Diabetes | Mount Sinai Today

What Do I Need to Know About New Diabetes Medications?

Updated on Jun 14, 2023 | Diabetes, Your Health

Diabetes affects nearly 11 percent of the U.S. population. For people living with diabetes, they may be prescribed medication to help them manage their condition.

Reshmi Srinath, MD, Associate Professor of Medicine (Endocrinology, Diabetes, and Bone Disease) at the Icahn School of Medicine at Mount Sinai and Director of the Mount Sinai Weight and Metabolism Management Program, discusses medications that are available for type 2 diabetes and what you need to know.

There are many different types of medications for type 2 diabetes, including pills and injections. What are the most common treatments, and what are the pros and cons?

There are numerous medications; however, our mainstay starting drug is metformin, a medication that works to relax the pancreas, which produces insulin and make the body more sensitive to insulin. It also reduces liver glucose production and lowers appetite. We start metformin for any patient who has prediabetes or type 2 diabetes that is uncontrolled. It also lowers inflammation and reduces cancer risk.

Newer diabetes medications work on the gut. These are daily or weekly injections that target a hormone that comes from your small intestine called glucagon-like peptide (GLP). These medications help the pancreas control blood sugar and produce insulin. They also have a significant benefit for weight loss as they slow the way food travels through your gut, which leads you to get full quicker and eat less, which helps control your glucose levels.

There is also another class of medications called SGLT2 inhibitors—pills that relax the kidneys and help them filter sugar. They also can help you improve your blood pressure and regulate your weight. Numerous studies have shown benefits from these medications in reducing the risk of heart disease and heart failure and reducing stroke risk. Lastly, there is insulin, our most potent medication that helps regulate blood sugar.

How well do these medications work?

Most medications on the market are quite effective. They help to lower your blood sugar and a marker called hemoglobin A1C, a diabetes risk marker where values over 6.5 percent correlate with type 2 diabetes. Values between 5.7 and 6.4 percent correlate with prediabetes, which is very important for our patients to know. We know that a majority of these medications do help to lower hemoglobin A1C, at least 1 to 2 percent.

What are some of the more significant side effects?

Injectables that work on GLP1 affect the gastrointestinal system, and the most common side effects include bloating, flatulence, and constipation. They also can activate gastric reflux, and potentially worsen constipation. The SGLT2 inhibitors work on the kidney. People on these describe feeling more thirsty, and that they are peeing more. Occasionally, patients may develop urinary tract or yeast infections.

Metformin is well tolerated. People do describe some gastrointestinal side effects in terms of some stomach upset bloating and nausea, but usually that goes away within the first week. The main risk with insulin is making sure patients aren’t developing low blood sugar due to too much insulin being administered.

Why is it important to take medications for type 2 diabetes?

It is very important you take medications. We know that diabetes is tightly linked to the risk of heart disease and stroke, which can be associated with greater mortality and morbidity. We know that diabetes, when uncontrolled, can lead to complications, including vision problems and potentially blindness. Diabetes can also lead to worsening kidney function and potentially kidney failure.

Diabetes itself can lead to symptoms of numbness, tingling in the hands and feet, which can eventually lead to a condition called neuropathy, where patients can actually lose sensation in their extremities, particularly the feet, which can lead to risk of injury, foot ulcers, and potential amputation. These are complications we want to avoid. I think the first step is really being vigilant and taking preventative measures, including taking your medications, being closely monitored by your physician, and monitoring your blood sugar.

Medications to treat type 2 diabetes have been in the news. What are they, and how do they work?

A lot of these medications have been in the news recently because they both help to manage type 2 diabetes and weight, which is a risk factor for type 2 diabetes. By helping patients lose weight, we can prevent them from developing type 2 diabetes. For example, you may have heard of drugs like Ozempic® and Mounjaro™, these are injectables that both work to help control diabetes but also have significant weight loss benefits.

We now have FDA approved versions of these, which are indicated for weight loss. Ozempic® has now what we consider a companion called Wegovy®, both known as semaglutide. These are both medications that work similarly. They’re the same drug, but Wegovy is approved for weight loss, and Ozempic® is approved for type 2 diabetes. Similarly, Mounjaro™, which is one of the newest drugs for type 2 diabetes, is being tested for obesity, and will likely get FDA approval for obesity.

In general, who are the most appropriate candidates for these drugs?

This is really a conversation to have with your primary care doctor or endocrinologist. As I mentioned earlier, obesity and weight gain are risk factors for type 2 diabetes. It’s important that you keep an eye on your blood test results and blood sugar.

