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Top 10 Diabetes Treatments You May Have Missed

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on July 19, 2022.

Are You at Risk for Type 2 Diabetes?

Diabetes and prediabetes are two of the top pressing health issues in the nation. Recent estimates from the Centers for Disease Control (CDC) estimates that about 130 million people are living with prediabetes or diabetes in the US. About 1.4 million new cases of diabetes were diagnosed among adults in 2019.

Prediabetes occurs when the blood sugar levels are higher than normal but not yet high enough to be classified as type 2 diabetes. Weight loss and increased exercise can help prevent a type 2 diabetes diagnosis.

Even more concerning is the number of people who are at future risk for these conditions. It was reported by the CDC that:

  • Of the 37.3 million people who have diabetes, 8.5 million people (or 23% of adults) are undiagnosed.
  • Of 96 million adults with prediabetes (38.0% of the adult US population), almost half of these are in people 65 years of age and older.

Diabetes remains the 8th leading cause of death in the U.S; the top 3 are: heart disease, cancer and COVID-19 (2020 data).

Treatment for Type 2 Diabetes

There's no cure for type 2 diabetes, but patients may be able to manage their condition by eating healthy, staying active through regular exercise, and maintaining a normal weight. But sometimes this just isn't enough.

Medication treatment for type 2 diabetes often begins with oral metformin, a drug that is the backbone of oral diabetes treatment regimens. From there, different drug classes may be added to metformin, and for some patients, the use of injectable insulin may be necessary.

  • Insulin is a hormone the body needs to utilize the glucose (sugar) from food to provide energy for the body.
  • In type 1 diabetes, the pancreas makes no insulin and it must be replaced. In type 2 diabetes, either the pancreas either doesn't make enough insulin, there is resistance to the effects of insulin, or both.

A1C Levels

Diabetes treatments are monitored using a blood sugar target called hemoglobin A1C (HbA1c or just A1C) that gives average blood glucose levels over the past 3 months.

For adults, the American Diabetes Association (ADA) recommends a target HbA1C of below 7%; however, in March 2018, the American College of Physicians (ACP) issued new guidance, suggesting targets between 7% and 8%. Part of the ACP reasoning is to adhere to a more individualized approach to type 2 diabetes treatment. For example, in the elderly, very low blood sugars can be linked with serious health issues, including confusion and fainting.

High blood sugar levels can increase the risk for serious complications due to diabetes such as:

  • vision loss
  • peripheral nerve damage
  • kidney impairment
  • hard-to-treat infections
  • impotence
  • heart disease

However, the latest diabetes news is encouraging. Newer drugs with a positive outcome on heart disease and death, improved monitoring devices and an understanding of how diet and exercise impact diabetes is adding up to a gain in outcomes for patients.

The vast majority of people with type 2 diabetes are living longer lives due to better medications, and a better understanding of the disease and the numerous complications that result from this chronic disease.

In response to the type 2 diabetes epidemic, the U.S. Food and Drug Administration (FDA) continues to approve and improve type 2 diabetes medications and ease dosing regimens for patients.

Here is a selection of some top type 2 diabetes treatments and the latest breakthroughs:

1. Mounjaro

  • In May 2022, the FDA approved Eli Lilly's Mounjaro (tirzepatide), a first-in-class adjunct used with diet and exercise to improve glycemic (blood sugar) control in adults with type 2 diabetes mellitus.
  • Mounjaro lowers blood sugar levels and reduces body weight in patients with type 2 diabetes mellitus.
  • Mounjaro is classified as a glucose-dependent insulinotropic polypeptide (GIP) receptor and glucagon-like peptide-1 (GLP-1) receptor agonist, both natural incretin hormones.

It comes as a 2.5 mg, 5 mg, 7.5 mg, 10 mg, 12.5 mg and 15 mg subcutaneous (under the skin) injection in an auto-injector. The recommended starting dosage is 2.5 mg subcutaneously once weekly, increasing to 5 mg once weekly after 4 weeks. The maximum dosage is 15 mg subcutaneously once weekly.

FDA approval was based on the Phase 3 SURPASS program, with five clinical trials lasting from 40 to 52 weeks with over 6,200 participants. Studies included comparisons with injectable semaglutide 1 mg, insulin glargine and insulin degludec. Effectiveness was evaluated for Mounjaro 5 mg, 10 mg and 15 mg used alone (monotherapy) or in combination with commonly prescribed diabetes medications, including metformin, SGLT2 inhibitors, sulfonylureas and insulin glargine.

