Understanding Non-Insulin Injectable Therapies for Diabetes
In recent years, the Food and Drug Administration (FDA) has approved two classes of diabetes medication that are injectable, but not insulin:
- Glucagon-like peptide 1 (GLP-1) receptor agonists
- Amylin analogs
GLP-1 Receptor Agonists
After we eat, our small intestine releases GLP-1, a type of naturally-occurring hormone called an incretin that tells our bodies we’re full. GLP-1 works by slowing the rate at which our stomach empties after eating and by helping the pancreas secrete more insulin; insulin then works with other appetite-regulating hormones to make us feel full. This process lowers blood sugar, suppresses appetite, and causes weight loss.
GLP-1 receptor agonists mimic the activity of GLP-1. Currently, the FDA has approved several types of this class of medication:
- Exenatide (Byetta, Bydureon)
- Albiglutide (Tanzeum)
- Dulaglutide (Trulicity)
- Liraglutide (Victoza)
- Lixisenatide (Adlyxin)
Side effects of GLP-1 receptor agonists include gastrointestinal symptoms like nausea, vomiting and diarrhea. These effects tend to diminish over time. There have been some reports of kidney damage or failure, and there may be an increased risk of acute pancreatitis, but these serious side effects are rare.
Amylin analogs are injectable medicines that resemble a hormone called amylin. After you eat, the pancreas releases amylin, along with insulin, to help control blood sugar levels. People with type 2 diabetes may have lower levels of amylin in their bodies. Amylin analogs help to mimic the behavior of amylin: They lower blood sugar, slow the speed at which food empties from the stomach, and suppress appetite.
The FDA has only approved one amylin analog, pramlintide (Symlin), to treat diabetes.
Side effects of amylin analogs include nausea, vomiting, headache and low blood sugar.
Because these recently approved therapies are so new, we don’t have long-term data about them. According to the American Diabetes Association (ADA) guidelines, there’s a clear preference to stick with the tried and true treatments, like metformin, insulin, and sometimes sulfonylureas. The guidelines don’t yet have a place for these newer non-insulin therapies because it’s difficult for the ADA to adopt, encourage, and highly recommend treatments that have no long-term data on safety.
However, there are some specific patients who could greatly benefit from these non-insulin injections. For those who haven’t had adequate success with other treatments, adding GLP-1 receptor agonists or amylin analogs can sometimes do the trick. While GLP-1 receptor agonists can also be effective treatments for patients who are personally resistant to trying insulin, amylin analogs are only approved for use in patients who are also taking insulin. These drugs can cause weight loss, so they may benefit patients who need to lose weight to control their diabetes.
As we continue to research these drugs and learn more about their benefits and risks, perhaps more uses will come into play. For now, as a general physician, I prescribe diet, exercise, and the treatment standards of metformin, insulin, and sulfonylureas to my patients with diabetes.
THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.