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What?! Another New Medication for Diabetes?

by Dr. Sharon Orrange on March 14, 2014 at 7:44 am

With 25 million Americans with adult-onset diabetes I guess it’s great we have so many new medications coming down the pipeline. As a primary care doctor, even my head is spinning learning the details of the newest diabetes medications but it’s exciting . . . and here is another one.

Remember, all guidelines agree that for most folks metformin is the first line diabetes medication, and it’s cheap and easy. Newer medications are auditioning for second place.

The FDA has recently approved a once a day pill that is indicated as a first line treatment after diet and exercise have failed to control your sugars. Farxiga (dapagliflozin), a once-daily oral treatment has been approved to control sugars in adults with type 2 diabetes mellitus.

Farxiga is a 5 mg pill taken in the morning, with or without food. Farxiga is one of the newest diabetes medications in a class called sodium-glucose cotransporter 2 (SGLT2) inhibitors, which remove glucose via the kidneys. That’s cool right—remove glucose by way of the kidneys, that’s new. You see, Farxiga inhibits a sodium-glucose transporter (SGLT2) that is responsible for the resorption of the majority of glucose in your kidneys. By inhibiting this transporter, you increase the amount of glucose that is lost in your urine. That’s a good thing.

Similar to some of the other new diabetes meds, not only did Farxiga help improve blood sugar control but it offered additional benefits of weight and blood pressure reductions.

What’s the downside? Farxiga will be expensive, because it’s a new brand name medication. Farxiga has been studied on more than 11,000 adults with type 2 diabetes. Low blood pressure was seen in some patients with kidney disease, so before starting folks on this medication a blood pressure check is a good thing. Elderly people and those with kidney disease also showed a low risk of a bump in their creatinine so it’s recommended kidney function be checked (a blood test for BUN and creatinine) prior to initiation of Farxiga and monitored periodically thereafter.

When Farxiga was studied as a second medication added to metformin, significant reductions in HbA1c (blood sugar levels) were seen, as well as weight loss. As mentioned above, lower blood pressure was another good “side effect” seen in those taking Farxiga; this would be good for those with high blood pressure. As with metformin and the other newer diabetes medications, no major episodes of low blood sugar (hypoglycemia) were seen which is awesome news.

Take home message: Farxiga is indicated as an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus.

Dr O.

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