Ep 6: Exploring Medication Options for Prediabetes

[00:00:00] Oscar Camejo: The first practical thing that I started doing was researching how to eat and then exercising.

[00:00:08] Dr. Bayo Curry-Winchell: The first and most important step for anyone diagnosed with prediabetes or at risk of type 2 diabetes is to make healthy lifestyle changes. But there are also a number of different medications that can help.

[00:00:20] Sandra Leal: What we've learned in just the last decade is tremendous. 

[00:00:24] Dr. Bayo Curry-Winchell: In this episode, we'll talk about the different types of medication that are sometimes prescribed to help prevent type 2 diabetes and other medications that can treat conditions that put people with prediabetes at higher risk. 

[00:00:38] Sandra Leal: Medication for cholesterol, medications to prevent pain or depression, plus the diabetes medications themselves.

[00:00:46] Dr. Bayo Curry-Winchell: We'll share resources and tips for getting affordable medication. 

[00:00:50] Adrienne Maye: Sometimes the prescription and what they may have as an alternative may or may not be covered by your insurance. 

[00:00:57] Dr. Bayo Curry-Winchell: Welcome back to the Preventing Type 2 Diabetes Podcast. I'm your host, Dr. BCW.

The Preventing Type 2 Diabetes Podcast is a production of Mission Based Media and was made possible with support from the American Pharmacists Association Foundation. This series is for educational purposes only. It is not a substitute for formal medical advice, diagnosis, or treatment. So if you have questions about your health, talk to a qualified healthcare provider.

In the last few episodes of this podcast, we've talked about lifestyle changes like eating a healthy diet, exercising regularly, reducing stress, and getting enough sleep. These are important steps everyone could take to try and prevent type 2 diabetes. For people who have been diagnosed with prediabetes, blood sugar levels can run high. And there are a few different medications available by prescription that can help bring those sugar levels down.

[00:01:56] Dr. Anjanette Wyatt: In my practice, I feel that metformin is one of the medications that is an older medication that works very well. 

[00:02:03] Dr. Bayo Curry-Winchell: That's Dr. Anjanette Wyatt.

[00:02:06] Dr. Anjanette Wyatt: I currently serve as the president of the American Pharmacists Association Foundation.

[00:02:11] Dr. Bayo Curry-Winchell: Dr. Wyatt has a family history of type 2 diabetes and was herself diagnosed with prediabetes.

[00:02:18] Dr. Anjanette Wyatt: When I received the diagnosis of prediabetes, the first thing that my physician discussed is a change of diet, exercise, lifestyle changes, which are good, but a lot of times you can't change that overnight. Some physicians will decide to put you on medication.

For me, it was metformin. 

[00:02:35] Dr. Bayo Curry-Winchell: Metformin works by reducing the amount of blood sugar your liver produces and helping your body respond better to insulin. If you listen to episode one of our series, you'll remember that insulin is the hormone that helps sugar enter our cells so the sugar can be used for energy.

Metformin has been approved as a treatment for people with type 2 diabetes. And it's important to mention that the U. S. Food and Drug Administration hasn't officially approved it for use by people with prediabetes. But many doctors do prescribe it to help delay or prevent type 2 diabetes. This is called off label use.

We say off label use when a medication is prescribed for a purpose that is different from what the FDA originally approved it for. In other words, the medication is being used off label for a condition or situation that wasn't specifically studied or approved by the FDA. This practice is legal and common, as doctors sometimes find that certain medications can be effective for treating conditions beyond their initial FDA approval.

There's another type of medication that's making headlines. You may have seen or heard about the medications Ozempic, Wegovy, or Mounjaro. These are brand names for medications that are part of a group of drugs called GLP-1 receptor agonists. Let me say that again, that's GLP-1 receptor agonists. I know that's a mouthful, but it's something you may hear often when discussing diabetes.

You may also hear GLP-1 receptor agonist medications referred to simply as GLP-1s, semaglutide, liraglutide, or several other names we have listed in the show notes. In this episode, we will refer to these medicines either by their brand names or by the term GLP-1s. When your blood sugar levels go up after you eat, GLP-1s give your body a nudge to make more insulin.

The additional insulin helps lower blood sugar levels, which not only improves blood sugar control, but may also lead to weight loss. GLP-1s appear to reduce appetite and slow down the movement of food from your stomach to your small intestine. This can make you feel full faster and longer, which can reduce the amount of food you eat.

For some people like Jessica who struggle with their blood glucose and weight, a GLP-1 can be a good option. 

