DPP-4 inhibitors
This new class of medicines works by enhancing the body's ability to lower blood sugar when it's too high. It does this by preventing the breakdown of a naturally occurring compound in the body known as an incretin hormone, or GLP-1. Sitagliptin (Januvia) is currently the only DPP-4 inhibitor on the market (another similar drug, Galvus, is currently under Food and Drug Administration review), and it comes with a hefty price tag. Sitagliptin prolongs the activity of proteins in the body that increase the release of insulin after blood sugar rises, such as after a meal. The drug, taken once a day, blocks an enzyme called dipeptidyl peptidase 4 (DPP-4), which breaks down incretin hormones, leading to better blood sugar control.
Potential side effects: This drug may make blood glucose go too low and cause hypoglycemia if taken with a sulfonylurea. It may cause upper respiratory tract infection, stuffy or runny nose and sore throat, headache, and occasionally stomach discomfort and diarrhea.
Concerns specific to older adults: There are two schools of thought on this drug. As a general rule, says Rubin, who was an assistant clinical professor of medicine at University of California Medical Center in San Francisco for 20 years, the elderly is not a group you rush to try the latest drugs on. Since this is a very new drug with little in the way of safety data from clinical research trials available, he says, he doesn't prescribe it much to his senior patients. Earle, on the other hand, says that given the limited number of diabetes drugs that are safe for seniors, she's found Januvia a welcome and beneficial new addition to her repertoire for her older patients.
Combination pills
Sometimes two types of medicines are given together in one pill. Common combinations include glyburide combined with metformin (brand name: Glucovance), glipizide combined with metformin (Metaglip), and rosiglitazone combined with metformin (Avandamet). One benefit of taking a combination pill is there's one less pill to remember to take. A potential downside: There's no control over the dosage of the medications in a combination pill.
A doctor may first prescribe one type of pill. If it doesn't control blood sugar, the physician may recommend taking more of the same medication, adding another pill or insulin to the treatment plan, or changing to a different oral drug or insulin.
