Diabetes Drugs: Benefits, Risks & Legal Concerns

Diabetes is a chronic disease that affects blood sugar control. It occurs when the body can’t produce enough insulin or can’t use it properly. In Type 1 diabetes, the pancreas stops making insulin. In Type 2 diabetes, the body’s cells become insulin-resistant.

Uncontrolled diabetes can lead to other health problems, such as kidney damage, stroke, vision loss, heart disease and lower limb amputations.

Luckily for the estimated 38.4 million Americans with diabetes, there are drug and device treatment options. However, they aren’t without side effects — and some have faced legal action from the patients who used them.

Types of Diabetes

There are four main types of diabetes: Type 1, Type 2, gestational diabetes and type 1.5 diabetes. Type 1 is an autoimmune disease, most often beginning in childhood. Type 2 is often lifestyle-related, and it usually presents in adult patients. Gestational diabetes occurs during pregnancy. A newer fourth type, called type 1.5 diabetes, most often occurs in younger adults but usually has manifestations more like type 1 diabetes.

Diabetes risk increases with age. Prediabetes is a condition where blood sugar levels are higher than usual. It can lead to Type 2 diabetes and can increase the risk of stroke and heart disease. Lifestyle changes such as losing weight and exercising more can prevent a Type 2 diabetes diagnosis for most people with prediabetes.

Blood sugar imbalances cause diabetes symptoms, such as fatigue, vision problems, increased hunger, weight changes, frequent urination and increased thirst. Type 1 diabetes symptoms are severe and fast, whereas Type 2 diabetes has a more gradual onset. Regular checkups and bloodwork can detect Type 2 diabetes earlier.

Type 2 diabetes is the most common form of diabetes in the U.S.

Diabetes treatment involves lifestyle changes and medications. Type 2 diabetes may require a combination of medications and insulin as the disease progresses.

Diabetes treatments vary significantly between Type 1 and Type 2 diabetes and include a range of medications and devices designed to manage blood sugar levels. While Type 1 diabetes primarily requires insulin therapy, Type 2 can be managed with lifestyle changes, oral medications, and in severe cases, insulin.

Syringes, pens and wearable devices like insulin pumps help to administer insulin. Five types of insulin are available for diabetes patients: rapid-, short-, intermediate-, long-, and ultra-long acting insulins.

Insulin is safe if used as directed, but it can cause hypoglycemia as a side effect.

Type 2 Diabetes Medications

Patients may take Type 2 diabetes medication to control blood orally or by injection; the type and dosage will vary depending on severity and other conditions. In combination therapy, patients may use multiple medications at one time.

Some Type 2 diabetes medications may cause serious side effects. For example, rare but serious Ozempic and Mounjaro side effects may include gastroparesis or paralyzed stomach. Gastroparesis causes undigested food to remain in the stomach, and if severe, it can cause severe abdominal pain and vomiting that may last for weeks. Some patients filed Ozempic lawsuits against the drug’s maker claiming they were never warned of the risk.

Doctors may switch medications periodically depending on how a patient reacts to a medication. It’s important to have routine checkups with your medical provider to see if your medications are working and to discuss any side effects.

GLP-1 and dual GLP-1/GIP receptor agonists are drugs that aid glucose management in Type 2 diabetes. They lower blood glucose and body weight, potentially benefiting heart health.

These drugs also curb appetite and promote weight loss. Most medications in these classes are injections, but Rybelsus (semaglutide) is a daily oral option. Different brands are FDA-approved for either the treatment of Type 2 diabetes or overweight or obesity.

Benefits

In two clinical trials involving people with Type 2 diabetes, treatment with the GLP-1 receptor agonist was associated with better glycemic control, reduced oral use of hypoglycemic agents and reduced systolic blood pressure.

Side Effects

GLP-1-based therapies for diabetes can cause gastrointestinal side effects like nausea, vomiting and diarrhea in 10 to 50% of patients. In clinical trials, these side effects were similar to previous studies, with a three- to sixfold increase in gastrointestinal side effects.

