What’s the deal with new diabetes drugs? Whenever I give a talk on diabetes medications to say, a group of nursing students, I groan when it comes to the type 2 meds and usually comment, “don’t blink; there will be a new one in ten minutes.” It’s crazy how many classes of drugs, combination of drugs, names of drugs, etc., there are. But keep in mind they all do different things and work in different ways. The more we learn about how the human body and diabetes work, the more types of drugs there will be.
So are they good or bad? Of course, it’s not that easy. Professional opinions are all over the place with respect to new diabetes drugs. Some providers jump on the bandwagon and start prescribing new drugs as soon as they’re out. Others are more hesitant. Sometimes they are skeptical about the effect of the drug, or they want to “wait and see” (some side effects don’t show up right away). I heard a family practice physician say once, “I don’t prescribe any of those new drugs because the old ones work just fine and they’re cheaper.”
Which leads me to the number one problem with new drugs: they’re too expensive. Many health insurance companies don’t pay for new drugs right away. And if a new drug is not covered (on “formulary”), it will be outrageously expensive for the patient. So is the answer to just not use them, or should someone be fighting for better coverage? On the one hand, we need people to use these drugs in order to find out how well they work. But do you want to be the guinea pig? Some people feel the research that is done to get drugs approved by the FDA is sufficient proof that it’s good to go. Others would like a little more to go on.
Sometimes newer drugs really do work better, and groups like the FAA, for example, take forever to approve them. This means that people who want to fly (planes) have to take older, less effective drugs in order to keep their license.
Many providers are still prescribing very old drugs, like sulfonyureas, for example, because they are cheap. Questions have been tossed around for years about how well these diabetes drugs work. But they’re still being used because they are cheap. We know for sure that sulfonyureas cause hypoglycemia, and sometimes excessive hypoglycemia and hypoglycemia that occurs at random times. We also know that people who take these drugs tend to gain weight. These are two great reasons to question whether or not to prescribe them for a patient. Hypoglycemia is dangerous (and annoying), and weight gain defeats every purpose of the person with type 2 diabetes.
New types of insulin have come and gone over the past 90 years. Rapid-acting insulin analogues are amazing and I don’t know where we’d be without them, but pregnant women didn’t use them for years – including me! In fact, I used an analogue after having my first baby and then went back to using Regular insulin during my second pregnancy. I imagine that would be unheard of today.
Thank you to the trailblazers who are willing to try new things. And thank you to the providers who are cautious on account of patient safety. Thank you to those who are working hard to find the next best drug(s).