The Decade in Diabetes

New treatments for type 2 diabetes give patients more power over their disease

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Treatments for type 2 diabetes are not what they used to be… they are even better! Throughout the past decade, new drugs and other tools have made it easier for patients to live with the disease.

Even as new cases of diabetes are on the rise, those who already have the disease are reaping the benefits of new classes of drugs, better devices, and a deeper knowledge of how diet and exercise can be a crucial part of treating type 2 diabetes.

On top of that, doctors are diagnosing and treating their diabetic patients much earlier than they did 10 years ago, which has led to better lives for patients.

What is type 2 diabetes treatment?

The main goal of treating type 2 diabetes is to help patients keep their blood sugar levels as close to normal as possible. Patients who have control over their blood sugar have a better chance of delaying or preventing complications.

Treatment for type 2 diabetes involves four key approaches:

  • Blood sugar monitoring
  • Healthy diet
  • Regular exercise
  • For some patients, diabetes drugs and insulin therapy

It may seem like a daunting task to manage your diabetes, but it does not have to be. Remember that there is a team of experts to help you through the process. Your doctor, diabetes educator, and dietitian will work with you to keep your blood sugar level under control.

What are the new type 2 diabetes drugs?

Some diabetes drugs have been working well for patients for years. In fact, metformin (sold as Fortamet and Glucophage) was used as early as the 1920s, and is still being used today as a first-line treatment for type 2 diabetes.

But we have come a long way since the 1920s. In just the last 10 years, new drugs and new types of insulin have made diabetes treatment better.

Here are some of the bigger advances in drug and insulin treatments from the last decade:

  • DPP-4 inhibitors improve blood sugar by preventing the breakdown of a compound called GLP-1. GLP-1 lowers blood sugar levels in the body, but does not work well as an injected drug because it breaks down too quickly. Instead, DPP-4 inhibitors let GLP-1 remain naturally active in the body, which lowers blood sugar levels only when they get high. Januvia (sitagliptin) and Onglyza (saxagliptin) are the two DPP-4 inhibitors currently available.
  • Incretin mimetic or GLP analogs are drugs that increase insulin after meals. Insulin is a hormone that manages blood sugar levels. Byetta (exenatide) and Victoza (liraglutide) are injectable forms of these drugs.
  • Symlin (pramlintide) is used in combination with insulin at mealtime. It slows down the movement of food through the stomach, which keeps blood sugar from rising too high after a meal.
  • Combination drugs have been a major step forward in diabetes treatment. As many drugs work in different ways to reduce blood sugar, they can be used together in the form of one pill. Metformin is frequently combined with other drugs, such as DPP-4 inhibitors or sulfonylureas. Combination drugs make the daily chore of taking medications much easier, as patients do not need to take as many pills. Actoplus MET, Prandimet, Avandamet, Duetact, and Metaglip are all examples of combination drugs.
  • Insulin treatments have also improved over the last decade. It used to be the case that patients on insulin therapy would have to inject the hormone multiple times a day. Now, patients can take one injection that lasts all day.

According to Marc L. Reitman, M.D., Ph.D., of the National Institute of Diabetes and Digestive and Kidney Diseases, "The biggest advances in therapeutics from the last decade are DPP-4 inhibitors and GLP-1 analogs."

Dr. Reitman believes that the next big drug class for type 2 diabetes will be SGLT2 inhibitors. SGLT2 (subtype 2 of the sodium-glucose transport proteins) is in charge of reabsorbing more than 90 percent of sugars in the kidney. By blocking this protein, blood sugar is removed from the urine, which keeps patients blood sugar at healthier levels.

Currently, Bristol-Myers Squibb is testing a SGLT2 inhibitor called dapagliflozin.

"It's not clear how long it will be for this drug to be approved, or if it will be approved," says Dr. Reitman. "It will be a great advancement in diabetes treatment once it is available to patients."

Even with these advances and new drugs on the horizon, there have been problems with some older drugs, specifically Actos (pioglitazone) and Avandia (rosiglitazone). Actos has been associated with an greater risk of bladder cancer, while Avandia was found to increase the risk for heart-related problems. Recently, the FDA significantly restricted access to Avandia because of those risks.

What are the new devices for managing type 2 diabetes?

People with type 2 diabetes used to have to check their blood sugar multiple times a day, which can be a huge hassle for many patients. Now, continuous glucose monitors let patients know whenever their blood sugar gets out of control. These devices work through little sensors implanted in the skin. The sensors send information about current blood sugar levels to a wireless device that the patient wears like a beeper. This allows patients to get updates on their blood sugar every few minutes.

Insulin pumps have also become much more advanced, making it simpler for patients to inject insulin. The new pumps give smaller and more accurate doses. These more precise doses mean that patients can avoid being overloaded with insulin. Too much insulin can make blood sugar dangerously low.

At this moment, researchers are working on ways to make insulin pumps fully automated. In other words, they are trying to make an artificial pancreas - the organ that produces insulin. An artificial pancreas would work much like a healthy pancreas, which detects changes in blood sugar levels and responds by making the right amount of insulin. This process would be created with a blood sugar monitor that automatically triggers a pump to give an insulin dose.

What do we know about diet and exercise for type 2 diabetes?

Obesity is the main cause of type 2 diabetes around the world. A healthy diet and regular exercise are crucial to controlling weight and preventing diabetes.

"Obesity rates are rising," says Dr. Reitman. The increase in obesity is contributing to the increase in type 2 diabetes. Dr. Reitman explains that obesity and diabetes are on the rise for reasons that are more easily explained (too much computer time, too little exercising, too much unhealthy foods, etc.) and because of things we do not understand as well (the roles of fat and cholesterol in diet).

"There are many contributors to the rising rates of both obesity and diabetes, and that can make it hard to understand," he says.

Nonetheless, research from the last decade has shown that lifestyle changes are a major part of fighting diabetes. People who eat healthy and get regular exercise have better results than those who sit around eating poor diets.


It is a popular misconception that there is an official "diabetes diet." Really, your diabetes diet is a mix of healthy carbohydrates, fiber-rich foods, heart-healthy fish, and "good" fats. Such a diet includes:

  • vegetables
  • whole grains
  • fruits
  • non-fat dairy products
  • beans
  • lean meats
  • poultry
  • fish

Physical activity is good for everybody, especially people with type 2 diabetes. Diabetes patients should talk to their doctor before starting an exercise program. Once the doctor gives the OK, patients can choose from a variety of enjoyable activities such as walking, swimming, or biking. It is recommended to get about 30 minutes of aerobic exercise most days of the week.

Diabetes patients also need to remember that exercise can lower their blood sugar. It is important to keep on eye on blood sugar levels before and after exercise. It may even be necessary to eat a snack before exercising to make sure blood sugar does not get too low.

Patients who make these lifestyle choices are more likely to be better off than those who continue to be inactive and eating unhealthy foods. The hard part, says Dr. Reitman, is to get patients to make these choices.

What's next?

Researchers are working hard to find better ways to diagnose and treat type 2 diabetes. One of the next big avenues for diabetes research is in the field of genetics.

Studies have shown links between genetic variations and higher likelihoods of obesity or diabetes. However, there is no one gene that is a "smoking gun," says Dr. Reitman. Researchers are going to find a lot of genes that play a role in the development of diabetes and obesity. It may take a long time before any genetic discoveries are translated into treatments that will benefit patients with type 2 diabetes.