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Invokana

The fact that so many people are getting diabetes has one plus side for people who already have it. From the point of view of the pharmaceutical companies, there is money in numbers. It is just the type of disease pharmaceutical companies like: it is chronic and often requires a number of medications to keep it in control. On the positive side, that means that they are willing to spend the years and boatloads of money it takes to develop new drugs to treat it. And they rolled out the first entry in a whole new class of drugs to treat type 2 diabetes just this past March. It is called, Invokana®, and it belongs to a broader class of drugs called sodium-glucose co-transporter 2 (SGLT2) inhibitors.

The diabetes drugs currently on the market fall into two major categories: those that help increase the amount of insulin released from the pancreas, and those that decrease insulin resistance. Invokana® doesn’t do either of these things.

SGLT2 inhibitors work though the kidney. They prevent the reabsorption of glucose in the urine into the blood and also increase excretion of glucose in the urine. By increasing glucose output in the urine, the amount of glucose in the blood is decreased. It may strike you as ironic that Invokana®, and it’s soon-to-be cousin drugs (several others are in the development stages), mimic the picture of poorly controlled diabetes. After all, significant amounts of glucose in the urine indicate that the blood glucose is high and the body isn’t getting the energy it needs. The difference here is that the amount of glucose entering the urine is controlled. As an added benefit, Invokana® has the potential to aid in weight loss. During clinical trials to test Invokana®, participants lost 3.3 percent of their body weight when on the drug for 26 weeks. A1C reduction was 1.1 percent when compared with placebo in clinical trials when used at higher doses. This compares favorably with other oral agents on the market used to treat type 2 diabetes.

No drug is perfect, and Invokana® comes with its share of side effects, notably vaginal yeast infections and urinary tract infections. (Read more about yeast infection and diabetes here: http://health.walgreens.com/expert_blogs/show/755594/Those-Pesky-Yeast-Infections-and-Diabetes.) This makes sense as the drug works by increasing the glucose load in the urine. Since the drug pulls water into the urinary tract to make enough urine to handle the extra glucose molecules, it has the potential to cause dehydration. It may also not be a benefit to your heart. There is evidence that Invokana® can raise “bad” LDL levels and, in clinical trials, there was a small increase in the number of people experiencing either heart attack or stroke within the first 30 days of taking the drug.

Because of these concerns, the FDA is requiring Johnson and Johnson to do further post-marketing clinical trials.
One known warning: Invokana® should not be taken by people with significant kidney disease.

Invokana® is certainly not a panacea, but it does allow people with diabetes another choice in medication. Most people with diabetes will use between two or three oral medications before starting insulin, and Invokana® adds to this list of options.

Live well and enjoy!

Nora
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