Cost

Without insurance, Wegovy can cost as much as $13,600 a year, according to the Kaiser Family Foundation. But with insurance and discounts from the drugs’ manufacturers, some can cost as little as $25 a month.

Lawsuits

Patients taking GLP-1 receptor agonists have filed lawsuits after experiencing severe gastrointestinal side effects. The main side effect claimed in Ozempic lawsuits is severe gastroparesis, a paralyzed stomach. If you have had severe side effects or if someone you love died after taking a GLP-1 receptor agonist like Ozempic, lawyers are actively taking cases.

SGLT2 inhibitors, or gliflozins, treat Type 2 diabetes while benefiting heart and kidney health. Blocking glucose reabsorption in the kidneys lowers blood sugar, aids weight loss and reduces blood pressure.

Benefits

An article published in the International Journal of Molecular Science suggests that SGLT2 inhibitors offer health benefits beyond glycemic control. These benefits include weight loss, protection against major cardiovascular events, blood pressure reduction, and delaying the onset and progression of chronic kidney disease (CKD).

Side Effects

Common side effects of SGLT2 inhibitors include urinary tract and yeast infections, diabetic ketoacidosis, low blood sugar and low blood pressure, according to the American Kidney Fund.

Cost

GoodRx reports that several SGLT2 inhibitors run about $350 to $594 per month. They are expensive, but they are still more affordable than GLP-1 agonists.

Lawsuits

Plaintiffs in SGLT2 inhibitor lawsuits say manufacturers “negligently, recklessly and carelessly marketed, distributed and sold [each drug] without adequate instructions or warning of its serious side effects and unreasonably dangerous risks.” Federal litigation is ongoing for those affected by Invokana’s and Farxiga’s severe side effects.

Metformin may be used alone or with insulin. It helps manage Type 2 diabetes by reducing liver glucose and increasing muscle insulin sensitivity. Metformin is taken twice daily, and it may cause diarrhea. It is available in an extended-release formulation that may be taken once daily if tolerated. It is not approved for use in treating Type 1 diabetes.

Benefits

Metformin offers various advantages, such as weight loss, lowered blood pressure and cholesterol, reduced risk of heart disease, and effective management of Type 2 diabetes. Its ability to regulate blood sugar levels benefits individuals with different health concerns.

Side Effects

Metformin can cause side effects like diarrhea, nausea, stomach discomfort and gas. Other symptoms include weakness, headache, rash and muscle pain. Serious effects such as rapid breathing, muscle pain, severe diarrhea, or kidney failure should prompt immediate medical attention.

Cost

Without insurance, generic metformin ranges in price from $4 to about $15, according to GoodRx.

Lawsuits

Plaintiffs have alleged that their metformin use led to cancer. Some lawyers are accepting metformin lawsuits from patients who developed cancer after taking the diabetes drug.

Dipeptidyl peptidase-4 (DPP-4) inhibitors can help control Type 2 diabetes by stimulating insulin release. These drugs block an enzyme called DPP-4, which breaks down a hormone called incretin. By blocking DPP-4, incretin levels remain high enough to lower blood glucose. So, these medications can help keep blood sugar levels stable and reduce complications from diabetes.

Benefits

DPP-4 inhibitors are a safer type of pill for diabetes that can lower blood sugar levels without causing weight gain. They don’t require injections and have a lower risk of causing low blood sugar, but they should be used with caution when taken with other medications.

Side Effects

DPP-4 inhibitors may cause some side effects, such as headaches, sore throats and upper respiratory infections. Serious side effects are rare but can include pancreatitis (inflammation of the pancreas) and joint pain. If you experience severe symptoms, it’s always best to consult with a doctor.

Cost

DPP-4s are among the more expensive diabetes drugs. Conversely, drugs like sulfonylureas and metformin are more affordable. However, the cost of DPP-4s can vary greatly, from $75 for Onglyza to $1,575 for Zituvio if you don’t have insurance.

Lawsuits

Lawsuits against Boehringer Ingelheim, the manufacturer of both Tradjenta and Jentadueto, claim the company did not adequately warn patients about the risk of pancreatic side effects.