[00:05:02] Jessica Patrick: I always assumed that I was destined for diabetes, that there was no way around that with my genetic predisposition. Not only did my paternal grandmother have diabetes, but my maternal grandmother did as well, and my mother does. And all were type 2 diabetes.

And now I'm thinking, you know what, they may be on to something. This may be something that is going to be the thing that sticks and really changes my life in a way that I never thought possible.

[00:05:31] Dr. Bayo Curry-Winchell: For Jessica, the benefits have been obvious. 

[00:05:35] Jessica Patrick: I have been on it seven and a half months now. My A1C is down a full point.

[00:05:42] Dr. Bayo Curry-Winchell: Remember that A1C, also known as hemoglobin A1C, is like a snapshot of your average blood sugar levels over the past few months. So Jessica's average amount of sugar in her blood has gone down and that's a good thing.

[00:05:56] Jessica Patrick: So it's huge. My cholesterol is down. I'm down 60 pounds and I am now back in the gym working out, like riding bikes.

[00:06:09] Dr. Bayo Curry-Winchell: GLP-1s are generally taken by injection, which means they are delivered by a shot and are taken daily or weekly. They are relatively new medications and, like with all new medications, there are still some things we don't know. 

[00:06:23] Sandra Leal: We haven't had it around long enough to know how long people should stay on it.

[00:06:27] Dr. Bayo Curry-Winchell: Sandra Leal is a pharmacist and a former president of the American Pharmacists Association.

[00:06:33] Sandra Leal: I have seen some studies that are showing that if people get off of it, they start gaining weight again. But we don't know how long or duration. I think those are the kinds of data that we're going to start seeing with more use of these products.

[00:06:46] Dr. Bayo Curry-Winchell: If you have questions about your medication options, benefits, and side effects, it's important to talk to your healthcare provider. And remember that medications are not a replacement or substitute for healthy lifestyle choices about nutrition, exercise, and sleep.

[00:07:03] Sandra Leal: Whether or not you stay on the medication, if you don't change your life and you stop the medication, you haven't done anything different, you're going to gain the weight back because that's essentially where you were before the medication. 

[00:07:15] Dr. Bayo Curry-Winchell: The success of a certain drug can sometimes make it harder to obtain because they suddenly become popular outside of their original intended use. That happened recently with some of the GLP-1 medications.

[00:07:30] Sandra Leal: There's so much popularity, people on TikTok talking about it, right? There's all of the social media surrounding it. There's celebrities that are using it. So it's definitely creating interest in individuals to try to figure out if this is an option for them. 

[00:07:44] Dr. Bayo Curry-Winchell: Some GLP-1s are now attracting attention as a solution that can help anyone lose weight, regardless of their diabetes status. And insurance companies are looking carefully at the people it's being prescribed to, sometimes with damaging consequences. 

[00:07:59] Jessica Patrick: I was approved through the insurance company right away at a time where this medication wasn't quite as in the forefront of the media. And once it became a hot topic, there were reassessments and I got a letter saying we need to re-pre authorize this medication for you.

[00:08:17] Dr. Bayo Curry-Winchell: That can impact those who really need it like Jessica, who has been diagnosed with prediabetes. This GLP-1, combined with the changes to her food choices and activity levels, has helped her stay away from a diagnosis of type 2 diabetes. 

[00:08:32] Jessica Patrick: After having been on it for six months and seeing a significant difference in how I feel and my numbers, they no longer cover my medication. I'm extremely stressed out about it right now because it is terrifying to think about going back to the difficulties that I struggled with on a daily basis prior to being prescribed. 

[00:08:55] Dr. Bayo Curry-Winchell: For some people who need medication to manage prediabetes and prevent type 2 diabetes, the cost of these prescription medicines can be a challenge.

[00:09:05] Sandra Leal: This is a big factor for any condition, but when you have a condition that definitely requires for you to take medications, to monitor your blood sugar. That's one thing that you should always be discussing with your provider. 

[00:09:17] Dr. Bayo Curry-Winchell: If cost is an issue for you or someone you love, here are a few tips. First, and it may seem obvious, ask your doctor how much your prescription costs.

[00:09:28] Sandra Leal: That conversation never happens. You just assume that if a provider writes it, that you're going to pick it up at the pharmacy and then you realize it wasn't covered.

[00:09:37] Dr. Bayo Curry-Winchell: If the medicine you've been prescribed is not covered or affordable, you may be able to use a less expensive or generic alternative. 

[00:09:45] Sandra Leal: The doctor that you go to or the prescriber that you go to might prescribe a trade name, a specific trade name, and realize that it's not covered under the plan, but there might be an equivalent product from the other company that is covered.

