potential casues for type 2 diabetes Diabetes is a disease in which blood sugar levels in your body are too high. It can cause serious health problems. Learn about diabetes ...side effects untreated diabetes
Type 2 diabetes is one of the most serious medical conditions affecting the U.S. An estimated 30.3 million people in the U.S., or about 9.4 percent of the population, have diabetes. That’s up from 2.5 percent of the population in 1980.
The disease is still most common among older people, affecting nearly a quarter of those 65 or older. But over the past 20 years, it''t know they have it. And those that do often aren''article-section-title''t experience symptoms. Yet, the damage to organs occurs even in the absence of symptoms. That''s important that you know your blood test results, so you can understand if you are at risk for, or have, diabetes.
Medical experts don''article-section-title''s immune system attacks specific organs, essentially attacking itself. Specifically, aberrant immune cells damage and destroy the part of the pancreas that produces insulin. In the case of type 1 diabetes, the body attacks the insulin-producing cells in the pancreas. Since the insulin producing cells are eventually totally destroyed, people with type 1 diabetes must inject insulin every day.
Type 2 the 1 last update 08 Aug 2020 diabetesType 2 diabetes
In this form of the disease, the pancreas produces enough insulin, at least in the early years. But for reasons that are still not well understood, the body’s cells become resistant or insensitive to it. To compensate, the pancreas pumps out increasing amounts of insulin to normalize blood glucose levels. Over time—as long as a decade—this ever-increasing production becomes unsustainable, and the pancreas’ ability to produce insulin declines.
As a result, the telltale marker of diabetes emerges: Glucose levels rise in the blood because it is unable to enter the body’s cells. The excess glucose damages the body’s tissue and leads to the symptoms and complications of diabetes. When the blood glucose level gets high enough, the sugar begins to appear in the urine and causes increased urination.
Elevated blood sugar puts a strain on many parts of the body. Over years, it is particularly toxic to the body’s blood vessels; it causes small vessels to weaken, for example in the eye and kidney, and larger vessels supplying the heart, brain and extremities to thicken. This leads to long-term complications.
Proper treatment that keeps blood sugar in the normal range, combined with aggressive treatment to keep blood pressure and cholesterol in normal range as well, sharply reduces the risk of complications.
There are many theories and ideas about the causes of type 2 diabetes. Studies show the disease runs in families, meaning it has a strong genetic component.
But the major reason diabetes has increased over the past 30 years is the increased prevalence of excess body weight and obesity, both of which are major factors in the development of insulin resistance. In the US, 85 percent to 90 percent of people with type 2 diabetes are overweight or obese.
In the last decade, doctors and researchers have recognized that a large number of people in the U.S. have fasting blood sugar levels above 100 mg/dL, the upper limit of normal, but less than the 126 mg/dL required for a diagnosis of diabetes. The most recent estimate from the Centers for Disease Control and Prevention indicates that 34 percent of adults 20 and older—84 million people—have blood glucose levels in this range and could be considered to have "pre-diabetes." It’s also sometimes called borderline diabetes or impaired fasting glucose.
What concerns doctors is that a growing body of research now shows that people with pre-diabetes have both a high risk of developing diabetes, and an elevated risk of heart disease and stroke even if their fasting glucose level never rises above 126 mg/dL.
In an analysis involving 10,428 people in Australia, for example, those with pre-diabetes were found to have 2.5 times the risk of for 1 last update 08 Aug 2020 dying from heart disease over a 5-year period compared to people whose blood sugar was normal.In an analysis involving 10,428 people in Australia, for example, those with pre-diabetes were found to have 2.5 times the risk of dying from heart disease over a 5-year period compared to people whose blood sugar was normal.
Such findings are leading some doctors to identify and treat people with pre-diabetes. But most doctors agree, and research backs it up, that dietary and lifestyle changes, with the main goal of losing weight, can be very effective for keeping pre-diabetes under control, and before any medication needs to be prescribed.
