In part two of this long look at type 2 diabetes, I hone in on the classes of drugs used to treat it. Let’s take a look and see how well they lower HbA1C, a measurement of hemoglobin that reveals blood glucose levels over the past three months.
To read part one of this series, click here.
Over 95% of diabetes seen in adults is type 2 diabetes. The difference between types 1 and 2 is that something with the former is deficient in insulin, whereas a person with the latter is insulin-resistant (high blood levels of insulin). Insulin resistance is a situation in which the cells of the body, especially fat and muscle cells, are resistant to the effects of insulin. This means there is more trouble removing and using blood glucose. Therefore, greater amounts of insulin are needed to bring about the insulin effects.
What causes insulin resistance? Primarily, it is being overweight or obese. Other causes include: metabolic syndrome; pregnancy;, infection; severe illness; stress; and steroid use. The metabolic syndrome is simply the result of high insulin levels leading to central obesity, cholesterol, and blood pressure abnormalities.
There are various classes of anti-diabetic drugs. Here are a few:
— Sulfonylureas and Meglitinides: Drugs that increase the amount of insulin secreted by the pancreas:
— Biguanides and Thiazolidinediones: Drugs that increase insulin sensitivity.
— Alpha-glucosidase inhibitors (AGIs), Dipeptidyl peptidase-4 (DPP-4) Inhibitors and Glucagon-like peptide (GLP)-1 Analogs: Drugs that reduce the rate of glucose absorption from the gut.
Stay with me for a moment while I get technical. DPP-4 inhibitors and GLP-1 analogs are “incretin mimetics” or acting like “incretins.” These are meal-stimulated gastrointestinal hormones that trigger the pancreas to release insulin. These hormones also slow the absorption rate of various nutrients such as glucose into the blood stream by delaying gastric emptying time. They also inhibit “glucagons,” which are known to raise blood sugar. Glucagon-like peptide (GLP)-1 and gastric inhibitory peptide (GIP) are the most-studied here. Both compounds are rendered inactive by the enzyme DPP-4. DPP-4 inhibitors reduce glucagon and blood glucose levels by increasing GLP-1 and GIP levels, which inhibit glucagon release, increase insulin release, and decrease gastric emptying time, thus reducing blood glucose levels.
Here is what a recent study found about how effective some of these drugs are:
Sulfonylureas: Lower HbA1C an average of 0.79%
Meglitinides: Lower HbA1C an average of 0.79%
Thiazolidinediones: Lower HbA1C an average of one percent
AGIs: Lower HbA1C an average of 0.65%
DPP-4 inhibitors: Lower HbA1C an average of 0.79%
GLP-1 analogs: Lower HbA1C an average of 0.99%
Overall, type 2 diabetes drugs can lower HbA1C by an average of 0.8%. The entire range of their lowering capacity is 0.18 to 1.62%.
Now that we’ve looked at this level of effectiveness, my purpose here is to give readers the most current up-to-date evidence-based review of the most studied and the most promising dietary supplements in diabetes. In the next issue, I will primarily look at whether they can lower HbA1C. That is how we’ll know if certain supplements can work for type 2 diabetes.