The pharmaceutical industry seems to always be booming with new medications to treat numerous health conditions, such as autoimmune diseases, diabetes, and weight loss aids.
Diabetes is increasing in prevalence, which only drives the demand for treatment options.
In this article, we’ll review some of the newer diabetes drugs that have hit the market and explain how they all work.
New medications for type 2 diabetes
Within the last decade, the FDA has approved several new medications for the treatment of type 2 diabetes.
While some of the newer medications are oral (in pill form), many of them are injectable.
Some of the newer medications only need to be injected once weekly, which is a convenience in comparison to daily dosing.
While new treatment options for diabetes can be exciting and effective, they come with some potential drawbacks.
First, some of these medications have only been on the market for a short time, meaning we don’t have any ultra-long-term data on their safety.
However, all medications approved by the FDA for use in humans have to have undergone clinical trials to ensure safety.
Typically the entire process to approve a new medication takes around ten years, so most major risks have been identified.
Secondly, the newer the medication, the less likely a generic version exists. You can expect to pay more for newer medications unless your healthcare insurance or prescription drug coverage plan covers the medication.
Ozempic (injectable semaglutide)
Medication class: GLP-1 receptor agonist
Initial United States FDA approval: 2017
Dosing range: 0.25 milligrams once weekly for four weeks, then 0.5 milligrams weekly for at least four weeks. If blood sugar targets aren’t met with 0.5 milligrams weekly, the dose can gradually be increased to a maximum of 2 milligrams weekly.
Common side effects of ozempic:
- Gastrointestinal symptoms like upset stomach (nausea and vomiting), stomach pain, loss of appetite, heartburn, burping, gas, and bloating
- Diarrhea or constipation
- Headache
- Dizziness
- Tiredness (fatigue)
- Injection site pain
Rare potential side effects:
- Thyroid cancer (tumors)
- Pancreatitis
- Kidney problems due to possible dehydration from vomiting and/or diarrhea
- Gallbladder problems
How does Ozempic work, and what are some benefits?
Ozempic and other GLP-1 receptor agonists work to lower blood sugar by stimulating insulin release, but only in response to high blood sugar (this means it’s less likely to cause hypoglycemia).
Ozempic also helps slow the release of sugar from your liver while also slowing digestion, which can help promote satiety and result in weight loss.
One of the benefits of Ozempic is that it can help you lose weight, which can also improve your insulin sensitivity and lower your blood sugar level.
Rybelsus (oral semaglutide)
Medication class: GLP-1 receptor agonist (oral)
Initial United States FDA approval: 2019
Dosing range: 7 or 14 milligrams per day (3 milligrams used for 30 days to initiate the use of medication). Must be taken on an empty stomach 30 minutes prior to eating or drinking.
Common side effects of rybelsus:
- Nausea
- Diarrhea
- Vomiting
- Stomach pain
- Decreased appetite
- Constipation
Rare potential side effects:
- Thyroid cancer (tumors)
- Pancreatitis
- Kidney problems due to possible dehydration from vomiting and/or diarrhea
- Gallbladder problems
How does Rybelsus work, and what are some benefits?
Rybelsus works in the same way that Ozempic does by promoting insulin release and slowing digestion.
One of the benefits of Rybelsus is that it’s in oral form, which is a good option if you don’t want to use needles for medication injections.
Trulicity (dulaglutide)
Medication class: GLP-1 receptor agonist
Initial United States FDA approval: 2014
Dosing range: 0.75, 1.5, 3, and 4.5 milligrams injected weekly
Common side effects of trulicity:
- Nausea
- Diarrhea
- Vomiting
- Abdominal Pain
- Decreased appetite
- Indigestion
- Fatigue
Potential rare side effects:
- Thyroid cancer (tumors)
- Pancreatitis
- Kidney problems due to possible dehydration from vomiting and/or diarrhea
- Gallbladder problems
How does Trulicity work, and what are some benefits?
