If you are living with type 2 diabetes, you are certainly not alone. One in 10 people in the US has diabetes, according to the CDC. However, despite major advances in diabetes treatment over the past 20 years, fewer than half of those with diabetes reach their blood sugar target.

In part, this may be due to the fact that physicians may be slow to make adjustments in a patient’s treatment plan, even when the patient’s treatment goals are not being met. One reason for this may be the sheer number of medicines currently available. However, waiting too long to correct treatment for type 2 diabetes can have long-term side effects that can increase the risk of heart disease and kidney disease and other problems.

What is type 2 diabetes?

Type 2 diabetes is an incurable disease where the body’s ability to use glucose or sugar as fuel is compromised. Our bodies produce a hormone called insulin that makes the sugar from the carbohydrates in the food we eat reach cells and be used as energy. In type 2 diabetes, the insulin resistance decreases, and over time the body produces less. This means that the sugar in the cells decreases to get more fuel, and more sugar in the blood can be used. High blood sugar levels over time can cause damage to vital organs such as the heart, kidneys, nerves, and eyes.

Some of the risk factors for people with type 2 diabetes, such as genetics and age, are irreversible. Other risk factors, such as obesity or overweight, can be reversed. That is why losing 5% to 10% of a person’s initial weight through healthy diet and exercise is always the key to managing type 2 diabetes.

Many diabetes medications successfully lower blood sugar

The target of blood sugar in most adults with diabetes is A1C less than 7%. (A1C is a normal human blood sugar level for about three months.) For most people, diet and exercise are not enough to achieve this goal, and one or more medications may be needed. Metformin is a tried and tested drug that has been used for decades to treat type 2 diabetes, and is recommended by many experts as a first-line treatment. It is affordable, safe, effective, and well tolerated by most people.

If metformin does not regulate blood sugar adequately, another drug should be added. It is at this point that doctors and patients have to choose between the wide range of medications and drugs available to treat type 2 diabetes. In general, for people at low risk of heart disease or who do not have a history of diabetic kidney disease, most diabetic medications that are effective in metformin effectively lower blood sugar and can lower A1C to less than 7%.

So, how to choose a drug? Each person with diabetes has their own goals, needs, and interests. Before choosing a medication, it is important to ask the appropriate questions:

  • Is my blood sugar my goal? Is the drug affordable?
  • Do I have heart or kidney disease? What are the side effects?
  • Is it a pill or an injection, and how often do you take it?

Regardless of the treatment chosen, the American Diabetes Association Standards of Care recommends reviewing diabetes control every three to six months, followed by a change in treatment if needed.

New diabetes medications: Measuring benefits and risks

Recently, new treatment options for type 2 diabetes – glucagon-like peptide-1 (GLP-1) receptor agonists and sodium-glucose cotransporter-2 (SGLT2) inhibitors – have become increasingly popular. These classes of new drugs lower blood sugar and have beneficial effects on the heart and blood vessels and kidneys.

GLP-1 receptor agonists are drugs that lower blood sugar after a meal by helping your body’s insulin to work more efficiently. All but one of these drugs are injected under the skin, daily or weekly. Several of them, such as liraglutide (Victoza), semglutide (Ozempic), and dulaglutide (Trulicity), have been shown to reduce the risk of cardiovascular disease in people who are at high risk for it, or have pre-existing heart disease. . They also promote weight loss. Some people who use GLP-1 receptor agonists may experience side effects such as nausea and vomiting, and in rare cases pancreatitis.

SGLT2 inhibitors such as empagliflozin (Jardiance), canagliflozin (Invokana), dapagliflozin (Farxiga), and ertugliflozin (Steglatro) are also a new class of drugs that work by blocking your kidneys from returning sugar to your body. They also have benefits for the cardiovascular system, especially for those with heart disease, and have been shown to slow down the progression of diabetic kidney disease. Other benefits include lowering blood pressure and promoting weight loss.

Using these drugs may increase the risk of genital yeast infection, especially in women. An unusual but serious side effect of SGLT2 inhibitors is diabetes ketoacidosis, which is a medical emergency that can be avoided by stopping these medications by consulting your doctor before major surgery, or if you are sick or fasting.

Although these diabetes medications have more to offer than just improving blood sugar, they are still expensive and inaccessible to most people. That’s why it’s important to have an open and honest conversation with your doctor about what’s most important to you and what’s in line with your goals and preferences. Control of a complex disease such as diabetes takes the whole team, you become an important member of the team.