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Type-2 Diabetes is a condition that is typified by high and uncontrolled blood sugar. It affects nearly 3 million people in the UK.

  • Causes tiredness, dry eyes, and frequent urination
  • More serious complications can result over time
  • Treatable with anti-diabetic medication

Description

Type-2 diabetes is a very common condition in the UK. Of the 3 million people estimated by the NHS to be affected by diabetes as a whole, around 90 percent of these are thought to be type-2 cases. While type-1 and type-2 are similar in that they are both characterized by high blood sugar, there are some differences.

Persons with type-1 will normally produce no insulin at all (or a significantly reduced amount), due to the immune system inhibiting the function of the pancreas. Those with type-2 however, will produce insulin, but not enough to sufficiently keep blood sugar levels in check (peripheral tissue will develop a resistance to the hormone). People with type-1 will also usually discover the condition in their childhood or teenage years; whereas the onset of type-2 diabetes is much more likely to occur in those who are over the age of 40, but it can come about earlier than this.

Certain groups of people are at increased risk of developing type-2 diabetes. Those who have a bad diet, or are overweight, are much more likely to encounter the condition. It is also more prevalent in people of Chinese or South Asian ethnicity, and in persons of Black African or Caribbean origin.

Because the initial symptoms (sight issues caused by dryness in the eyes, increased urinary frequency, and feelings of lethargy or tiredness) are fairly non-specific and not always noticeable, many cases of type-2 diabetes might go undiagnosed for long periods. The complications of the condition, however, can be quite serious.

Uncontrolled blood sugar levels can, over time, impose severe issues, such as heart disease, or liver or kidney damage. For this reason, it is important if you notice the earlier symptoms to have your blood sugar levels checked, as diabetes is a progressive illness and becomes more debilitating when left untreated.

Prevention and limitation of the condition start with making lifestyle changes. Those who are overweight may be advised to adopt a healthier diet and exercise regimen. But for some, these measures alone may not succeed in helping to bring blood sugar down. In such cases, prescription treatment may be issued.

The type of medication you are issued will generally be determined by the severity of the condition, and the extent of difference made by dieting. Metformin and Glucophage are examples of single-agent medicines which contain a biguanide, and thereby work by reducing the amount of sugar in the blood in three ways: by limiting the number of sugars generated by the liver; slowing down the ingestion of sugar through the gut; and increasing the receptiveness of muscular cells to insulin, so that more sugar is extracted from the blood and utilized by the body.


Onglyza contains an agent called saxagliptin, which is a type of drug called a dipeptidyl peptidase-4 inhibitor. Put simply, the enzyme which the drug inhibits is responsible for breaking down insulin-boosting hormones. By preserving the presence of these hormones, the medication helps the pancreas to generate more insulin, which in turn regulates blood sugar.

Those who have found these solutions alone to be less than sufficient may be advised to use a treatment containing a combination of a biguanide and a DPP-4 inhibitor, such as Jentadueto or Komboglyze. Victoza on the other hand is an injected medication. It contains an ingredient called liraglutide, which mimics the action of one of the insulin-boosting hormones described above, thus helping to stimulate insulin production and slow down the passage of food through the gut.

Types of Treatment

Adopting a healthier lifestyle, such as eating better and undertaking light exercise, will usually be the first thing a doctor suggests when treating the condition. However, in those instances where these measures alone do not bring down blood sugar levels sufficiently, prescription treatment may be recommended.

Such medications include biguanides, such as Glucophage and the generic version, Metformin, and DPP-4 inhibitors such as Onglyza. A number of medications contain a combination of these two ingredients (Janumet and Komboglyze) or an amalgam of metformin and thiazolidinedione (Competact). Most of the type-2 diabetes treatments available are tablets, but you can also buy injectable solutions such as Victoza and oral suspension forms of Metformin.

Which product you are prescribed will depend on several factors which your GP will need to take into account.

How do they work?

Mainly by reducing blood sugar levels.

Biguanides like Glucophage work by slowing sugar production by the liver, increasing the receptiveness of muscle cells to insulin (so as to extract more sugar from the blood), and slowing down the rate at which sugar is absorbed through the gut.

DPP-4 inhibitors like saxagliptin, which is the active constituent of Onglyza, prevent the enzymatic reduction of GLP-1 and GIP, which are hormones that boost insulin levels by acting on the pancreas. They also limit the presence of glucagon, a chemical that causes the liver to generate more sugars.

Thiazolidinediones increase the efficiency of insulin by making cells in the body more receptive to it, again, helping to bring blood sugar levels down.

What are the side effects?

The side effects associated with these medications are wide-ranging, particularly when taken in conjunction with other antidiabetics or insulin. Refer to the product pages to find out more.

Can I take them with other medications?

In some cases, the use of anticoagulants or antibiotics may need to be monitored, adjusted, or avoided altogether when using these products. Consult the information for each item for more information.

FAQ

What’s the difference between the medications?

The main difference between them is their content. Some contain a single agent (Glucophage, Metformin, Onglyza, Victoza) while others (Competact, Jentadueto, Eucreas, Janumet, Komboglyze) consist of a combination. Numerous doses are available, and the drug you are prescribed will be determined by the stage of treatment you are at, and your blood sugar levels.

Should I take tablets, oral suspension, or injections?

Again, it depends on the item best suited to your condition at its present stage. Which application method you prefer to use or are more comfortable with may also play a part. Talk to your doctor if you want to find out more about the different options.

Are there different side effects?

Yes, and they are wide-ranging. Refer to the relevant product page to find out more.

Is it right for me?

The medication you use will be determined during a consultation with your GP or specialist clinician. They will discuss medicine options with you, and start a prescription for the most suitable item.

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Tom Perry, M.D., attended Tulane University and graduated Magna Cum Laude with a B.S. degree in Parasitology. He received his M.D. degree in 1983 from the University of Virginia School of Medicine, where he gained extensive research experience, including studies conducted through the National Institutes of Health.