A Guide to New Diabetes Drugs

Published in Hopkins Medicine - Spring/Summer 2021

New medicines for people who have diabetes seem to pop up all the time: drugs that help the body break down carbohydrates, drugs that increase excretion of glucose in the urine, drugs that help muscles respond to insulin and drugs that stimulate the pancreas to produce it … the list of pharmaceutical options to treat diabetes gets longer and longer.

The downside of this wealth of treatment options is that it can be difficult for health care providers to stay on top of the latest research and standards of care.

Johns Hopkins endocrinologist Rita Rastogi Kalyani has authored a clinical practice review article that distills the newest trial results and guidelines into a systematic approach for treating patients with diabetes and a risk of cardiovascular disease. Kalyani’s article, published in the April 1 New England Journal of Medicine, is the first clinical practice review that the journal has published on diabetes management in almost a decade.

People who have type 2 diabetes are more than twice as likely to develop atherosclerotic cardiovascular disease and heart failure than people who don’t have the disease. The NEJM article presents an up-to-date approach for health care providers when choosing among glucose-lowering therapies for their patients with diabetes, particularly to reduce the risk of cardiovascular disease.

“We’ve seen a major shift in diabetes care over the past few years. We now have tools to better understand how to reduce both microvascular and macrovascular complications in people with type 2 diabetes,” says Kalyani, whose article examines the cardiovascular benefits and risks of the most commonly used drugs for diabetes that are currently available on the U.S. market.

Kalyani lists specific agents in two newer drug classes as beneficial for patients with diabetes who already show signs of heart or blood vessel disease.

The NEJM article also details specific drugs that offer additional benefits for patients with diabetes who have conditions such as multiple cardiovascular disease risk factors, heart failure and chronic kidney disease. And it includes comprehensive drug tables that lay out the factors to consider in clinical practice when choosing a glucose-lowering drug for patients with type 2 diabetes, including A1C-lowering efficacy, route and frequency of administration, cost, effects on weight, risk of hypoglycemia, side effects and clinical benefits.

“Health care providers in primary care, endocrinology, cardiology and nephrology are now prescribing these newer glucose-lowering drugs for their patients,” Kalyani says. “Diabetes care will need to be increasingly collaborative in the future and, at its core, remain patient-centered.”