Like other GLP-1 receptor agonists, Trulicity promotes insulin secretion, inhibits the release of glucagon (a hormone that raises blood sugar), and slows digestion to boost satiety.
Trulicity is once-weekly dosing, and it can be taken with or without food, which is a convenience over medications that need to be taken on an empty stomach (like Rybelsus).
Trulicity is also FDA-approved to reduce the risk of cardiovascular events like heart attack and stroke.
Jardiance (empagliflozin)
Medication class: SGLT2 inhibitor
Initial United States FDA approval: 2014
Dosing range: 10-milligram or 25 milligrams daily (oral)
More common side effects of jardiance:
- Urinary tract infections (UTIs)
- Dehydration which may cause dizziness, lightheadedness, and weakness
- Yeast infections
- Nausea
- Upper respiratory tract infections
- Increased urination
- Dehydration
- Low blood pressure (more likely if you have kidney disease or are dehydrated)
Rare potential side effects:
- In rare cases, some people taking Jardiance developed necrotizing fasciitis (damaging skin of the perineum) from a bacterial infection
How does Jardiance work, and what are some benefits?
SGLT2 inhibitors work by reducing the amount of glucose removed from your body through your urine.
Jardiance’s primary method of action is to reduce the amount of glucose reabsorbed in your kidneys, which helps to lower your blood sugar level without causing hypoglycemia (low blood sugar).
Some other benefits of Jardiance are that it might promote weight loss and healthy blood pressure levels, which can reduce your risk of cardiovascular disease and events like heart attack and stroke.
Mounjaro (tirzepatide)
Medication class: dual GLP-1 receptor agonist and glucose-dependent insulinotropic polypeptide (GIP)
Initial United States FDA approval: 2022
Dosing range: 2.5 milligrams, 5 milligrams, 7.5 milligrams, 10 milligrams, 12.5 milligrams, or 15 milligrams in a weekly injection
Common side effects of mounjaro:
- Nausea
- Diarrhea
- Decreased appetite
- Vomiting
- Constipation
- Indigestion
- Stomach (abdominal) pain
Potential rare side effects:
- Thyroid carcinomas (tumors)
- Pancreatitis
- Low blood sugar (hypoglycemia)
- Kidney problems
- Severe stomach problems
- Allergic reactions
- Changes in vision (worsening of retinopathy can occur with drastic blood sugar changes)
- Gallbladder problems
How does Mounjaro work, and what are some benefits?
Besides working as a GLP-1 receptor agonist (as mentioned with most of the above drugs), Mounjaro also works by activating glucose-dependent insulinotropic peptide (GIP), a hormone secreted in your small intestine.
GIP stimulates insulin secretion in response to the rise in glucose release when you eat, helping to lower your blood sugar levels. GIP also slows down digestion to boost satiety.
Tirzepatide is the first medication in its class and is among the newest for the treatment of type 2 diabetes.
New medications for type 1 diabetes
The treatment of type 1 diabetes is different from that of type 2 diabetes. Type 1 diabetes is far less common than type 2 and must be treated with insulin due to the destruction of insulin-producing cells in your pancreas.
GLP-1 receptor agonists and other medications that don’t provide insulin aren’t enough to control blood sugar levels if you have type 1.
Traditionally, type 1 diabetes is treated with a combination of long-acting, short- or rapid-acting, and/or intermediate-acting insulins to provide 24-hour coverage.
Premixed insulins containing different types of insulin (e.g., intermediate- and short-acting) are also used.
The newer types of insulin approved for the treatment of type 1 diabetes are ultra-concentrated or long-lasting insulin, setting them apart from the older types of insulin (which are still highly effective for many patients). These medications can also be used to treat type 2 diabetes.
Tresiba (insulin degludec)
US FDA approval: 2015
Insulin type: ultra-long acting/basal
How it’s different from older types of insulin: Unlike Levemir and Lantus (most common long-acting insulins), which have a maximum of a 24-hour action time (less for Levemir), Tresiba can last up to 42 hours per the manufacturer.