Lifestyle modifications have also become a mainstay of treatment for people with diabetes. Studies consistently show that lifestyle changes alone—especially weight loss in those who are overweight or obese—can prevent the complications of diabetes. For some people, these changes can eliminate or reduce the need for drugs.
Since many people with diabetes also have high blood pressure and/or high cholesterol, your doctor will aim to get those under control, too, using diet and lifestyle changes, and medicines if necessary.
This report focuses on eight classes of diabetes medicines often used as first or second line treatment for adults with type 2 diabetes. Like all drugs, the names of the drug groups and the names of the individual medicines in those groups are not easy to pronounce or remember. We do our best to keep things simple but can’t avoid using these complex names.
Good to know: We do not evaluate insulin by itself since it''article-section-title''article-section-title''s important to discuss any side effects you experience with your doctor.
Since many people with diabetes are trying to lose weight, the weight gain that can occur with some diabetes medicines can be especially frustrating.
The box below gives an overview of side effects associated with various diabetes drugs. The potential side effects of each drug are discussed at length in the next section.
Side Effects of Oral Diabetes Drugs
|Most of the side effects listed here ease over time or stop when the medication is discontinued. However, a few can be permanent in certain people|
Most notably, some diabetes drugs can cause low blood sugar, or hypoglycemia. This is a dangerous side effect and one that leads some doctors to prescribe one diabetes drug over another.
Unfortunately, some people do not experience minor symptoms to warn them that their blood sugar is getting dangerously low (called hypoglycemia). That’s one reason your doctor will emphasize that you must check your blood sugar regularly if you take a diabetes medicine that can cause for 1 last update 08 Aug 2020 low blood sugar.Unfortunately, some people do not experience minor symptoms to warn them that their blood sugar is getting dangerously low (called hypoglycemia). That’s one reason your doctor will emphasize that you must check your blood sugar regularly if you take a diabetes medicine that can cause low blood sugar.
The good news is that the diabetes drugs have been compared to each other in many good studies, and some of the drugs have been used for years and helped millions of people.
The bad news is that most of the careful studies have not tracked the effects of the drugs over many years, which is critical for understanding the long term benefits as well as possible problems. Even so, the studies help clarify the benefits and adverse effects of most diabetes drugs, and signal typical and expected effects among people with diabetes.
Importantly, such studies do not reveal how a specific person with diabetes will respond to any particular drug. Only your doctor and you can decide precisely which drug or drug combination is best for you given your health status, weight, other medical needs, and severity of your diabetes. And only you and your doctor can track how well a particular drug or combination of drugs is helping you.
Our evaluation leads to the following overall conclusions:
potential casues for type 2 diabetes vs 1 (🔴 treatment diet) | potential casues for type 2 diabetes yo mamahow to potential casues for type 2 diabetes for Metformin is a superior drug based on the available evidence. This medicine lowers HbA1c the same amount or more than other diabetes drugs, does not cause weight gain, decreases cardiovascular mortality more than sulfonylureas, and appears to have the best safety profile when comparing serious side effects in people who do not have kidney, liver, or heart disease. As further discussed below, however, certain patients should not take metformin.
Taking two diabetes drugs can have a positive additive effect on reducing HbA1c. This is a major plus for the many people with diabetes whose blood glucose is not well controlled by taking just one drug. The downside is that taking two drugs poses a higher risk of side effects. However, if you take lower doses of each drug, the added risk of side effects can be reduced.
Newer drugs are more expensive. The newer diabetes medicines can cost substantially more than the older ones.
Blood sugar (HbA1c) reductions are generally similar across drugs, except dipeptidyl peptidase-4 inhibitors and alpha-glucosidase inhibitors ,which have a smaller effect. SGLT-2 inhibitors are also generally weaker than metformin, SU, TZDs, or GLP agonists.
Diabetes drugs have differing effects on weight. Body weight was decreased or maintained with metformin, dipeptidyl peptidase-4 inhibitors, glucagon-like peptide-1 receptor agonists, alpha-glucosidase inhibitors, and sodium-glucose co-transporter 2 inhibitors.
