Insulin No Longer Plan B for Type 2 Diabetics

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New drugs for ‘adult’ diabetics is also changing care

By Mariah Summers

Treatment methods for Type 2 diabetes are rapidly changing with the development of new drugs and the erosion of the stigma around insulin use.

The disease, also referred to as adult onset diabetes, is usually diagnosed in adulthood and carries a number of misconceptions, the most common being that Type 2 diabetes is the disease of people who don’t take care of themselves.

“A lot of people think it is a disease of self-neglect, and patients may feel self-conscious,” says Dr. Ronald Tamler, assistant professor in the Division of Endocrinology and clinical trials leader of the Diabetes Program at Mt. Sinai School of
Medicine, “but it has a strong familial component.”

According to Dr. Tamler, the stigma of using insulin is born in this misconception that Type 2 diabetes is somewhat of a self-inflicted disease. Still, physicians are trying to break down the stereotypes of using insulin, including that it is a treatment of last resort, as it was once thought to be.

“People are often afraid to use insulin because it makes them think they have failed in their diet,” says Dr. Stuart Weiss, clinical assistant professor in the Department of Medicine and New York University’s Langone Medical Center. “It used to be a treatment of last resort. Now if people don’t use it, that can lead to poor blood sugar control.”

In addition to patients’ reluctance to use insulin, physicians are also unwilling at times to prescribe the drug, due to the time and emotional investment such a prescription requires.

“There is a resistance among physicians to prescribe insulin when it is needed because it takes time and an emotional toll on preparing the patient for insulin use,” Dr. Tamler says. “Insulin can be very good if needed, and there are ways to overcome the stigma on both the part of the physician and the patient.”

Among these solutions, Dr. Tamler listed insulin pens, pumps, superfine needles and pills that can be taken to supplement insulin injections throughout the day.

“One device, insulin pens, can be carried around in a pocket and can be used anywhere,” Dr. Tamler says. “You can use them and no one would know you’re taking insulin.”

As patients progress through the disease, the schedule of administering insulin could become more challenging, but such alternatives to a typical shot can help ease the psychological and physical impact of the treatment.

While the stigma attached to insulin injections continues to crumble, doctors say there are currently new forms of Type 2 diabetes treatments in development.

“The big developments in the industry have not really been in the world of insulin, but rather in the world of oral medications, which are typically given earlier in the course of diabetes,” says Dr. Tamler. “A big push is currently being made in the following category of medications for T2DM: DPP4 inhibitors, like Januvia, and GLP-1 agonists, like Byetta.”

A benefit of these new treatments is that they promote weight loss, making it easier for patients to accept them, even though they are injections.

“These new products not only help the body work to improve insulin, but also help to better control glucose and weight loss,” NYU’s Dr. Weiss says of the new injection treatments. “Most medications contribute to weight gain, and this does not. These products lead to a more significant weight loss and blood sugar does not get too low.”

Other treatment developments for Type 2 diabetes include new oral medications that will be available to patients in the near future. Two of these oral medications are SGT-2 inhibitors and Glucokinase agonists, both of which are not yet on the market.

Even with these forthcoming treatments, physicians warn that diabetes patients must always consider their diet in addition to any medication they are taking.

“Another way to reduce insulin injections is to have a non-carb meal,” Dr. Tamler says. “Determining certain meal choices if possible, with limited carbohydrates, can help with treatment.”

“The bottom line is there is no treatment that can’t be overwhelmed by a bad diet,” Dr. Weiss says. “That is the cornerstone of treatment. The future is going to be based on more people eating properly. All the medications in the world will not beat that. Aside from the social issues, the science is moving ahead.”

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