Uncovering the Evolution of Diabetes Management

Diabetes is a chronic condition characterized by high blood glucose levels. It affects more than 38 million people—11.6% of all people in the United States live with diabetes. The evolution of diabetes medication begins in the 1920s with the discovery of insulin by Charles Best and Frederick Banting. Following the discovery, insulin became the standard form of treatment until researchers began studying oral medications in the 1950s and 1960s. Options like tolbutamide and chlorpropamide stimulated the pancreas to produce more insulin. In the latter half of the 20th century, medicines like metformin became a cornerstone in treating type 2 diabetes due to its ability to reduce glucose production by the liver and improve insulin sensitivity.

Modern diabetes care includes using glucagon-like peptide 1 (GLP-1) agonists to manage blood sugar levels. In this blog, we discuss how GLP-1 indications have broadened over the last several years, the class of drugs’ limitations, and the future of pharmaceutical developments within the scope of clinical research.

As we delve deeper into diabetes research, it becomes increasingly evident that the disease has a far-reaching impact on overall health. Linked co-morbidities of diabetes include, but are not limited to, kidney disorders, cardiovascular diseases, and obesity.

The Evolving Role of GLP-1 Agonists: Promising Trends and Broader Indications

GLP-1 agonists have recently gained widespread media attention as a diabetes and weight loss medication. However, GLP-1 medicines are not new to the market. The FDA first approved GLP-1s in 2005 for treating Type 2 diabetes. The drugs mimic hormones in the body that stimulate insulin production. With increased insulin, the body’s blood sugar levels drop.

Since 2005, research studies have explored the broader applications of GLP-1 medicines. In 2014, the FDA approved GLP-1 agonists for weight loss in individuals with a Body Mass Index (BMI) of 30 or above or a BMI of at least 27 with weight-related health conditions. The medicines curb hunger and slow food movement from the stomach to the small intestine.

Beyond their role in glucose control and weight loss, the FDA has approved these medications for obesity and cardiovascular health. Researchers are also exploring their potential benefits for conditions such as MASH, substance abuse, and liver disease.

Guidelines for Effective Pre-Diabetes Management: Insights from the American Academy of Clinical Endocrinology (AACE)

In 2023, the AACE released updated treatment guidelines for Type 2 diabetes. The guidelines act as a resource for healthcare professionals to make decisions on how to manage Type 2 diabetes better, including recommendations for those with pre-diabetes. The algorithm still emphasizes the importance of lifestyle interventions, such as diet and exercise, as the initial steps in managing pre-diabetes.

The most meaningful change in the AACE guidelines is the first agents used for those diagnosed with pre-diabetes. Previous recommendations included medications like metformin or phentermine–topiramate extended-release (PHEN/TPM ER) to combat pre-diabetes, while the newest guidelines suggest medicines like GLP-1 agonists. The change represents the dramatically improved efficacy of GLP-1s over other agents.

Limitations of Current Medications: Need for Improved A1C Target Levels

While medications play a vital role in diabetes and pre-diabetes management, it is essential to recognize their limitations. Current pharmaceutical agents have shown some efficacy in significantly lowering Hemoglobin A1C levels—a key marker of long-term glucose control. However, for patients with high A1C values, clinicians don’t have access to a single agent to reach target levels. Targets for the A1C levels typically need to fall under seven, depending on the patient.

Ongoing research aims to develop more targeted diabetes medications based on patients’ specific health needs. Currently, several agents used to lower A1C target levels also have broader applications. Medications, including sodium-glucose cotransporter 2 (SGLT-2), have FDA approval for heart failure, chronic kidney disease with proteinuria, and diabetes.

The Power of Lifestyle Modifications: A Foundation for Diabetes Management

Alongside medication, lifestyle modifications still matter tremendously for effective diabetes management. By adopting healthy habits, individuals can actively participate in their care. Dietary recommendations for those with pre-diabetes and diabetes include portion-controlled meals eaten at regular intervals throughout the day. Also, regular exercise helps improve insulin sensitivity, lowers blood glucose levels, and supports weight management.

Stress can have a significant impact on blood glucose levels. Managing stress through self-care practices and therapy can reduce stress levels.

The Role of Clinical Research: Opportunities for Advancement

Clinical research plays a vital role in advancing diabetes management. Participating in clinical trials contributes to collecting data on how medications work over time and among different populations. Additional benefits include:

Access to Medications: Bridging the Insurance Gap

One of the lesser-known advantages of participating in clinical trials is access to medications that insurance may not cover. Many insurance companies resist providing coverage on newer treatment options. Policies are more prone to pay for medicines like metformin since the cost per pill is exceptionally low. Metformin has been used to treat diabetes since the 1950s and is still considered a good agent. Patients who want to try treatments outside of the ones approved by their insurance coverage can do so through clinical studies.

Healthcare Opportunities at Clinical Sites

Clinical Research sites provide another option for community members to get care for diabetes and comorbid conditions. Researchers and technicians perform blood tests, EKGs, urinalysis, and more at clinical sites. Patients may contact IMA Clinical Research to look for assistance finding research studies that might prove beneficial for managing their diabetes—especially when insurance denies coverage for examinations and treatments.

Clinicians can work with patients to determine their preferences regarding oral and injectable medications for diabetes management. Patient preference is one consideration when deciding between oral and injectable medications. Additional factors include the individual’s diabetes type, disease severity, and other health conditions.

Reducing Cardiovascular Risk: Longitudinal Studies and the Quest for New Treatments

Longitudinal studies conducted as part of clinical research provide valuable insights into the long-term effects of medications on cardiovascular health. By choosing to take part, individuals may reduce the risk of common heart events associated with diabetes. For instance, clinical trials showed that GLP-1 and SGLT-2 medications allowed for improved outcomes in patients with type 2 diabetes who were at substantial risk for cardiovascular events.

The Future of Diabetes Management: Research and Development in Pharma

Ongoing research and development in pharmaceutical companies and the medical community is driving constant evolution in diabetes management leading to significantly better outcomes for patients. Therefore, it is essential for healthcare professionals and individuals with diabetes to stay informed of research advancements. Developing a comprehensive plan for diabetes management that includes medication, lifestyle modifications and the latest research findings will help promote more effective ways to control glucose levels and target co-morbid conditions.

Contact us to learn more about IMA Clinical Research’s capabilities in diabetes research and related co-morbidities and how you can partner with us to bring new treatments to patients.

References

• Mudaliar, S. (2023, February 21). The evolution of diabetes treatment through the ages: From starvation diets to insulin, incretins, SGLT2-inhibitors and beyond. The Journal Indian Institute of Science, 1–11. https://doi.org/10.1007/s41745-023-00357-w
• Bailey, C. J. (2022). The origins of type 2 diabetes medications. The British Journal of Diabetes, 22(2), December 2022. https://doi.org/10.15277/bjd.2022.388
• Zinman, B., Skyler, J. S., Riddle, M. C., & Ferrannini, E. (2017). Diabetes research and care through the ages. Diabetes Care, 40(10), 1302–1313. https://doi.org/10.2337/dci17-0042
• American Diabetes Association. (2019, January). Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes-2019. Diabetes Care, 42(Suppl 1), S90-S102. https://pubmed.ncbi.nlm.nih.gov/30559235/