In relatively short-term studies, the greatest weight loss was experienced by people taking a glucagon-like peptide 1 receptor agonist or a sodium-glucose co-transporter-2 inhibitor.
Weight increased with sulfonylureas, thiazolidinediones, and meglitinides. The differences seen between drugs was up to 11 pounds.
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For example, the evidence clearly shows that the sulfonylureas pose a higher risk of hypoglycemia than most other oral diabetes medications except repaglinide (Prandin). Sulfonylureas also pose a higher hypoglycemia risk compared with the injectable medication class of the 1 last update 08 Aug 2020 glucagon-like peptide 1 receptor agonists. For example, the evidence clearly shows that the sulfonylureas pose a higher risk of hypoglycemia than most other oral diabetes medications except repaglinide (Prandin). Sulfonylureas also pose a higher hypoglycemia risk compared with the injectable medication class of glucagon-like peptide 1 receptor agonists.
Several combinations of injectables (glucagon-like peptide-1 receptor agonists, basal insulin, and premixed insulins) added to metformin showed varying risks for hypoglycemia. The combination of metformin plus a glucagon-like peptide-1 receptor agonist had a lower risk of hypoglycemia than the combination of metformin plus either premixed or basal insulin.
Minor but annoying side effects may also play a role in your and your doctor’s choice of a diabetes medicine or medicines. For example, gastrointestinal side effects—including bloating, gas, nausea, vomiting and diarrhea—are very frequent with acarbose and glucagon-like peptide-1 receptor agonists. They occur less with metformin.
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|Sulfonylureas (glyburide, glimepiride, glipizide)|
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|Alpha-Glucosidase Inhibitors (acarbose, miglitol)|
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|Thiazolidinediones (Actos, Avandia)|
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|Meglitinides (nateglinide, repaglinide)|
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|Dipeptidyl Peptidase-4-inhibitors (Januvia, Onglyza, Tradjenta, Nesina)|
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Sodium-Glucose Co-Transporter-2 Inhibitors (Farxiga, Invokana, Jardiance)
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Glucagon-Like Peptide-1 Receptor Agonists (Byetta, Bydureon, Victoza, Tanzeum, Trulicity)
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1. Bennett WL, et al, Oral Diabetes Medications for Adults With Type 2 Diabetes: An Update. Comparative Effectiveness Review No. 27. March 2011 (Prepared by Johns Hopkins University Evidence-based Practice Center under Contract No. 290-02-0018.) AHRQ Publication No. 11-EHC038-EF. Rockville, MD: Agency for Healthcare Research and Quality. March 2011. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm.
2. Bennett WL., et al, Comparative effectiveness and safety of medications for type 2 diabetes: an update including new drugs and 2-drug combinations. Ann Int Med. (May 3 2011); Web published in advance of print publication, March 14, 2011.
Results from multiple studies prior to 2007 found that Avandia (rosiglitazone) was associated with an increased risk of heart attack and stroke. In 2007, the FDA announced major restrictions on the use of Avandia. Yet, as newer studies came out, in 2015, the FDA eliminated all restrictions on Avandia, indicated the benefits of the drug may exceed its risks.
The story behind this sharp change is too complex for this report. We still advise that you discuss the heart attack and stroke risk of Avandia with your doctor if he or she prescribes it.
Avandia and Actos pose an elevated risk of heart failure, too. Between 1 and 3 people in 100 without a history of heart disease will develop the condition if they take one of these drugs. Because of this risk, the FDA has placed “black box” warning on the labels of both Actos and Avandia.
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A U.S. Food and Drug Administration (FDA) safety review found that type 2 diabetes medicines containing saxagliptin and alogliptin (both dipeptidyl peptidase-4 inhibitors) may increase the risk of hospitalization for heart failure, particularly in patients who already have heart or kidney disease. The FDA also added a warning to their labels. Whether this is true for all drugs in this class or whether this only pertains to those at higher risk for heart failure is still unclear.
