally regulates blood glucose levels.
The ACP said this class of drugs can reduce the risk
of all-cause mortality, major adverse cardiovascular events, and stroke among
people with type 2 diabetes.
“Ozempic is a very powerful medication with specific
mechanisms that address diabetes better than most other drugs, but it alone
cannot address all the things diet and exercise can,” Dr. Suzannah
Gerber, a researcher at the Tufts Friedman School of Nutrition
Science and Policy in Boston, told Medical News Today.
“However, Ozempic can get strong results quickly which
can be very encouraging for patients — an opportunity to bolster other healthy
lifestyle behaviors,” she added.
Weight loss drugs are effective but expensive
“SGLT-2s and GLP-1s are costly, but lower cost options
(like sulfonylureas) were inferior in reducing all-cause mortality and
morbidity,” the ACP stated.
No genetic versions of the recommended drugs are
currently available. An editorial published
with the new guidelines noted that cost presents a significant barrier to
people using these medications.
“Patients with obesity and diabetes need easier access
to these medications, especially given their unmatched effectiveness for
glucose control and weight reduction,” according to the editorial penned by
physicians at the Duke University Division of General Internal Medicine in
North Carolina.
“It’s frustrating to hear how well these medications
are working but how difficult they are to get,” Stacey Simms,
host of the podcast Diabetes Connections TYPE 2, told Medical News
Today. “I have several listeners who’ve started on Ozempic or Mounjaro and
see great success in bringing down their A1C [blood sugar levels]. But a few
months in, the pharmacy tells them the supply isn’t there. I just spoke to a
man who’s been taking Mounjaro since August of 2023 and now can’t find it
anywhere. His doctor recommended he switch to Zepbound…That’s
easier to find for some reason. He made the switch, but insurance won’t cover
it. His choice is to pay $1,000 a month or worry that his A1C will go back up.”
Putting type 2 diabetes medication guidelines to use
The ACP guidelines focused on beneficial clinical
outcomes rather than metrics such as glycemic control.
The physicians’ group noted that treatment needs to be
tailored to the needs of each individual, taking into account factors such as
age, co-morbidities, and personal preferences.
“These updates are in line with current guidelines
from the American Diabetes Association and the American College of Cardiology
and reflect current clinical practice,” Dr. Jacqueline Lonier, an assistant professor of medicine at
Columbia University Irving Medical Center’s Naomi Berrie Diabetes Center in New
York, told Medical News Today. “As most patients with type 2
diabetes are treated in the primary-care setting, the increasing utilization of
SGLT2 inhibitors and GLP1 agonists by our primary-care colleagues will improve
outcomes in people with type 2 diabetes on a population level.”
The clinical guidelines cautioned against treating
people with type 2 diabetes with inadequate glycemic control with dipeptidyl
peptidase-4 (DPP-4) inhibitors, saying that “high-certainty evidence showed
that adding a DPP-4 inhibitor does not reduce morbidity or all-cause
mortality.”
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