In my last article on the newest generation of diabetes pills (the DPP-4 inhibitors), I basically said that their benefits were not impressive and the costs were too high. I stand by those comments, but I need to add some clarifying thoughts. I continue to use drugs like Januvia, Onglyza and Trajenta because certain individuals seem to get a better effect from them than I generally expect. If, for instance, a diabetic is on maximum dose of the older (and cheaper) diabetic medications and the glucose control is not good, instead of going directly to insulin as the next step, I will try the DPP-4 inhibitors (gliptins). If the glycohemoglobin A1c level drops by a percentage point (e.g from 9% to 8%) I will continue the new drug therapy. If the change is minor (less than a percentage point) then there is little reason to continue spending my patients’ money on a therapy which has failed. In these cases, insulin needs to be started. The nice thing about insulin treatment is that it almost always results in a swift and dramatic improvement in blood sugar. Few of my patients willingly accept insulin at the beginning and are glad they were given one more chance to stay on pill therapy, even if it is just a temporary reprieve.
These comments are for educational purposes only and do not constitute medical advice.
Editor in Chief, Metabolism.com