VIDEO: Medication advancements impacted by diabetes technology innovations

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There are four areas of research in diabetes technology that I think have had great impact and benefit for patients. Those include new drugs, new sensors, new ways of handling information, and new procedures. Regarding drugs, I'm going to mention several new classes that I think are important. The first one is that we're seeing new and better types of insulin. Ideally, you'd like insulin to get into the bloodstream very quickly when it's mealtime to match the food intake. And we're seeing faster and faster insulins coming on to the market, so that in some cases, a person, not only can take their insulin just before they eat, but even right after they eat. The insulin gets in so quickly it can still get in in time to help deal with the food. We're also seeing longer acting insulins. Since around the year 2000 we've had access to insulin that lasts just almost all day, or even a little bit more than all day. About maybe six years ago, there were a couple insulins that came out that would last in the bloodstream for approximately a day and a half. So a person could take a dose every day, and that's pretty long acting. However, I think in the next year or so, we're going to see at least one, maybe more than one, drug come on the market that can last for a week.

And I recently was involved in a study of this drug and our patients did pretty well with it. So instead of having to remember to take a dose every day, it'll be possible to take this drug every week. And because the dose is seven times as high as what we're taking now, the doctors and patients have to get used to these kinds of high doses. For example, if someone is currently using 20 units of basal insulin per day, that's a once-a-day injection, now, every week they'd use 140 units. People aren't used to that kind of dose of insulin but it is safe because it lasts over the entire week. So I think that the short-acting is getting shorter, the long-acting is getting longer, and that's good, gives people more options.

Another kind of drug that we're hearing a lot about in the news is called a GLP-1 receptor agonist or glucagon-like peptide-1 receptor agonist. This type of drug has been shown already to be helpful for type two diabetes. It helps people lose weight. And now this class of drugs is being used by some people who don't have diabetes, just for obesity. And even some people who aren't even going to a doctor are getting a hold of it somehow. But these GLP-1 receptor agonist drugs are safe and they're very effective. Like any drug, there's a potential risk of a few side effects that doctors would tell people about. But for almost everybody, they're very safe. And people have lost a lot of weight using these drugs. They're also quite effective for type two, for many people as a substitute for insulin. So if a person has type two, they're taking pills, the pills aren't strong enough, traditionally, at that point, the doctors have said, "Well, now the only thing we have left is insulin." Insulin works very well, but it is associated in some cases with weight gain or with low blood sugar. The GLP-1 receptor agonists don't cause weight gain, they cause weight loss, that's why they're used for obesity. And they don't cause low blood sugar, except under certain circumstances. There's still always going to be a need for insulin because sometimes the GLP-1 receptor agonists don't work. So insulin is always the last resort. But I predict that in a few years, the GLP-1 receptor agonist will be known as first line drugs. Currently, a person with type two is told to take metformin. If that doesn't work to add a second drug. I think, in a few years they'll be told it's just reasonable to get started with a GLP-1 receptor agonist because they're so effective, they have heart protective activities, and why wait until somebody is doing poorly and starting to get maybe early signs of heart disease on pills, when you can go right to the GLP-1 receptor agonists, which are so effective. The biggest problem with them is that they're expensive. So there's always going to be people who just can't afford them. But I think if people can afford them or if their insurance covers them, or if they're available for whatever reason, they're going to become so popular, because they work and they have minimal side effects, that I think they're going to become a first line drug for type two diabetes.

Another drug that's recently come out for type two diabetes that's very popular now, is a kind of drug called SGLT2 inhibitor. And this is a drug that works on the kidneys, and in effect, gets people to pee out more glucose when the glucose level is high. So if you eat and your blood sugar goes up above a certain point, it sort of skims off the excess. If your blood sugar is normal you don't pee out any more glucose, but if your blood sugar is high, you pee out extra glucose. I also think that eventually, that kind of drug might even become used for type one diabetes. There was a big study of using this drug from a company in Texas, and there were some side effects although people did do well with it, and it did not get approved for type one diabetes. But I think that there's ways of getting around the side effects now, and I think, eventually, we'll see this approved, not only for type two where it's becoming very popular, but even for type one, but that's at least five years off. Now, it turned out in these type two studies, the way the drug works on the kidneys that you pee out glucose, you also pee out fluid. And it seems to work in some ways like a diuretic, like a water pill, even though it's not exactly a water pill. And it's been shown to be helpful for heart patients. Cardiologists have done some studies, and they've shown that if people have heart failure the drug helps them and they have fewer hospitalizations once they're started, and they live longer. So at this point, I would call it a drug that was originally developed for diabetes, but it's also been used now for cardiologists. Some of them don't even care about diabetes, they just care about treating their heart patients. And even if the heart patient doesn't have diabetes, doesn't even matter to these doctors because they're using it to treat heart failure. I think this is a drug that has a lot of potential. There's some risk of side effects that doctors have to know about, but I think that's becoming an effective drug. So those are some drugs I think are hopeful.