New Medications Available
For Type 2 Diabetes Mellitus the first line of drug therapy recommended around the world is Metformin. However as T2DM is a progressive disease the vast majority will require a second or third oral therapy or one of the newer injectable non insulin therapies before insulin is used. There are several considerations followed when choosing these second or third line therapies. Following the 2018 American Diabetes Association and the European Association for the Study of Diabetes meetings both societies have set out position statements recommending that the patient’s risk of Cardiovascular disease be considered in the choice of second or third line therapies, in recognition of the great increase in risk of Cardiovascular disease in those with T2DM.
Two classes of drugs, DPP-4 inhibitors and SGLT-2 inhibitors, have been released for the management of T2DM in the past few years and Cardiovascular outcome trials have been completed or are in the process of being completed for many of these drugs.Both of these classes of drugs are advised to be used as second or third line therapies after Metformin.
In Australia Jardiance(Empagliflozin) an SGLT-2 inhibitor has been TGA approved for the reduction of cardiovascular disease in T2DM patients with pre existing cardiovascular disease and we await the results of a similar study into Forxiga(Dapagliflozin) with great interest. Most studies into the DPP-4 class or drugs suggest they have no deleterious effect on Cardiovascular disease.
Combinations of SGLT-2 inhibitors and DPP4 inhibitor drugs in one tablet for T2DM are now available in Australia on a PBS Authority prescription including Glyxambi (Empagliflozin(Jardicance) 10mg with Linagliptin(Trajenta) 5mg and Empagliflozin 25mg with Linagliptin 5mg) and Qtern (Saxagliptin(Onglyza) 5mg and Dapagliflozin(Forxiga) 10mg).