  • Participants achieved average A1C reductions between 1.8% and 2.4%. While not indicated for weight loss, participants treated with Mounjaro lost between 5.5 kg (12 lbs) 11 kg (25 lbs) on average.
  • Side effects reported in at least 5% of patients include nausea, diarrhea, decreased appetite, vomiting, constipation, indigestion (dyspepsia), and stomach (abdominal) pain. The package insert carries a Boxed Warning for thyroid C-cell tumors.

2. Humalog (insulin lispro)

Insulin is a hormone that works to lower levels of blood glucose (blood sugar) and is found either naturally in the body or man-made and given by injection or inhalation. The development of life-saving insulin for people with diabetes is one of the top medical breakthroughs in the history of medicine.

Hypoglycemia (low blood sugar) is the most common side effect with insulins. Always have a quick source of some type of sugar available for hypoglycemia episodes, for example:

  • jelly beans
  • glucose tablets
  • fruit juice.

Humalog (insulin lispro), from Eli Lilly is one of several man-made insulins for patients with diabetes. Humalog is known as a “fast-acting” insulin that starts to work about 15 minutes after injection, peaks at one hour, and it keeps working for 2 to 4 hours. It is typically given within fifteen minutes before a meal or immediately after a meal and may be used in regimens with an intermediate- or long-acting insulin for insulin coverage throughout the day.

The Humalog Junior KwikPen (100 units per mL) is also available for children as a prefilled 3 mL disposable pen with half-unit dosing.

Admelog (insulin lispro) is the first rapid-acting insulin approved as a “follow-on” (or biosimilar-type product) to Humalog. Costs with Admelog may be lower than other insulin lispro products. In June 2020, Lyumjev (insulin lispro-aabc injection) from Eli Lilly was the second approved follow-on to Humalog.

Learn more: Which biosimilars are approved in the US?

3. Jardiance (empagliflozin)

Death from heart disease is 70% higher in diabetics compared to those without diabetes. So controlling heart (cardiovascular) disease in patients with type 2 diabetes in an important goal.

Jardiance (empagliflozin), from Boehringer Ingelheim and Eli Lilly, is classified as a sodium glucose co-transporter-2 (SGLT2) inhibitor and was originally approved in 2014 to improve blood sugar control (HbA1c) in adults with type 2 diabetes alongside diet and exercise. Jardiance is also approved in adults to lower the risk of cardiovascular death in patients with type 2 diabetes and heart disease, and for treatment of heart failure.

Other SGLT-2 inhibitors on the U.S. market include: Farxiga (dapagliflozin), Invokana (canagliflozin) and Steglatro (ertugloflozin).

Jardiance side effects may include:

  • dehydration and low blood pressure that can result in dizziness and fainting
  • yeast infections
  • low blood sugar with insulin or insulin secretagogues
  • elevation in LDL cholesterol
  • increased risk for urinary tract infections
  • impaired kidney function.

Other combination products that contain empagliflozin are: Glyxambi (empagliflozin and linagliptin), Synjardy (empagliflozin and metformin) and Synjardy XR, and Trijardy XR (empagliflozin, linagliptin and metformin).

Based on the latest guidelines, SGLT-2 inhibitors like Jardiance or GLP-1 agonists such as Trulicity (dulaglutide) may be added based on your need for control of risk factors such as established heart disease (risk of major events like a heart attack or stroke), chronic kidney disease or heart failure.

4. Lantus (insulin glargine)

While short-acting insulins like Humalog are used at mealtimes, long-acting basal insulins work to keep the blood sugar levels even throughout the day. Lantus (insulin glargine), from Sanofi, is used to treat adults with type 2 diabetes and adults and children 6 years and older with type 1 diabetes.

Lantus provides a slow, steady release of insulin and helps to manage the blood sugar levels between meals and overnight.

  • The onset of Lantus is usually within 1 to 3 hours, with a duration of 24 hours.
  • Due to its long duration of action it is injected subcutaneously (under the skin) just once a day, at the same time each day.

Some patients use a rapid acting human insulin or an oral diabetes medication in combination with Lantus.

  • Lantus comes as a 100 units/mL in either 10 mL vials or as the 3 mL SoloStar prefilled pen.
  • With the SoloStar pen, you dial the dose you need on the pen and use the push button for injection.

Other insulin glargine products include Basaglar and Toujeo.

Semglee (insulin glargine) from Mylan / Viatris was first approved for the same uses by the FDA in June 2020 as a more affordable follow-on to Lantus. It was considered an equivalent to Lantus under the 505(b)(2) NDA pathway, meaning it could be prescribed for the same indications as Lantus, but was not considered a biosimilar, and was not interchangeable.

