The quest for effective treatments to treat type 2 diabetes has taken a turn with new drugs in the spotlight. In response, the American College of Physicians (ACP) recently released an updated clinical guideline for newer diabetes medications.
Newer medications gaining the most attention include glucagon-like peptide-1 agonists (GLP-1a) and sodium–glucose cotransporter-2 inhibitors (SGLT2i). While these breakout drugs show promising results to improve health outcomes beyond controlling blood sugar levels, their higher prices raise questions about overarching value. At issue: Are these pricey drugs worth the cost?
In response, the ACP conducted a systematic review and evaluated the cost-effectiveness of these newer medications. An important trigger for this review is that there are currently no generic formulations for GLP-1s and SGLT-2. This means no cost relief.
Here are several key takeaways from the ACP review that could affect how to approach diabetes management, particularly for our senior population:
1. GLP1a and SGLT2i are considered low-value options as first-line treatments compared to the tried-and-true metformin. However, when added to existing therapies like metformin and lifestyle modifications, they may offer intermediate value, potentially improving outcomes while keeping costs reasonable.
2. Insulin analogues, often prescribed for seniors with more advanced diabetes, may be similarly effective but more expensive than the traditional NPH insulin. This finding underscores the importance of weighing the benefits against the financial burden, especially for those on fixed incomes.
3. The value of the glucose-dependent insulinotropic peptide agonist (GIP/GLP1a) remains uncertain. Therefore, the guideline calls for further research to determine its place in the treatment arsenal.
While the new guideline highlights the potential benefits of newer medications, it also emphasizes the need for careful consideration of patient preferences, effectiveness and cost implications. This is especially true for older adults who may be facing additional financial and health challenges.
