Diabetes Forecast

Do My Husband's Meds Work Against One Another?

The article in the December 2009 issue about incretins was very interesting. It is the first piece I've read that explains what Byetta and Januvia are supposed to do, in a way I can actually understand! My husband is on an insulin pump and taking Byetta injections as well as Januvia and Actos tablets. Are these all designed to work together, or is one, or more, working against the others? Judy Morgan, Oklahoma City Judy Morgan, Oklahoma City, Oklahoma

Craig Williams, PharmD, responds: Questions about combining diabetes medications are increasingly common because so many options now exist. Chronic medical conditions other than diabetes (like heart failure or kidney disease) often play an important role in deciding what combinations of medications are best for a particular patient. Without knowing more about your husband, we cannot give specific advice, but let's consider the four-drug combination that you asked about.

Januvia and Byetta belong to related classes of medications. These drugs work on one or more hormones in the gut that affect insulin secretion, appetite, and glucose production by the liver. Actos works differently and improves the effects of insulin in different areas of the body. All of these effects potentially complement insulin action, and it is reasonable to combine any of them with insulin. However, I wouldn't say the combination of all three agents plus insulin is common, especially since Januvia and Byetta have somewhat overlapping effects. There may not be much benefit to using Januvia and Byetta together. But certain combinations work well for certain patients.

In its approvals of Actos, Januvia, and Byetta, the Food and Drug Administration said there was not enough data to routinely recommend that any of these drugs be continued in combination with insulin. In fact, in the past, oral medications were used mostly to delay the need to start insulin. Once a patient went on insulin to control his or her diabetes, oral medications were reduced or stopped altogether. While some providers still favor that strategy, more are now willing to combine therapies because some oral medications, such as metformin, have shown benefits in combination with insulin. This is particularly true in patients who take only a once-daily injection of background (long-acting) insulin.

If this combination appears to be helping your husband safely maintain blood glucose control, then it may be a good choice for him. But insulin plus these three other medications is a lot, and you and your husband should continue to work closely with his provider to ensure that each one is truly needed.



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