Are these drugs game changers for diabetes, weight loss, heart or kidney disease - or all three?

Some of the newer medications used to treat diabetes type 2 have also been found to have the added benefit of weight loss. And now, recent studies have also shown additional benefits for cardiovascular and kidney disease.

“Historically, the medications used to treat diabetes type 2, such as Glyburide, Glipizide, and Glucotrol worked well in lowering blood sugar, but they had the potential side effect of weight gain,” said Nathaniel G. Clarke, MD, MS, RD, an endocrinologist with the Hyannis-based Endocrine Center of Cape Cod.

“It was a conundrum because we needed to treat the diabetes and patients were usually already overweight,” he said. “We would put them on the medication to lower their blood sugar but it caused them to gain weight.”

The current generation of medications for the treatment of type 2 diabetes is now “fundamentally different” than it was years ago, he said.

They differ in a couple of ways, according to Dr. Clark:

• There now are medications that not only lower blood sugar but also help with weight loss. This is very important in terms of getting to the etiology of why a person has diabetes type 2 to begin with, which is usually obesity.
• Endocrinologists have come to understand that two major groups of medications that came on the market to treat diabetes also have profound advantages regarding cardiovascular and kidney disease.

GLP1 agonists act as incretin hormones that work by stimulating GLP-1 receptors, to increase insulin secretion and lower blood sugar after a meal. SGLT2 inhibitors are sodium-glucose inhibitors that act on the kidneys to remove more sugar from the bloodstream and into the urine, which lowers the blood sugar, said Dr. Clark.

The new medications include the following, according to Dr. Clark:

• GLP1 antagonists given by injection daily or weekly:
  • Trulicity
  • Mounjaro
  • Ozempic
  • Victoza
  • Rybelsus
• SGLT2 inhibitors
  • Invokana
  • Farxiga
  • Jardiance
  • Steglatro

“Very large studies and very good trials have shown these medications have tremendous cardiovascular benefits in preventing patients’ first heart attack or a subsequent heart attack,” said Dr. Clark. “The question is, are these heart / kidney drugs that have an advantage in treating diabetes or are these diabetes drugs that have an advantage in terms of cardiovascular and kidney benefits?

“In regard to kidney disease, while the GLP1 drugs certainly help with kidney disease, it is the SGLT2 inhibitors that act at the level of the kidney that have shown tremendous benefits in slowing kidney disease and in some cases, helping with fluid overload syndrome such as heart failure.”

Insulin Resistance

The GOLO diet TV ads talk about insulin resistance and how their diet programs help alleviate it. This can be confusing to the consumer because they don’t explain insulin resistance and that it can eventually lead to prediabetes and type 2 diabetes, said Dr. Clark, who explained what this all means.

“The way I explain it is that obesity is one of the major causes of insulin resistance,” said Dr. Clark. “That is why there is such a tight connection between obesity and type 2 diabetes. When you review the Centers for Disease Control & Prevention (CDC) data and the graphs they use to show the percentage of Americans who have diabetes type 2, the trend has shown the percentages getting higher and higher every year. The same holds true for the percentages of Americans with obesity. When you look at the upward curves for type 2 diabetes and obesity, the two curves are almost identical. The major risk for developing diabetes type 2 is obesity. It is unclear to what extent insulin resistance is part of why people develop obesity. If you are obese, you are likely to have insulin resistance and insulin resistance is one of the key features of diabetes type 2.”

Screening for Diabetes Type 2

The symptoms of diabetes type 2 can be subtle or nonexistent, unlike diabetes type 1 which presents clear symptoms of fatigue, weight loss, increased thirst and urination.

“The most noticeable symptom of diabetes type 2 would be fatigue because of high blood sugar and the body using a lot of energy to deal with it,” said Dr. Clark. “We generally find out a person has diabetes type 2 by simply doing routine blood work in primary care. There has been a lot of controversy about whether to screen everyone, but what we have found is that it is more effective to do screening based on the risk factors for type 2 diabetes: family history, being obese / overweight, having another condition that travels with diabetes like hypertension, high cholesterol or being a member of one of the high-risk ethnic groups such as African American, Native American or Hispanic/Latino American.

“The new medications have been a game changer,” said Dr. Clark. “They help patients lose weight while controlling their blood sugar and have documented benefits on the heart and kidneys. Diabetes type 2 is a marathon, not a sprint. It is a lifelong pursuit as no cure has been found.”