- 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.”
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.
“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.”
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.”