[00:10:00] Dr. Bayo Curry-Winchell: Here's registered nurse, Adrienne Maye. 

[00:10:03] Adrienne Maye: I will first talk to the pharmacist to see if there are any alternatives that you may be able to take in place of this medication. At the same time, I would also reach out to my provider to see if there are any alternatives that they can prescribe. Sometimes the prescription and what they may have as an alternative may or may not be covered by your insurance if insurance is an option for you, but you always need to check with your provider, the prescriber that wrote the prescription, and then also talk with your pharmacist because they're very helpful in talking to you about what's available that may be in the same drug class.

[00:10:38] Dr. Bayo Curry-Winchell: Sometimes even health providers refer to a class of drugs by a brand name, when in fact, they may be referring to the type of drug. Dr. Anjanette Wyatt explains. 

[00:10:49] Dr. Anjanette Wyatt: Metformin, for example, it's been out on the market for so long that you probably wouldn't see the brand name. 

[00:10:57] Dr. Bayo Curry-Winchell: There are a couple of names for metformin, including Fortamet and Glumetza.

[00:11:02] Dr. Anjanette Wyatt: It's good to know both names just in case you go to the pharmacy and you get the generic instead of the brand, but typically at a pharmacy, you will have the brand name on one side, the generic name on another side.

[00:11:15] Dr. Bayo Curry-Winchell: If you have health insurance, pharmacist Sandra Leal also recommends that you familiarize yourself with what your insurance will cover, because you may be surprised at what you find. 

[00:11:25] Sandra Leal: Some of the things for diabetes fall under durable medical equipment, if it's a glucose monitor, insulin supplies, pharmacy benefits are the medications, and then some of them are medical benefits, the actual visits to see a nutrition counselor, for example, to see your doctor, a certified diabetes educator.

Some programs offer things like walking programs, exercise, gym access, things like that, that are available to you for coverage that you don't even have to pay for out of pocket. So it's really important to understand what benefits you have, which ones you can apply, what you might not even realize you have.

[00:12:00] Dr. Bayo Curry-Winchell: Remember your insurance company will have a comprehensive list of what is covered. So if you're in any doubt, call them and ask. If any of these drugs aren't covered by an insurance plan and are too expensive to buy, there are also several programs that can help people qualify for free or low-cost prescriptions.

Lots of drug companies have patient assistant programs that offer some products at a reduced price for people who qualify. You can find these online by searching for the Patient Access Network Foundation or visiting rxassist.org along with other websites. We have links on our websites at healthunmuted.com/resources. You may be able to find a cost saving program at your local pharmacy, and several pharmacies accept discount cards and coupons. Non-profit organizations like Partnership for Prescription Assistance can also help people get medicines for free or nearly free. And of course, there is Medicare, Medicaid and state pharmaceutical assistance programs. Remember, you can find more information on all these resources at our website at healthunmuted.com/resources. 

For anyone who is at risk of developing type 2 diabetes, there's more at stake than just diabetes itself. There are also concerns about complications like eye and nerve damage, heart attacks, sexual dysfunction, strokes, and even anxiety and depression. In addition to lifestyle changes, medications can also help delay or prevent developing these medical problems. For example, if your cholesterol is high, you may be prescribed a medication called a statin. Statins help lower cholesterol and they can also reduce your risk of heart disease and stroke. If you have high blood pressure, which is also known as hypertension, then you may get a prescription for an ACE inhibitor, diuretic, or other type of drug.

We have links to useful articles on our website. These medications can help lower blood pressure, which is important because people with prediabetes and high blood pressure are at a higher risk of heart attack and stroke. Talk to your provider about your options for blood pressure medications to help decide which one may be best for you.

And there are other medications that can support people experiencing anxiety, depression, sexual dysfunction, congestive heart failure and other conditions commonly experienced by people with prediabetes. Be sure to tell your provider about your physical and mental health concerns. Tell them anything you know about your family history and speak openly about any medications, vitamins, alcohol, or recreational drugs you may be taking.

In the next episode, we talk about support, resources and the confidence to change. 

[00:14:49] Adrienne Maye: Diabetes is a day-by-day process. It's a journey. It's a marathon. 

[00:14:54] Dr. Bayo Curry-Winchell: You can do this and you're not alone. 

I'm Dr. BCW and this show is part of the Health UNMUTED audio library by Mission Based Media. It was created with support from the American Pharmacists Association Foundation. To listen and learn more, visit healthunmuted.com and follow our show on your favorite social platform or podcast player. And if you found this episode helpful, please share it with someone you know. Thanks for tuning in and helping spread the word.