5 New Type 2 Diabetes Treatments On the Horizon

Whether you’re newly diagnosed or it has been part of your life for years, everyone’s experience living with Type 2 diabetes is different. Medications don’t make up the entire picture. But the right ones for you are often chosen based on your treatment goals, risk factors, personal preferences, and more.

Today, there are about 60 Type 2 diabetes medications to choose from. And researchers are studying roughly 100 more in clinical trials. What’s more, many are innovating new ways to treat the condition while also providing heart, kidney, and body weight-related benefits. 

Here, we’ll discuss five new Type 2 diabetes treatments that may be available down the road.

1. Sotagliflozin

Jardiance, Farxiga, and Invokana: these popular medications all belong to the same class, known as sodium-glucose co-transporter 2 (SGLT2) inhibitors.

SGLT2 inhibitors are oral medications that work in your kidneys to get rid of excess sugar (glucose) and sodium (salt) through your urine. This effect can help lower your blood glucose levels. And it can provide kidney and heart-related benefits for certain people, too. 

Researchers are studying a new medication called sotagliflozin. It works in a similar way to the SGLT2 inhibitors mentioned above. But what makes it unique is that, in addition to how it works in your kidneys, it also affects glucose absorption in your intestines. This targets sugar coming from your diet, which may help lower your blood glucose after a meal.

Sotagliflozin is the first medication in a class called dual SGLT1/2 inhibitors. It works on SGLT1 proteins in your intestines, and both SGLT1 and SGLT2 proteins in your kidneys. Its side effects are similar to SGLT2 inhibitors, with the addition of diarrhea.

Potential benefits

Sotagliflozin has been shown to help lower hemoglobin A1C (A1C) levels — your average blood sugar levels over 3 months. And it was found to work just as well as a few other diabetes medications, including Jardiance (empagliflozin) and glimepiride (Amaryl). 

If you’re living with both Type 2 diabetes and heart failure, sotagliflozin may have some added benefits. Results from two studies suggest that it can lower the risk of death and worsening heart failure by 22% to 43%. This includes types of heart failure that are difficult to treat.

And if you have chronic kidney disease (CKD), sotagliflozin may lower the risk of death related to heart disease. It may also lower the risk of hospitalization and urgent care visits for heart failure.

Whether sotagliflozin is the right medication for you may depend on your risk factors and medical history. If you have CKD, for example, sotagliflozin could be preferred to also help prevent strokes.

Availability

The FDA is currently reviewing sotagliflozin’s application for approval. A decision is expected in May 2023. For certain people with Type 2 diabetes, sotagliflozin may be approved to help lower the risk of:

• Heart attack

• Stroke

• Death related to heart disease

• Hospitalization and urgent care visits due to heart failure

2. IcoSema

If you’re taking insulin as part of your treatment plan, a daily long-acting insulin is likely part of your regimen. And if you’re not taking one already, your healthcare provider may add a non-insulin injectable medication, like semaglutide (Ozempic), to the mix. 

Semaglutide is a glucagon-like peptide-1 (GLP-1) agonist that’s injected once weekly. It mimics a gut hormone that increases insulin release in response to food, blocks your liver from making glucose, and makes you feel full. If you also have heart disease, semaglutide can help lower your risk of heart attack and stroke. 

Researchers have been studying IcoSema, a new medication that combines insulin and semaglutide into a single injection. This concept isn’t new. But similar combination products need to be injected once daily. And IcoSema is injected once weekly.

IcoSema combines semaglutide with insulin icodec, a new once-weekly insulin that’s also being studied. Insulin icodec binds to specific proteins in your blood, allowing it to last longer in your body compared to other long-acting insulins.

Low blood glucose (hypoglycemia) may be possible with IcoSema. You may also experience side effects like nausea, vomiting, or diarrhea.

Potential benefits

When added to long-acting insulin, semaglutide has been shown to significantly lower A1C and cause weight loss. Combining both of them into a once-weekly injection may give you a more convenient dosing option. In other words, IcoSema could mean fewer injections.

Availability

IcoSema is currently being studied in several different phase 3 clinical trials. The trials are all expected to be completed by early 2024. So, we may see IcoSema available within the next few years.

