The way doctors treat diabetes is changing.
For years, people with type 2 diabetes who needed to take medication to lower their blood sugar started with an old drug called metformin. New guidelines now recommend that patients can start on one of the newer diabetes drugs, which may also reduce weight and protect the heart and kidneys.
The switch could help many people with diabetes who also struggle with conditions like high blood pressure, kidney disease and obesity, while also fighting the high blood sugar that is a hallmark of their diabetes.
“It’s a fundamental departure from the classic approach of fixing blood sugar, which we focused on earlier because that was all we could really do,” said Dr. Marie McDonnell, director of the diabetes program at Brigham and Women’s Hospital in Boston, who has received research funding from some diabetes drug companies.
These newer diabetes drugs belong to two classes known by the acronyms SGLT-2 and GLP-1 because of their mode of action.
The goal of the changes was to make the treatment more patient-specific rather than drug-focused, said Dr. Nuha Ali El Sayed, an endocrinologist at the Joslin Diabetes Center in Boston, who is the vice president for improving health care at the American Diabetes Association.
The However, newer drugs cost more than metformin, and some patients may not be able to afford the out-of-pocket costs and have to take metformin, doctors said. For example, Ozempic costs almost $900 per month, and Jardiance comes in at around $590 per month.
In contrast, patients can get the typical monthly supply of metformin, which is generic, for $25.72 without insurance or rebates, according to data from GoodRx Holdings Inc., which offers coupons for drug discounts.
“I think these drugs work really well; It just makes me angry that they are so expensive and out of reach for many of the people who benefit most from them,” said Dr. Rozalina McCoy, who treats diabetes patients at the Mayo Clinic in Rochester, Minn.
Ozempic can be difficult to find for some diabetics as it has emerged as a popular weight loss supplement.
Photo: Neeta Satam for The Wall Street Journal
Novo Nordisk A/S, which sells Ozempic, and Eli Lilly & Co., the maker of Jardiance, said insured patients do not pay the list price of their medicines and the companies have programs in place to help people pay their costs, including sometimes covering a patient’s expenses.
Some doctors also said most studies evaluating the newer drugs hadn’t tested them without metformin, clouding whether the heart, kidney and weight benefits were due to the new drugs alone. Additionally, the studies tested the SGLT-2 and GLP-1 drugs in patients at high risk for heart or kidney problems, not all who might receive them under the new guidelines.
Supply could be an issue. Some diabetic patients have had trouble filling prescriptions for Novo Nordisk’s Ozempic and Lilly’s Mounjaro and Trulicity because they have proven to be popular weight-loss aids, even though drug regulators have not approved them for such use. The companies have said they are taking steps to help people with diabetes get the drugs.
August Bellardine started taking metformin after being diagnosed with type 2 diabetes. He now takes Rybelsus.
Photo: August Bellardine
August Bellardine, a retired Navy electronics officer from Winder, Georgia, said he began taking metformin in about 2000 after he was first diagnosed with type 2 diabetes. Last year, a doctor partially prescribed Ozempic to help him lose weight. He lost 5 pounds in the first three weeks on the drug. After two months on the Ozempic, however, he switched to a GLP-1 pill called Rybelsus due to supply issues.
“I’m on the right track. What I’m doing is good – it makes me feel good,” said Mr Bellardine, 65.
Diabetes is a chronic disease that affects the ability to control blood sugar, causing it to build up and eventually leading to heart, kidney, and other health problems. According to the Centers for Disease Control and Prevention, approximately 37 million people in the United States have diabetes, most of them type 2.
Long-standing ADA guidelines had recommended that people with diabetes who could not control their disease through diet and exercise should begin drug treatment by taking metformin.
Studies found that metformin, which was first approved in the US in 1995, lowered high blood sugar levels. However, many people with type 2 diabetes also struggle with heart, weight, and kidney problems, which often require treatment with other medications.
The ADA changed its guidelines last December, adding the newer diabetes drugs to its recommendations for first-line treatments.
The SGLT-2 inhibitors, which stand for sodium-glucose cotransporter-2, lower blood sugar by preventing the kidneys from absorbing it again. Instead, the blood sugar is released through the urine.
The pills include AstraZeneca PLC’s Farxiga, Boehringer Ingelheim GmbH’s Jardiance and Lilly, Johnson & Johnson’s Invokana, and Merck & Co.’s Steglatro.
The GLP-1 compounds mimic the body’s natural response to food and produce a hormone called glucagon-like peptide 1, which stimulates the production of insulin. It is the insulin that helps lower blood sugar levels. The drugs also suppress people’s appetites, doctors say.
The class includes AstraZeneca PLC’s Byetta and Bydureon, Sanofi SA’s Lilly’s Trulicity and Adlyxin, and Novo Nordisk’s Ozempic, Victoza and Rybelsus. All are injected except for the Rybelsus pill. Lilly’s Mounjaro targets GLP-1 as well as another gut hormone.
The Food and Drug Administration started approving drug classes years ago. In 2008, the agency recommended drugmakers test their diabetes drugs to make sure they didn’t dangerously increase heart risk after researchers linked the diabetes drug Avandia to heart attacks.
SHARE YOUR THOUGHTS
How will the new guidelines improve care for people with diabetes? Join the conversation below.
In 2021, the FDA approved a GLP-1 drug Novo Nordisk is calling Wegovy for chronic weight control; The drug was previously approved under the brand name Ozempic for the treatment of type 2 diabetes. The FDA is currently reviewing whether Lilly’s Mounjaro, which is currently approved for diabetes, should be approved to treat obese adults.
According to the ADA’s new guidelines, when deciding which drug to prescribe, physicians should consider whether a diabetic has a higher risk of heart and kidney disease and their weight and blood sugar levels.
“This ushers us into what I could call an era of precision pharmacology for diabetes, which is currently in its infancy but didn’t even exist 10 years ago,” said Dr. Suneil Koliwad, Chief of the Department of Endocrinology and Metabolism at the University of California, San Francisco, and has advised several pharmaceutical companies.
dr Koliwad said he prescribes metformin for most of his patients first, partly because it’s less expensive than the newer drugs. He prescribes the newer drugs when it’s best for the patient, he said, though he sometimes has to deal with health insurance paperwork and high expenses.
Write to Ariana Perez-Castells at [email protected]
Copyright ©2022 Dow Jones & Company, Inc. All rights reserved. 87990cbe856818d5eddac44c7b1cdeb8