Toujeo (insulin glargine U-300)
US FDA approval: 2015
Insulin type: ultra-concentrated long-acting/basal
How it’s different from older types of insulin: Insulin glargine is the active ingredient of Lantus, but Toujeo is unique because it comes in a concentration of 300 units per milliliter. This means that people on high doses of insulin could take smaller doses of Toujeo, which is a benefit.
In addition, Toujeo has a longer shelf life compared to Lantus and lasts up to eight weeks after opening compared to Lantus’ 28-day shelf life after first use.
Lyumjev (insulin lispro-aabc)
US FDA approval: 2020
Insulin type: rapid-acting or fast-acting (bolus/mealtime insulin)
How it’s different from older types of insulin: Lyumjev has the same active ingredient as Humalog but is designed to be absorbed more quickly, which can help reduce post-meal blood sugar spikes. Per the manufacturer, studies showed that Lyumjev was absorbed around 35% faster than Humalog (in people with type 1 diabetes) and nearly 30% faster than Humalog in patients with type 2 diabetes.
Semglee (insulin glargine-yfgn)
US FDA approval: 2020
Insulin type: long-acting/basal
How it’s different from older types of insulin: Semglee is considered biosimilar to Lantus, so it really isn’t different from Lantus (insulin glargine). For instance, you could switch from taking 20 units of Lantus to 20 units of Semglee and expect similar outcomes.
Tzield (teplizumab)
This medication is unique because it isn’t insulin and is the first medication of its kind to be approved, which is an exciting innovation in the realm of type 1 diabetes prevention.
US FDA approval: 2022
Medication type: Per Yale University, teplizumab is “a monoclonal antibody that modifies T cells in a way that prolongs the pancreas’ ability to create insulin.” This means that Tzield may help prolong your pancreas’ ability to produce insulin, a function that is destroyed by your immune system if you have type 1 (autoimmune disease).
How it’s different from other medications for type 1: Tzield is designed to slow the progression of type 1 diabetes, particularly in children and young adults (typical age of onset/diagnosis). Tzielf is an infusion delivered over the course of 14 consecutive days.
What to consider when choosing a diabetes medication
With all of these new medications becoming available to help treat both type 1 and type 2 diabetes, you might be wondering which one is the best fit – or if the older medications like metformin and sulfonylureas are still good enough for you.
Here are some things to consider when choosing a diabetes medication that you should discuss with your healthcare provider.
How long have you had diabetes?
The longer you have diabetes, the more insulin-resistant or insulin deficient you may become. This means that you might eventually need to take insulin even if your diabetes was well-controlled on oral medications for years.
If you’re newly diagnosed with diabetes, your healthcare provider will likely recommend a tried-and-true medication like metformin before trying other medications down the road.
How controlled is your blood sugar?
The higher your hemoglobin A1c is, the more aggressive you may need to get with your medications. For instance, if your A1c has been above 9% for years, it might be time to try insulin.
Is your current diabetes medication regimen effective?
The saying “if it isn’t broken, don’t try to fix it” can apply to your medications. If your blood sugar is well-controlled on older medications, then there’s no reason to try a new medication just because it’s new or novel.
Does your health and/or family history put you at greater risk of severe side effects?
As you can see with the GLP-1 receptor agonists medications, you should avoid taking them if you have a history of thyroid tumors, pancreatitis, or other conditions that might put you at increased risk of developing side effects. The same applies to other medications and potential side effects.
Can you afford it?
If one of the newer medications is going to max out your healthcare budget, perhaps you should consider discussing a different, more cost-effective medication with your healthcare provider.
Conclusion
Most of the newer medications for type 2 diabetes include GLP-1 receptor agonists and SGLT2 inhibitors.
The new medications for type 1 diabetes (most can also be used for type 2 as well) are ultra-long-acting and/or concentrated insulins, rapidly absorbed insulin, and a monoclonal antibody designed to slow the progression of type 1 diabetes.
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