In July 2021, the FDA approved Semglee (insulin glargine-yfgn), both biosimilar to, and interchangeable with (can be substituted for), its reference product Lantus (insulin glargine). An unbranded insulin glargine-yfgn is also available and substitutable. Semglee is available as two dose forms: a 10 mL multi-dose vial and 3 mL single-use prefilled pen (autoinjector). Semglee was the first interchangeable biosimilar insulin product approved in the U.S.

In Dec. 2021, Rezvoglar (insulin glargine-aglr) from was approved as the second biosimilar to Lantus. It comes as a 3 mL prefilled pen autoinjector (100 units/mL). Unlike Semglee, Rezvoglar is not interchangeable with Lantus, meaning your pharmacist cannot automatically substitute it for Lantus. Your healthcare provider will need to provide you a prescription specifically for Rezvoglar.

Both Semglee and Rezvoglar should be less expensive for you than Lantus, with or without insurance. Check with your pharmacy or insurance company for cost, coverage and copay.

5. Soliqua 100/33 (insulin glargine and lixisenatide)

Sanofi’s Soliqua 100/33 injection (insulin glargine and lixisenatide) is a combination of insulin glargine 100 Units/mL and lixisenatide 33 mcg/mL, a glucagon-like peptide-1 (GLP-1) agonist. The two drugs combined now mean one injection for the patient with type 2 diabetes - instead of two. That's a big improvement.

Soliqua 100/33 combines a long-acting, basal insulin with a GLP-1 (glucagon-like peptide-1) receptor agonist to help control blood sugar and lower HbA1c. It is used with diet and exercise to control blood sugar in adults with type 2 diabetes inadequately controlled on basal insulin (less than 60 units daily) or lixisenatide. It can also be prescribed for patients uncontrolled on oral antidiabetic medicines. It comes as a single dose, pre-filled pen and is given as a once-daily injection.

  • Insulin glargine (Lantus) is a long-acting basal insulin that provides a steady insulin release to manage blood sugar levels between meals and at bedtime.
  • Lixisenatide (Adlyxin) is a GLP-1 agonist that helps the pancreas produce more insulin in response to an increase in blood sugar and controls glucose production from the liver.

In studies, Soliqua 100/33 showed better HbA1c lowering (average blood sugar over time) versus Lantus with 55% of patients achieving a target of less than 7% at 30 weeks, compared to 30% with Lantus alone. Hypoglycemia rates were similar in both groups.

Some of the most common side effects with Soliqua include low blood sugar, nausea, stuff / runny nose, sore throat, diarrhea, respiratory tract infections, and headache.

In 2019, the FDA expanded the uses for Soliqua 100/33 to include type 2 diabetes patients uncontrolled on oral diabetes treatments such as metformin and / or a second oral antidiabetic therapy.

6. Toujeo (insulin glargine)

Long-acting insulin injections help patients with diabetes control their blood sugar levels over a 24-hour period. Sanofi’s Toujeo (insulin glargine) is the same active ingredient that's in Lantus. Toujeo is a once-daily, long-acting basal insulin for adults and children 6 years of age and older with type 1 or type 2 diabetes.

In the clinical trials evaluating Toujeo, all of the primary study endpoints were met by demonstrating similar blood sugar control with Toujeo as compared to Lantus. Toujeo’s onset is within 6 hours, and it has a duration of up to 36 hours, reaching a steady blood level by about day five.

The most common side effects reported for Toujeo include hypoglycemia (low blood sugar), allergic reactions, injection site reactions, lipodystrophy (abnormal distribution of body fat), pruritus (itching), rash, edema (fluid retention), and weight gain

Toujeo is available in 2 disposable prefilled pens (autoinjectors):

  • ‚ÄčToujeo SoloStar contains 450 units of Toujeo U-300 (300 units/mL). It delivers doses in 1 unit increments and can deliver up to 80 units in a single injection.
  • Toujeo Max SoloStar, approved in March 2018, contains 900 units of Toujeo U-300. It delivers up to 160 units in a single injection. It is recommended for patients requiring at least 20 units per day.
  • Your healthcare provider will tell you which pen is best for you.

7. Trulicity (dulaglutide)

Trulicity (dulaglutide) is a glucagon-like peptide-1 (GLP-1) receptor agonist for the treatment of type 2 diabetes. It is in the same class of drug as Saxenda, Bydureon, Victoza, Rybelsus and Ozempic, among others.

  • Trulicity, from Eli Lilly, is approved as a once-weekly subcutaneous (under the skin) injection used to improve blood sugar levels, along with diet and exercise, in adults with type 2 diabetes.
  • Its use has also been expanded to help reduce the risk of serious heart problems such as heart attack or stroke in adults with type 2 diabetes with established cardiovascular (heart) disease or multiple cardiovascular risk factors (for example: smoking, obesity, high blood pressure, elevated cholesterol (LDL), family history).

