Are you getting the right tablets?

MANY patients with type 2 diabetes can keep it under control with diet and exercise — but if these don’t work, here we look at the medication you’re likely to be offered.

FIRST-LINE TREATMENT

Metformin: This is the most common drug taken for type 2. It reduces the amount of glycogen — or stored sugar — your liver releases into the bloodstream and increases the cells’ sensitivity to insulin.

‘It’s inexpensive and has the lowest risk of side-effects such as weight gain and hypoglycaemia (where bloodsugar falls too low),’ says Professor Anthony Barnett, a leading diabetes researcher based at Birmingham Heartlands Hospital and the University of Birmingham.

There’s also emerging evidence that it helps lower the risk of heart disease, and the damage to small blood vessels that can cause eye problems, he says.

Cons: Metformin causes stomach problems such as diarrhoea in an estimated 10-15 per cent of cases.

SECOND-LINE TREATMENT

Daonil, Diamicron, Amaryl, Actos: These drugs are prescribed to be taken in conjunction with metformin or on their own.

The first three are a type of drug known as sulphonylureas; Actos is a glitazone drug. They work by increasing the amount of insulin your pancreas produces, or increase sensitivity to insulin, respectively. Glitazones also lower blood pressure, increase levels of the healthy HDL form of cholesterol and reduce blood fats.

Specialists say the earlier you are offered a second drug (on top of metformin), the more effectively your diabetes (and any associated complications) can be controlled.

‘We tend to be very cautious in our treatment of diabetes in the UK and GPs often wait too long to put a patient on that second drug,’ says Professor Barnett.

Under NICE guidelines, back-up drugs should be considered when you have a blood-sugar reading of 6.5 using an HbA1c test. Yet research from the University of Leicester in 2013 showed most UK doctors don’t take action until the reading is closer to 9.

‘ In Holland, 70 per cent of patients with diabetes have good glucose control, but in the UK it is only 30-40 per cent, and one reason for that is that we don’t prescribe the second drug early enough,’ says Professor Barnett.

‘The longer we wait, the harder it is for patients to get good control and, ultimately, this increases the risk of complications.’ Cons: These drugs can cause weight gain as they raise insulin levels — and insulin promotes fat storage.

Sulphonylureas have an increased risk of hypoglycaemia. ‘Fifty per cent of people stop taking this type of diabetic medication within a year — in many cases because of these effects,’ says Professor Barnett. ‘Glitazones, particularly, can cause weight gain of anything up to 10kg-12kg in one to two years.’

THIRD-LINE TREATMENT

Byetta jabs: The third line in treatment are newer drugs known as DPP-4 inhibitors and incretin mimetics, which effectively raise insulin levels.

You’d be offered these if your blood sugar is not being properly controlled by metformin and a sulphonylurea or glitazone.

Examples of DPP-4 inhibitors include Januvia and Galvus. Incretin mimetics, which are given as injections, are prescribed under brand names such as Byetta or Bydureon.

A third, even newer, type of tablet SGLT- 2 inhibitors ( eg, dapagliflozin) was launched in 2013 and works on the kidneys to increase the amount of glucose you excrete in the urine.

These can be offered as a second-line treatment to work alongside metformin if other drugs are contraindicated. Or they can be used as a third daily drug alongside metformin and one of the options above.

The advantage of the jabs is they increase people’s sensation of fullness, which helps with weight, says Professor Nicholas Finer, a specialist in diabetes and obesity at University College London and spokesperson for the Society of Endocrinologists. Cons: Because they’re expensive, many GPs won’t/can’t give these drugs early enough for them to have their true benefits say experts.

‘Fifty per cent of people don’t take their diabetes medication properly because of side- effects like weight gain and hypos — yet we have drugs less likely to cause these side- effects that offer a huge advantage, but NICE want us to give older, less expensive drugs,’ says Professor Barnett.

Depending on the drug, sideeffects can include dizziness and pancreatitis.