If you take one of these medicines (Actos, Avandia, saxagliptin, or alogliptin) and have swelling of any part of your body, sudden weight gain, or breathing problems, you should contact your doctor immediately.
Both Actos and Avandia have been linked to a slightly increased risk of fractures of the upper and lower limbs, such as the wrist or ankle, in women. The risk was small—about 2 percent higher in people taking Avandia or Actos, compared with those taking other diabetes drugs.
Actos has also been shown to increase the risk of bladder cancer in people who take it for a year or longer. The risk for 1 last update 08 Aug 2020 applies to all drugs containing pioglitazone, including Actoplus Met, Actoplus Met XR, and Duetact. Because of this, France banned Actos and combination pills and Germany has recommended that pioglitazone no longer be started in patients not already being treated with this medication.Actos has also been shown to increase the risk of bladder cancer in people who take it for a year or longer. The risk applies to all drugs containing pioglitazone, including Actoplus Met, Actoplus Met XR, and Duetact. Because of this, France banned Actos and combination pills and Germany has recommended that pioglitazone no longer be started in patients not already being treated with this medication.
People who have previously had or currently have bladder cancer should not use Actos or the combination pills that contain it at all.
If you’re on Actos, be alert for signs of bladder cancer, which include blood or red color in your urine, urgent need to urinate or pain while urinating, and pain in your back or lower abdomen. Contact your doctor if you experience any of those symptoms.
Actos and Avandia have been associated with new or worsening of macular edema—the build up of fluid in the back of the eye—causing vision impairment that can become permanent. If you take one of these treatments, be sure you receive regular diabetic eye care the 1 last update 08 Aug 2020 and if you experience any new vision problems, be referred to an ophthalmologist as soon as possible.Actos and Avandia have been associated with new or worsening of macular edema—the build up of fluid in the back of the eye—causing vision impairment that can become permanent. If you take one of these treatments, be sure you receive regular diabetic eye care and if you experience any new vision problems, be referred to an ophthalmologist as soon as possible.
potential casues for type 2 diabetes children (🔴 epidemiology) | potential casues for type 2 diabetes quoteshow to potential casues for type 2 diabetes for Metformin has been associated with rare occurrences of lactic acidosis—a build-up of lactic acid in the blood that can be fatal. This extremely rare risk appears to exist mostly for people with diabetes who also have moderate to severe kidney disease. Based on years of data suggesting that metformin appears safe in persons with mild to moderate kidney disease, the FDA recently loosened its restrictions on metformin. The agency now says that metformin can be safely used in patients with moderate kidney failure, but shouldn’t be used with more advanced levels of kidney failure.
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The FDA says there have been reports of inflammation of the pancreas, which can lead to permanent damage or even death, with the dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists. In addition, an increased risk of gall bladder disease and gall stones has been reported. These medications should not be used in patients with a history of pancreatitis or gall stones.
Anyone taking a glucagon-like peptide-1 receptor agonist or dipeptidyl peptidase-4 inhibitor who develops persistent severe abdominal pain should stop the medication and contact your physician immediately.
The newest class of medications, the SGLT-2 inhibitors, has recently been associated with ketoacidosis, a life-threatening build-up of acid in the blood. Patients with risk factors for ketoacidosis (such as pancreatitis and alcohol abuse) should not take SGLT-2 inhibitors. Patients taking SGLT-2 inhibitors should be monitored for ketoacidosis.
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The SGLT-2 inhibitors also can increase urination. Sometimes this can cause people to feel dizzy or weak and become dehydrated.
The SGLT-2 inhibitors (Farxiga, Invokana, Jardiance) increase the risk of genital yeast infections for both men and women. About 1 to 7 percent of men, and 3 to 18 percent of women, taking an SGLT-2 inhibitor can expect to develop a genital yeast infection, compared with 0 to 2 percent of men and 1 to 4 percent of women taking any other diabetes drug.
