Eleven classes of diabetes drugs

About the same time, yet another class of diabetes drugs became available, meglitinides. The first was replaglinide (AKA Prandin); the second was nateglinide (Starlix). These were short-acting drugs that work very similarly to the sulfonylureas, require dosing several times daily, and never became very popular with the medical community.

Then there was a bit of a break in approval of new classes of diabetes drugs, until early 2005, when pramlintide (Symlin), a synthetic analog of the human hormone amylin, became available. Pramlintide was different: it was an injectible medication for people taking insulin, whether they have T1DM or T2DM. Pramlintide was another non-starter: from my point of view, and apparently from that of many others, why should people taking insulin injections also take another injection of pramlintide to supplement their insulin.

But another injectible medication, this one for T2DM patients, has fared somewhat better in the marketplace. The drug, exenatide (brand name Byetta), a drug called an "incretin mimetic", has a side effect that may explain part of its success: weight loss. It also was approved in 2005.

And a year later, the FDA approved another class of diabetes drugs, the "DPP4-inhibitors." The name of the first was sitagliptin, brand name Januvia. Another, vildagliptin (Galvus) is approved in Europe but not in the US.

Then, in 2008, the FDA approved an older drug for a new reason, for the treatment of T2DM. The drug, colesevelam, has been approved since 2000 for treatment of hyperlipidemia, and now is also approved for use in combination with other diabetes drugs. It is in a class of drugs called bile acid sequestrants.

Most recently, 2009, the FDA approved another old drug for the treatment of T2DM. The drug, bromocryptine (brand name Cycloset), is in a class called dopamine receptor agonists, and as of yet hasn't been marketed for the new indication.

So, depending on how you count (I count insulin and the injectibles as separate classes, and I'm only counting drugs approved in the US for treatment of diabetes), there are now eleven classes of diabetes drugs, and several drugs in most of these classes.

Will there be more classes of diabetes drugs? Yes, inevitably there will be. The next may be the SGLT-2 (sodium-glucose transporter-2) inhibitors; and there are others being studied, including a class called glucokinase (or GK) activators.

Much different from 1995!