3. CagriSema

IcoSema isn’t the only semaglutide combination product being studied. CagriSema combines semaglutide and cagrilintide into a once-weekly injection. Cagrilintide is a new long-acting amylin analogue. 

Amylin analogues have several overlapping effects with GLP-1 agonists like semaglutide. This includes making you feel full and decreasing glucose production by your liver. Combining the two may provide additive effects.

Pramlintide (Symlin) is currently the only FDA-approved amylin analogue. But it’s short-acting, so you need to inject it before your main meals every day. Cagrilintide binds to certain proteins in your blood, similar to insulin icodec. This causes it to last longer in the body, allowing for once-weekly dosing with semaglutide.

Potential benefits

In August 2022, CagriSema’s manufacturer announced results from a phase 2 clinical trial. The trial compared the medication to semaglutide or cagrilintide alone in people with Type 2 diabetes and overweight. CagriSema was shown to lower A1C more than either medication by itself. And it resulted in greater weight loss, too.

Availability

Because of these promising phase 2 results, the manufacturer plans to start phase 3 trials in 2023. If everything goes as planned, CagriSema may be available within the next few years.

4. Retatrutide

In early 2022, the FDA approved a new medication called tirzepatide (Mounjaro). Tirzepatide works like semaglutide, but it mimics a second gut hormone for additive effects. In fact, tirzepatide has been found to work better than semaglutide at lowering A1C. And people taking it lost more weight.

Now, tirzepatide’s manufacturer is studying retatrutide (formerly LY3437943). Retatrutide is a once-weekly injection that targets three hormones involved in balancing blood glucose. These include the two hormones targeted by tirzepatide, plus glucagon. 

Glucagon is a hormone made by your pancreas to help balance your blood sugar levels. Retatrutide doesn’t contain glucagon. But it’s thought to mimic some of glucagon’s effects. These include lowering your appetite, helping you burn more calories, and breaking down fat.

Retatritude is the first medication in a class called GIP/GLP-1/glucagon receptor agonists (or GGG triple agonists).

Potential benefits

Retatritude works by mimicking three different gut hormones. And researchers believe this may improve glucose values and result in more weight loss than tirzepatide and GLP-1 agonists. However, results from a phase 2 trial aren’t available yet. And any potential benefits will need to be confirmed in a larger phase 3 trial.

Availability

Retatrutide is currently being studied in a phase 2 clinical trial that’s expected to wrap up in October 2022. Depending on the results, the medication could move forward to phase 3 trials. So, it may be a few years before retatrutide is available.

5. Imeglimin

Almost every cell in your body has mitochondria necessary for energy. But you may be surprised to learn that mitochondria are also thought to play a role in Type 2 diabetes. In particular, they may affect how certain cells respond to insulin and improve glucose levels in your body.

Researchers have been exploring ways to apply this idea to new treatments. One example is an oral medication called imeglimin. Imeglimin is the first of a new class called “glimins.” Glimins are thought to help mitochondria in your pancreas, liver, and muscle cells work better to help control blood sugar levels.

Potential benefits

Imeglimin has been studied in several phase 3 trials in Japan. These include trials studying imeglimin on its own, in combination with other diabetes medications, and with insulin. Imeglimin was shown to significantly lower A1C by itself and provide additional A1C reduction when added to other treatments.

Animal studies have suggested that imeglimin may also have heart and kidney-related benefits. But these effects haven’t been confirmed in people yet.

Availability

In September 2021, imeglimin was launched in Japan under the name “Twymeeg.” Imeglimin’s manufacturer is looking at opportunities to move the medication forward in the U.S. and other countries. Previous discussions with the FDA involved planning phase 3 trials that will study imeglimin’s effects in people with Type 2 diabetes and certain stages of CKD. A timeline for these studies has yet to be announced.

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Written by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Jewels Doskicz, RN, BA

Jewels Doskicz, RN, is an Arizona-based registered nurse with more than 20 years of hospital-wide clinical nursing experience. She has spent over a decade in medical writing and editing, with a focus on diabetes and autoimmune disease.

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