SGLT-2 inhibitors also increase the risk of urinary tract infections, including potentially life-threatening ones.
Taking effectiveness, safety, side effects, dosing, and cost into consideration, if you and your doctor decided that you need medicine to control your diabetes, we recommend the following as first-choice treatments, along with diet and lifestyle changes as suggested by your physician.
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• Glipizide and Glipizide Sustained-Release—alone the 1 last update 08 Aug 2020 or with metformin• Glipizide and Glipizide Sustained-Release—alone or with metformin
• Glimepiride—alone or with metformin
All these medicines are available as low-cost generics, either alone or in combination. Many of these recommendations are available, for example, as discounted generic drugs at various chain drugstores around the U.S. At Walmart for, example, we found various strengths of glimepiride, glipizide and metformin for $4 for a month''s supply.
In recent years, a strong medical consensus has emerged in the U.S., Europe, and Australia that most newly diagnosed people with diabetes who need a medicine should first be prescribed metformin.
Based on the in-depth evaluation of diabetes drugs on which this report is based, we agree with that advice. Unless your health situation prevents it, consider the 1 last update 08 Aug 2020 trying metformin first. If metformin fails to bring your blood glucose into normal range, you may need a second drug. Most commonly that should be one of the two other recommended drugs.Based on the in-depth evaluation of diabetes drugs on which this report is based, we agree with that advice. Unless your health situation prevents it, consider trying metformin first. If metformin fails to bring your blood glucose into normal range, you may need a second drug. Most commonly that should be one of the two other recommended drugs.
If you are unable to take metformin or do not tolerate it well, you face a choice of one of the sulfonylureas or a newer medicine as your first line medicine. Despite the elevated risk of hypoglycemia, we recommend trying glipizide or glimepiride. If glipizide or glimepiride alone fail to bring your blood glucose into control and keep your HbA1c at or below 7 percent, your doctor will likely recommend a second drug.
If upon initial diagnosis your glucose and HbA1c are quite high, you may be prescribed a combination of two drugs at the beginning of treatment—usually metformin plus a sulfonylurea.
Our evaluation is based in large part on an independent review of the scientific evidence on the effectiveness, safety, and adverse effects of the diabetes medicines conducted by the Johns Hopkins University-evidence based Practice Center with the Agency for Healthcare Research and Quality. This analysis reviewed hundreds of studies, including those conducted by the drugs’ manufacturers. A synopsis of the results of this analysis, written by the researchers at Johns Hopkins, forms the basis of portions of this report.
However, no statement in this report should be construed as the official position of the Johns Hopkins Evidence-based Practice Center, the Agency for Healthcare Research and Quality, or the U.S. Department of Health and Human Services. In particular, none of those entities played any role in our recommendations. Consumer Reports, publishers of Consumer Reports Best Buy Drugs, is solely responsible for those, and for all other specific advice and recommendations in this report.
An earlier version of this report from 2012 relied on additional sources listed here:
-An analysis of selected classes of diabetes drugs conducted by the Drug Effectiveness Review Project (DERP), an initiative to evaluate the comparative effectiveness and safety of hundreds of prescription drugs
-Three reviews of oral diabetes drugs by the Cochrane Collaboration
-An American Medical Association monograph on the oral diabetes drugs
-A Veteran’s Administration monograph on diabetes drugs
-Recent guidelines issued by the American Diabetes Association and American College of Cardiology
-Selected recent articles in peer-reviewed journals (See References)
Consumer Reports recommendations used the following criteria. The drug had to:
-Be as effective or more effective than other oral diabetes medicines
-Have a safety record equal to or better than other oral diabetes medicines
-Cost roughly the same or less than other oral diabetes medicines
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potential casues for type 2 diabetes diagnostic (👍 herpes) | potential casues for type 2 diabetes rashhow to potential casues for type 2 diabetes for 3. American Diabetes Association, Type 2 Diabetes Basics. Accessed December 21, 2012 http://www.diabetes.org/diabetes-basics/type-2/
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