By Monica Heger

The list of approved medications for type 2 diabetes is long and varied. Some drugs come in pill form; others must be injected. Some cause weight gain; others trigger weight loss. But all existing treatments to lower blood sugar, different as they may be, essentially work by modulating the activity of insulin. These drugs have proven quite effective in the short term, but they tend to lose their potency over time. As a result, drug companies have been racing to develop new diabetes medicines that act on a pathway that doesn’t involve insulin.

A drug called dapagliflozin could be the first such agent to gain market approval. Co-developed by Bristol-Myers Squibb (BMS) and AstraZeneca, dapagliflozin reduces blood glucose levels in an insulin-independent manner by preventing a protein called sodium-dependent glucose cotransporter 2 (SGLT2) from reabsorbing glucose in the kidney. As such, the simple sugar gets excreted through the urine instead of reentering the blood stream and elevating blood sugar levels, a condition known as hyperglycemia, one of the main symptoms of diabetes.

Dapagliflozin is “intriguing in that the mechanism is different,” says Edward Chao, an endocrinologist at the University of California–San Diego Medical Center, who is not affiliated with any drug companies developing SGLT2 inhibitors. “No medicine for diabetes has used the kidney as a means to help control sugar.”

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Image: Jill A. Brown, flickr, under Creative Commons