Trulicity comes in several strengths as a pen device with an automatic injector. Once-weekly dosing may be a big advantage for many patients. Another advantage to GLP-1 receptor agonists is a reduced risk for low blood sugar (hypoglycemia), especially compared to insulin or sulfonylureas.

GLP-1 receptor agonists should not be used by anyone with a personal or family history of certain types of thyroid cancer. A boxed warning exists for all GLP-1 receptor agonists for possible thyroid tumors, including cancer.

Common side effects with Trulicity include:

  • nausea
  • vomiting
  • diarrhea
  • stomach (abdominal) pain
  • decreased appetite.

8. Victoza (liraglutide)

Victoza (liraglutide) from Novo Nordisk is also a glucagon-like peptide-1 (GLP-1) receptor agonist (incretin mimetic) indicated to improve glycemic control in adults with type 2 diabetes mellitus. It is in the same class of drug as Trulicity, Ozempic, Rybelsus and Bydureon BCise.

Type 2 diabetes patients have a four times greater risk of developing heart disease, which is the leading cause of disease and death in patients with type 2 diabetes.

Although Victoza was originally approved in January, 2010, in 2017 it gained a new labeled indication to reduce the risk of heart attack, stroke and cardiovascular (CV) death in adults with type 2 diabetes and established heart (cardiovascular) disease. Victoza demonstrated a life-saving benefit that included a 22% reduction in cardiovascular death and a 15% reduction in all-cause death.

In June 2019, it was approved for the treatment of pediatric patients 10 years or older with type 2 diabetes

The most common side effects leading to the study discontinuation of Victoza were gastrointestinal (stomach) events, which are common with GLP-1 receptor agonists. The most common side effects overall are headache, nausea and diarrhea.

Victoza is available as a 0.6 mg (for initial titration), 1.2 mg or 1.8 mg injection dose in pre-filled, multidose pens. Each 3 mL pen contains 6 mg/mL of liraglutide. Victoza is used once daily each day, and it can be used at any time of the day, with or without food. Your healthcare provider will determine your dose.

9. Ozempic & Rybelsus

Ozempic (semaglutide injection) is a glucagon-like peptide-1 (GLP-1) analog from Novo Nordisk. It is used in patients with type 2 diabetes as an adjunct to diet and exercise to improve blood sugar control, as well as to reduce the risk of events like a heart attack, stroke or death in adults with established heart disease.

  • Ozempic is a subcutaneous (under the skin) injection given once weekly and comes as a pre-filled, disposable, single-patient-use injection pen.
  • As with other GLP-1 analogs, you should not use Ozempic if you have multiple endocrine neoplasia type 2 (tumors in your glands), a personal or family history of medullary thyroid cancer, insulin-dependent (type 1) diabetes, or diabetic ketoacidosis.
  • In studies, the most common adverse reactions reported in 5% or greater of patients treated with Ozempic were: nausea, vomiting, diarrhea, abdominal (stomach area) pain and constipation.

Rybelsus (semaglutide oral tablets), also from Novo Nordisk, was approved in Sept. 2019 as the first GLP-1 agonist given by mouth in the U.S. It is a novel oral product of the injectable form of semaglutide (Ozempic).

Rybelsus is given as an oral tablet once a day. The Rybelsus dose is taken at least 30 minutes before the first food, beverage, or other oral medications of the day with no more than 4 ounces of plain water only. This will help absorption.

The most common side effects reported in at least 5% of patients taking Rybelsus are nausea, stomach area pain, diarrhea, decreased appetite, vomiting and constipation.

10. Steglatro, Segluromet, and Steglujan (ertugliflozin)

As we have seen, patients with type 2 diabetes often need a combination of medications to control their blood sugar.

Merck’s SGLT2 inhibitor Steglatro (ertugliflozin), as well as two new combination agents that contain ertugliflozin: Segluromet (ertugliflozin and metformin), and Steglujan (ertugliflozin and sitagliptin) were FDA-approved in 2017. These are all oral agents used together with diet and exercise to improve blood sugar control in adults with type 2 diabetes mellitus.

Ertugliflozin works in the kidney to help get rid of glucose from your bloodstream.

In Phase 3 studies, Steglatro was studied alone and in combination with metformin and/or sitagliptin, as well as with insulin and a sulfonylurea. Steglatro plus metformin and sitagliptin resulted in significant A1C reductions of 0.7% and 0.8% compared with 0.2% for placebo, and weight loss of roughly 6.2 to 6.6 pounds.

This is not all the information you need to know about these or other diabetes treatments for safe and effective use and does not take the place of your doctor’s directions. Review the full product information and patient medication guide. Discuss this information and any questions you have with your doctor or other health care provider.

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Sources

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.