We typically assess diabetes risk by looking at fasting blood sugar and at hemoglobin A1C, and sometimes patients even do a glucose tolerance test, which is another way of determining if patients have a risk for diabetes. For patients who definitely have diabetes risk, it is important to have a conversation about your weight and whether you might be candidate for some of these medications, which are FDA approved for obesity. Many medications approved for type 2 diabetes are being closely regulated by insurance companies, so it is now getting harder to get these structures purely off label.

Learn more about Your Health.

How You Can Manage Type 2 Diabetes

Mar 24, 2023 | Diabetes, Your Health

More than 37 million people in the United States have diabetes, and 90-95 percent of them have type 2 diabetes, according to the Centers for Disease Control and Prevention. Type 2 diabetes occurs when your cells don’t respond normally to insulin, a hormone created by your pancreas that regulates blood sugar in your body for energy.

While the incidence of type 2 diabetes is rising, you can prevent or delay the disease with active lifestyle changes.

David Lam, MD, Associate Professor of Endocrinology, Diabetes and Bone disease at the Icahn School of Medicine at Mount Sinai, explains what is behind the rising number of people with type 2 diabetes and how we can actively treat and prevent this disease.

Why is type 2 diabetes so prevalent?

Type 2 diabetes has been increasing in prevalence all over the world over the last few decades, and the biggest driver is likely the rising incidence of obesity. Though it is still being studied, the prevailing thought is that obesity leads to a state of inflammation in the body caused by fat cells releasing inflammatory chemicals. When that happens, insulin, a hormone your body produces to regulate blood sugar levels, doesn’t work as well, and your body becomes more resistant to insulin. This is ultimately the pathway that leads to type 2 diabetes.

What is the impact of type 2 diabetes on a person’s life?

Type 2 diabetes can affect you in many ways—the actual disease, the monitoring recommendations that clinicians provide, and even the treatments we prescribe—can all affect your life.

From a disease perspective, symptoms of high or low blood sugar can affect how you feel. Complications that arise from long-term or not-well-controlled diabetes can include neuropathy—a type of nerve damage that can cause numbness or weakness—and kidney or eye disease. Some of the medications we prescribe can have side effects and need to be taken multiple times a day.

What are a few steps the average type 2 diabetes patient can do to remain healthy?

The first step is to receive regular care and follow-ups with your health care team—not just with your clinician, but with a nurse educator, a nutritionist, an ophthalmologist, or any other specialists that’s involved in your health care. This ensures you are on the right track to take steps to improve your overall health. It is also important to take medications as prescribed, and talk with your health care team if there are any issues. The second step is to get regular physical activity. And the final step is to be mindful of carbohydrate intake, such as limiting things like soda, refined grains such as white bread, and many snack foods.

Who is most at risk for developing type 2 diabetes?

You are most at risk for developing type 2 diabetes if you are a person with obesity; have a history of prediabetes, or a history of gestational diabetes; if you have a sedentary lifestyle and/or a family history of diabetes.

How can I support my family members with type 2 diabetes?
Be present and open to hearing what they need and understand what they are going through. Listen to what they say, avoid giving them unsolicited advice, and be sensitive to their needs. For example, if they say, “It’s really hard when I go to parties or family events, and all there is to eat is carbs,” be sensitive to that. Talk to friends and family members about why it’s important to have healthy foods at parties and gatherings. The diet we recommend for patients living with diabetes is a diet everyone can benefit from.

If societal factors are to blame, what can Mount Sinai and other health care organizations do to help reduce the prevalence of the disease?

The first is ensuring individuals have access to health care. It really takes a village to treat someone living with diabetes. You might need dieticians, primary care physicians, endocrinologists, ophthalmologists, pharmacists; it takes a big multidisciplinary team.

We have to make sure patients have access to these specialists, especially those who are at the most at risk. The medications we frequently prescribe can be very expensive. There are programs that can help reduce the cost of the medications, and patients might need the help from us in navigating these programs. Lastly, larger organizations can really help support prevention programs. There are established, research-proven diabetes prevention programs that really focus on weight loss, and they have been shown to help reduce the progression from prediabetes to diabetes. Larger organizations can help support these programs to make an impact on those who are at risk.

