Dr. Jill Kruse
Medications used to treat Type 2 diabetes have changed dramatically over the past 20 years. As our understanding of the disease has grown, scientists have learned that Type 2 diabetes is not caused by a single problem in the pancreas. Several organs and hormones play a role. Because of this, there is no single medication that can completely address every aspect of diabetes. This research has led to several new classes of medications, many of which are named for the enzyme, hormone or pathway they target.
While you may not recognize the acronyms, you have likely seen commercials for some of these medications.
Let’s break down the alphabet soup and explain how they work. Although drug names can look like someone grabbed a handful of Scrabble tiles, the ending of a generic drug name often provides a clue about its class. GLP-1 medications generally end in -tide, DPP-4 medications end in -gliptin, and SGLT-2 medications end in -iflozin.
The first GLP-1 receptor agonist, exenatide (Byetta), was introduced in 2005. GLP1 stands for glucagon-like peptide-1. These medications mimic a naturally occurring hormone called an incretin, which helps regulate blood sugar by stimulating the body to release insulin when blood sugar is elevated. They also reduce the amount of sugar released by the liver, slow digestion and increase feelings of fullness. Together, these effects can improve blood sugar control and may lead to weight loss. Other medications in this group include semaglutide (Ozempic and Wegovy), liraglutide (Victoza) and dulaglutide (Trulicity). Tirzepatide (Mounjaro and Zepbound) works on both GLP-1 and GIP pathways.
DPP-4 inhibitors were introduced in 2006, with sitagliptin (Januvia) as the first medication in the class. DPP-4 stands for dipeptidyl peptidase-4, an enzyme that breaks down incretin hormones in the body.
By blocking this enzyme, these medications allow incretins to remain active longer.
This helps increase insulin release and lower blood sugar.
Other medications in this class include saxagliptin (Onglyza) and linagliptin (Tradjenta).
SGLT-2 inhibitors arrived in 2013, beginning with canagliflozin (Invokana). These medications lower blood sugar by helping the kidneys remove extra glucose through the urine. Because some calories are lost along with that glucose, they can also contribute to modest weight loss. However, they do not cause as much weight loss as the GLP-1s and do not cause weight loss in people without Diabetes. SGLT-2 inhibitors have also been shown to provide benefits for some people with diabetes, including reducing the risk of hospitalization for heart failure and slowing the progression of chronic kidney disease.
While all these acronyms may seem like alphabet soup, each represents a different approach to treating diabetes.
Finding the medication that is right for you takes more than choosing the commercial you like best. Talk with your health care provider about your current medications, health conditions and treatment goals. Together, you can determine whether a -tide, -gliptin or -iflozin medication is right for you. Remember, there’s more to staying healthy than knowing your ABCs—or your GLP-1s, DPP-4s and SGLT-2s. You do not need a prescription to stay active and eat a healthy diet, which will also help you stay healthy out there, people!
Dr. Jill Kruse is a hospitalist at the Brookings Health System and owner of Flight Time Medical in Brookings, SD. She serves as a volunteer host for the Prairie Doc team, which is currently celebrating its 25th season of providing health education based on science and built on trust. Follow us on Facebook, Instagram, YouTube, and TikTok to stay connected. Our programming includes the medical Q&A show On Call with the Prairie Doc (most Thursdays at 7pm on YouTube, and Facebook), along with two podcasts and a weekly radio program (Sundays at 6am and 1pm on SDPB).