Thiazolidinediones (TZDs) improve insulin function in muscle and fat, reducing liver glucose production. They lower blood sugar without risking low blood glucose(hypoglycemia), but they may increase the risk of heart failure, leg swelling, and weight gain. Despite safety concerns, TZDs treat insulin resistance, and improve cardiovascular risk factors, despite safety concerns.

Benefits

TZDs may benefit Type 2 diabetes patients who are unable to tolerate or find success with other medications such as metformin, sulphonylureas or prandial glucose regulators. They are often cheaper and can be used in patients who have chronic kidney disease.

Side Effects

TZDs may cause eyesight issues, infections, reduced touch sensitivity, chest pain, water retention and weight gain. Less common but serious effects include anemia, bone fractures, heart issues, liver failure and macular edema. These drugs can affect how genes work, leading to different side effects for each drug.

Cost

Actos can cost as little as $23 without insurance, according to GoodRx. Avandia can be purchased for $170. Insurance coverage can vary, so check with your pharmacist or your insurer for the exact amount of your coverage.

Lawsuits

Today, litigation is mostly inactive. However, more than 10,000 Actos lawsuits accused manufacturer Takeda Pharmaceuticals of failing to adequately warn patients of the risks of bladder cancer, heart failure and other serious side effects.

Sulfonylureas such as glipizide and glyburide have been a key treatment option for Type 2 diabetes for nearly 60 years. They lower blood sugar levels and are affordable, as they are available in generic forms.

Benefits

Sulfonylureas are well-suited for non-overweight individuals with Type 2 diabetes. They stimulate pancreas cells to produce more insulin and enhance insulin effectiveness. They are easily administered, taken once or twice daily with meals. Sulfonylureas are generally safe for patients with chronic kidney disease.

Side Effects

Sulfonylureas may cause various side effects, including blurred vision, increased hunger, weight gain, joint pain, muscle cramps, nausea, sweating and unusual weakness. Rare but serious effects include abdominal pain, difficulty breathing, fainting, irregular heartbeat, rash, and yellowing of the skin or eyes. Consult a doctor if experiencing these symptoms.

Cost

Sulfonylureas are relatively affordable compared to many other diabetes medications. Without insurance, sulfonylureas range in price from as little as $14 for Glynase to $22 for Glucotrol XL.

Alpha-glucosidase inhibitors, a rarely used diabetes medication, treats Type 2 diabetes by slowing carbohydrate absorption, causing a slower rise in postprandial blood glucose levels. Alpha-glucosidase inhibitors also have small impacts on GLP-1 and other gut hormones. They are often prescribed to patients whose blood sugar spikes after meals or when other medications fail to control glucose levels.

Benefits

In contrast to sulfonylureas and thiazolidinediones, alpha-glucosidase inhibitors are often weight-neutral, or they may actually promote mild weight loss. They are less likely to cause hypoglycemia because they are taken with meals. Alpha-glucosidase inhibitors can usually be safely used in mild to moderate kidney disease.

Side Effects

Alpha-glucosidase inhibitors may cause gastrointestinal discomfort, such as flatulence, diarrhea, and abdominal pain. These usually diminish over time.

Cost

Alpha-glucosidase inhibitors range in price from $17 to $43, with acarbose being the less expensive option.

Meglitinides are also rarely used oral diabetes medications that help manage Type 2 diabetes by stimulating insulin release from the pancreas after meals, similar to sulfonylureas. Because they have a rapid onset of action and are short-acting, meglitinides are particularly useful for people with irregular meal schedules. They should be taken with meals to help lower postprandial blood glucose.

Benefits

Meglitinides are useful for people with Type 2 diabetes who experience high blood sugar levels after meals. They regulate certain receptors on pancreatic beta cells, stimulating insulin release. Meglitinides, such as nateglinide and repaglinide, are suitable for individuals who need quick insulin stimulation to manage their glucose levels when they eat.

Side Effects

Meglitinides can cause weight gain and hypoglycemia, especially when taken with other medications that also may cause low blood sugar. Additional side effects can include anxiety, blurry vision, nausea, and vomiting.

Cost

The cost of meglitinides ranges from $19 to $85 without insurance, and repaglinide is usually the cheaper option.