Learn more about diabetes care at Mount Sinai

Mount Sinai Gets $2.5 Million NIH Grant to Open New Avenues for Diabetes Treatment

Oct 8, 2020 | Diabetes, Featured, Research

Principal investigator Andrew F. Stewart, MD, Director of the Diabetes Obesity and Metabolism Institute and Irene and Dr. Arthur M. Fishberg Professor of Medicine, right, and Adolfo García-Ocaña, PhD, Professor of Medicine (Endocrinology, Diabetes and Bone Disease).

About 420 million people in the world have Type 1 or Type 2 diabetes, including 30 million in the United States, and all suffer from reduced numbers of beta cells, says Andrew F. Stewart, MD, Director of the Diabetes Obesity and Metabolism Institute and Irene and Dr. Arthur M. Fishberg Professor of Medicine at the Icahn School of Medicine at Mount Sinai. “There are 30 to 40 drugs on the market for diabetes, and none of them make beta cells regenerate,” he says. “Developing such a drug, and a precise way to deliver it, is our aim.”

A project led by Dr. Stewart recently received a $2.5 million, four-year grant from the National Institute of Diabetes Digestive and Kidney Disease, to support Mount Sinai researchers’ innovative efforts to regenerate insulin-producing beta cells that could lead to novel drugs for patients with diabetes.

Dr. Stewart’s team in 2015 identified the first potent human beta cell regenerative drug, harmine, which is in a class of drugs called DYRK1A inhibitors. They identified additional drugs that enhance the regenerative capabilities of harmine—TGF beta inhibitors in 2019, and GLP-1 receptor agonists in 2020. The new grant will support new efforts to develop a means to deliver these drugs precisely.

Robert J. DeVita, PhD, Research Professor of Pharmacological Sciences, and Director of the Medicinal Chemistry Core of the Drug Discovery Institute, and Chalada Suebsuwong, PhD.

“These drugs clearly are effective but also have the potential to cause unwanted effects outside the beta cell, so we now need a way to target the beta cell regenerative drugs to the beta cell,” says Dr. Stewart, principal investigator of the grant. “In lay terms, we have a UPS package to make your beta cells better, but we do not yet know the address to deliver the package.” There are potential strategies for delivering these “packages” by attaching them to a GLP-1 receptor agonist or a monoclonal antibody, each a widely used type of drug.

The current project is a collaboration among Dr. Stewart; Adolfo García-Ocaña, PhD, Professor of Medicine (Endocrinology, Diabetes and Bone Disease); Robert J. DeVita, PhD, Research Professor of Pharmacological Sciences, and Director of the Medicinal Chemistry Core of the Drug Discovery Institute; and Thomas Moran, PhD, Professor of Microbiology, and Director of the Center for Therapeutic Antibody Development.

The research has four aims: First, Dr. DeVita and his team are making TGF beta inhibitors that can be linked to other molecules targeting beta cells. Second, Dr. Moran is focused on making one such molecule, a monoclonal antibody, which can deliver the drugs to beta cells. Third, Dr. Stewart and Dr. DeVita will “conjugate” the drugs with the delivery methods to investigate which combinations work the best. And fourth, Dr. García-Ocaña will test the therapies on human beta cells in mice.

Thomas Moran, PhD, Professor of Microbiology, and Director of the Center for Therapeutic Antibody Development.

“We are excited about these collaborative and translational studies that link basic laboratory research with ultimate goal of treating patients. For the first time, we have a series of new molecules that could be effective for both major forms of diabetes,” Dr. DeVita says. “If successful, a new targeted molecule could be scaled up in the future for further drug development, with the potential to treat millions of people around the world.”

Dr. Stewart is the site principal investigator for another grant for the study of diabetes, obesity, and other metabolic disorders, which was recently renewed by the National Institutes of Health. That five-year, $9.5 million grant was awarded to support the Einstein-Mount Sinai Diabetes Research Center, a regional collaborative led by Jeffrey Pessin, PhD, the Judy R. and Alfred A. Rosenberg Professorial Chair in Diabetes Research at the Albert Einstein College of Medicine and principal investigator on the grant.

The Center was founded in 1976 and has long focused its efforts on minority and other underserved populations in the region. Five years ago, it expanded into a regional collaborative, partnering with Mount Sinai to increase its capacity to support research studies and services. “The idea of these center grants is to have a series of cores that allow us to help people who are doing research, to do it faster, better, and more cost-efficiently,” Dr. Stewart says. For example, at Mount Sinai a core providing expertise in immune technology is led by Dirk Homann, MD, Professor of Medicine (Endocrinology, Diabetes and Bone Disease); and a human islet adenovirus core is led by Dr. García-Ocaña.

