If or how should the new diabetic drug be incorporated for Diabetes II

I was diagnosed 28 years ago. You might ask your doc about just increasing the metformin and glipizide.
After using only diet and exercise the first 23 years, I was taking twice those amounts (up to max dosage) in addition to daily exercise a few years ago before starting on insulin 3 years ago.

@grrranny

Thanks for the info. I noticed that the newer drugs also protect the kidney and heart, in fact AARP pointed out that some have even reversed kidney damage while also treating diabetes.
My doctor dropped my metformin dose from 2000 mg because the recommendations are for lower doses in the senior population.

Thanks again,
SD

I'm not really informed on the drug tradeoffs, but trading the glipizide for a newer GLP-1 would seem likely.

So instead of that, what kind of dietary guidelines have you been following, both for the diabetes itself and for the related kidney disease? Perhaps there are some improvements possible there, too.

And for that matter exercise guidelines - which are no doubt more difficult due to the kidney disease.

Regarding diet and exercise - within reason I follow guidelines to both. May even be excessive on the exercise side.

I am trying to learn if and what drug are currently recommended verses those recommended in 2000. There have been many new drugs some of which show promise to not only slow progression but to stop and even reverse these diseases.

Mayo Clinic says: "This medicine is not recommended in patients 80 years of age and older who have kidney problems."

Thanks for the feedback.

You hit the nail on the head. There has not been a wide variety of drugs that have been developed or approved in the last 20 years with the exception of GLP-1s. This just comes down simply to the fact of how the US FDA is structured.

The average cost to get a drug approved in the United States is ~$2.3B USD and takes anywhere from 15-20 years to get the average drug approved. This means that the only companies and institutions can push research towards ultimate US FDA approval are existing and established pharmaceutical companies.

As a great example, in 2014 Salk Institute had established that FGF-1 may be able to treat Type-2 Diabetes in animal models. That research was repeated year-after-year by Howard Hughes, Yale University, and a variety of other fantastic institutions, but it has not even scratched at getting through to the US FDA. The only research that has moved along that front has been a Nevada-based biotechnology company, Zhittya Genesis Medicine, which has progressed that research into human-studies where it has shown fantastic results (according to company press-releases) in ~50 patients thusfar.

However, that being said, that company, and hundreds of companies based in the United States have to go through an incredibly arduous process to simply get to market. At $2B and 20 years to get a drug approved, that means that the average company has to spend $100M per year just to pass regulatory barriers, or roughly $333,000 per day, $40k per hour every hour for 20 years.

That is why treatment options feel stagnant. However, that being said, there is promising research out there!

Lots of new drug classes to discuss with your doctor:
SGLT2 - allows glucose to pass into urine (inhibits glucose recovery by kidney) Jardiance, Farxiga, etc. UTI risk with glucose (bacteria food) in urine
DPP4 - keeps natural GLP1 in blood longer; no effect combined with GLP1 Januvia, Tradjenta, etc. less effective but less side effects than GLP1 shots. 2ed Gen GLP1 (Ozempic) GLP1/GIP (Mounjaro); very effective, gastric side effects; not usually taken with sulforylureas (glipizide, etc.) or insulin due to risk of hypoglycemia. 1st gen also introduced in last 20 years but not seeing many new users (Liraglutide generic, but daily shot; Trulicity still brand less effective than Mounjaro).

@sad43 welcome to Mayo Clinic Connect. Your question makes a lot of sense. When you’ve been taking the same dose of the same med for a long time it is only natural to wonder if there’s something better. My personal opinion is that sometimes our bodies react like “Oh, this again, same old same old…..” and need to be shaken up a bit.
That said, we members here shouldn’t attempt to diagnose or prescribe but folks here have made some good suggestions that you can ask your provider about. Could you ask at your next follow up if there are any new medications that would be helpful in treating type 2 diabetes and chronic kidney disease (CKD)?

I agree with what Cheryl (volunteer monitor/mentor) has said. I have type 2 diabetes, diagnosed 27 years ago. I started out taking the Metformin and Glipizide, a statin and ace inhibitor, along with diet and exercise. Over the years, my diabetes got worse for a variety of reasons. As far as meds go, I now take 1000 mgs Metformin 2x, 14 mgs Rybelsus, 25 mgs Glyxambi, Novolog insulin 3x on sliding scale before each meal, and Toujeo insulin 36 unit before bed. I first used a FreeStyle Libre CGM, but switched to an Eversense 365 implant to monitor my blood sugars. I also take heart medicine and a statin. My last A1c was 6.0.

I mention all this to make this point, all of my diabetes treatments have come as a result of having a great rapore with my endocrinologist. Of doing my own research, and discussing my findings with my doctor, and asking questions. Together, we come up with a treatment plan based on a scientific approach to the disease. This has been a long journey for me, with ups and downs, with overcoming the guilt and the "blues". I have seen family members pass away from the results of this disease. And I have had to fight with insurance as well.

I mention all this because communication with your doctor, self-research, asking questions, and joining with groups and community like here at this Mayo Clinic support group, and sharing experiences can be of great benefit. But, there are no easy fixes. It takes work.

I know everything I have mentioned here is not new, but I think it is important to remind ourselves continuously we can fight this disease and we are not alone. There are millions of us after all.

Thanks for the useful info.

Thanks,

I've asked my PCP on a number of occasions and always get the same answer: you are on the best treatment regimen, which is precisely why I came to this site. So, thanks again.