New drugs for type 2 diabetes which don’t cause weight gain

A systematic review of the clinical and cost-effectiveness of newer drugs for type 2 diabetes has shown two groups which don’t cause weight gain are effective.

The study published by the National Institute for Health Research Health Technology Assessment (NIHR HTA) programme was commissioned on behalf of the NICE short guideline development group, to inform a review of the 2008 NICE Clinical Guidelines on type 2 diabetes mellitus (CG 87).

Diet and exercise are the best approach to controlling type 2 diabetes. As the disease progresses, oral medication can help to control blood sugar but about a third of patients eventually need insulin. Unfortunately, insulin may itself cause weight gain.

Several new classes of drugs for diabetes have been introduced in recent years. Professor Norman Waugh of the University of Aberdeen led a review examining the existing evidence on the clinical and cost-effectiveness of two new classes of drugs for diabetes:

  • The Glucagon-like Protein-1 (GLP-1) agonists (exenatide) which mimic the action of GLP-1 and enhance the secretion of insulin
  • The dipeptidyl peptidase 4 (DPP-4) inhibitors (sitagliptin and vildagliptin) which inactivate the enzyme DPP-4, responsible for breakdown of naturally occurring GLP-1

The study found that both the DPP-4 inhibitors and the GLP-1 agonists are clinically effective and are useful additions to diabetes drug treatment options. Most other drugs for type 2 diabetes make people put on weight, but the new ones are either weight-neutral (DPP-4 inhibitors ) or lead to some weight loss (the GLP-1s). The GLP-1s are injected and are more expensive than the DPP-4 inhibitors, which are oral. The researchers found that in people whose diabetes was not controlled by dual therapy, there was a place for treatment with gliptins and the GLP-1 agonists before starting insulin.

The review also examined the effectiveness of newer long-acting insulins. It concluded that in people with type 2 diabetes who need insulin, the insulin of first choice should be the original neutral protamine hagedorn insulin. The newer insulins, glargine and detemir, are marginally better but are more expensive.

Professor Norman Waugh commented: “The main research need is on how to motivate people with type 2 diabetes to lose weight, since that would reduce the need for them to have to take so many drugs to control their diabetes.”

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