“The Center has provided a major boost to basic science and clinical diabetes and obesity research and training efforts at both Mount Sinai, Albert Einstein College of Medicine, and multiple other medical schools in the greater New York region,” Dr. Stewart says. “The Einstein team has been an extraordinary scientific partner.”

I Am Diabetic. Am I At Increased Risk for COVID-19?

Mar 18, 2020 | COVID-19, Diabetes, Your Health

The novel coronavirus known as COVID-19 has upended the world. The entire country of Italy is on lockdown and Americans are being asked to stay indoors as much as possible, only venturing out for essential supplies like food and medicine.

People with compromised immune systems, like older adults and those with chronic medical conditions like diabetes, are particularly vulnerable to COVID-19. While safety precautions are the same as the flu, this virus is a much more serious illness. For people with diabetes, this means taking particular precautions to avoid the virus.

In this Q&A, Maria E. Peña, MD, Director of the Diabetes Alliance at The Mount Sinai Hospital, provides advice for people living with diabetes on how to navigate the world during the COVID-19 pandemic.

Why are people with diabetes more vulnerable to infections and complications of infections?

Diabetics have a compromised immune system which means that fighting viral infections takes longer and is more taxing on the body. Additionally, a report from the International Diabetes Federation found that viral infections cause fluctuations in blood glucose, making diabetes harder to control. And, viruses may thrive in environments of elevated blood glucose.

However, it is important to remember that although diabetics are more likely to experience complications when infected, it is unclear if diabetics are at a greater risk of contracting the virus.

What should people with diabetes do to prepare?

Patients should be sure to have all of their medications refilled as soon as possible, this also includes testing supplies for blood glucose self-monitoring. Additionally, if you are one of the many diabetes patients who has high blood pressure, be sure to have an at home blood pressure monitor.

As more potential cases arise, health care providers will be focused on caring for the sickest patients and office staffing may decrease. Therefore, there may be delays in refills. To avoid this, request that your pharmacy give you a 90-day supply of all medications. Additionally, be sure to have your doctor’s office contact information in case you have questions about your medication, blood sugar, or you are not feeling well.

Apart from making sure medications and medical supplies are on hand, what other precautions should diabetics take?

I recommend that diabetics create an emergency contact list of family members, neighbors, and/or friends who are aware of their medical history and medication list and can drive them to a hospital if necessary.

Additionally, avoid large public gatherings and designate someone to do your essential food shopping. Plan to have enough food and water in case you need to quarantine for several weeks. Hydration is particularly necessary when glucose levels are elevated.

Also, be sure to have soda, juice, and candy available in case your glucose levels drop rapidly. Patients with type 1 diabetes should ensure that they have glucagon kits that are not expired.

COVID-19 is a serious viral infection that appears to be more infectious than the flu and has no vaccine or antiviral to shorten its duration. Diabetics, and other immunocompromised people, should take detailed appropriate precautions to avoid possible infection.

Lecture Offers Insight Into Obesity and Diabetes

Updated on Jun 30, 2022 | Community, Diabetes

Distinguished endocrinologist and researcher Barbara Kahn, MD, the George Minot Professor of Medicine at Harvard Medical School, discussed the link between obesity and type 2 diabetes at the Icahn School of Medicine at Mount Sinai’s 2018 Stanley Mirsky, MD Lecture in November, during Diabetes Awareness Month. Dr. Kahn is a recipient of the Banting Medal—the highest award of the American Diabetes Association for scientific achievement—and a member of the National Academy of Medicine. Mount Sinai’s Division of Endocrinology, Diabetes, and Bone Disease holds the Stanley Mirsky, MD Lecture each year. The series was established with philanthropic support and honors the late Dr. Mirsky, a Mount Sinai faculty member and leader in diabetes treatment and research.

Jennifer Mirsky, daughter of the late Stanley Mirsky, MD, left, with Barbara Kahn, MD.

World Diabetes Day

Nov 20, 2016 | Diabetes, Health Tips, Your Health

The International Diabetes Federation has declared November 14^th to be World Diabetes Day. Diabetes, a chronic disease, is present when the pancreas does not produce enough insulin, leading to elevated blood sugar levels. Without proper management, people with diabetes can face serious health complications, including heart disease, blindness, kidney failure, and amputations. According to the Centers for Disease Control and Prevention, there are 29.1 million people in the United States living with diabetes. (more…)

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