Diabetes/Endocrine Topic Discussion
Recent data highlights that most adults diagnosed with diabetes, around 85.6%, receive diabetes medication. However, findings from the National Health and Nutrition Examination Survey (NHANES) reveal that only about half of American adults with diabetes manage to achieve the recommended HbA1c level of less than 7.0%. Modern medicine and guidelines from the American Diabetes Association (ADA) have emphasized the importance of certain classes of medications in treating diabetes. It’s argued that treatments targeting high blood sugar levels without addressing the underlying issues may not provide long-term benefits for the disease.
Metformin, a commonly used medication, is both effective and safe. It’s also cost-effective and may lower the risk of heart problems and death. However, while Metformin is good for controlling blood sugar levels, it doesn’t directly address the main issue in type 2 diabetes, which is the dysfunction of β-cells. Medication and lifestyle changes should be tried first, and only if they’re not effective should additional therapies be considered. Research has focused on finding treatments that address hyperglycemia, the root cause of diabetes.
Studies have shown that Metformin has added benefits. For example, it has been linked to a reduced risk of cardiovascular events for patients with type 2 diabetes who are at high risk of heart disease. Additionally, SGLT2 inhibitors are now recognized as an effective therapy. These medications act directly on the kidneys without relying on insulin, offering a new approach to diabetes treatment.
Patient compliance with medication is influenced by their understanding of its use and access to it. Practitioners and patients should educate themselves on the risks and benefits of medications by studying multiple evidence-based research, avoiding studies sponsored by organizations with vested interests. Patients need to be assured that their medication is beneficial and won’t harm them physically or financially.
Diabetes, especially type 2, is a significant concern for many, including the author who was diagnosed during pregnancy. Finding the right treatment can be a journey, often involving trial and error until an effective solution is found, which may not always involve medication therapy.
References:
Abdul-Ghani, M., & DeFronzo, R. A. (2017). Is it time to change the type 2 diabetes treatment paradigm? Diabetes Care, 40(8), 1121–1127.
Edelman, S. V., & Polonsky, W. H. (2017). Type 2 diabetes in the real world: The elusive nature of glycemic control. Diabetes Care, 40(11), 1425–1432.
Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2019. Diabetes Care, 42(Supplement 1), S90–S102.
Seufert, J. (2015). SGLT2 inhibitors – an insulin-independent therapeutic approach for treatment of type 2 diabetes: Focus on canagliflozin. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 543.
Diabetes/Endocrine Topic Discussion
Recent data indicates that 85.6% of adults with diagnosed diabetes are treated with Diabetes medication. Results from the National Health and Nutrition Examination Survey (NHANES) indicate that only about 50% of American adults with Diabetes are achieving HbA1c <7.0% (<53 mmol/mol) (Edelman & Polonsky, 2017). Modern day medicine and guidelines from the American Diabetes Association (ADA) have spent an enormous amount of time and resources to prove that certain classes of medications are best served to treat diabetes. It is argued that therapeutic interventions that target hyperglycemia but do not correct the underlying pathogenic disturbances are unlikely to result in a sustained benefit on the disease process, (Abdul-Ghani & DeFronzo, 2017).
Metformin is effective and safe, is inexpensive, and may reduce risk of cardiovascular events and death, (“Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2019,” 2018). While Metformin is an effective first line drug that offers several benefits such as cardiovascular protection, it lacks any effect on β-cell function, which is the primary pathophysiological disturbance responsible for progressive hyperglycemia in T2D patients, (Abdul-Ghani & DeFronzo, 2017). Medication and lifestyle changes should be introduced prior to adding a concomitant therapy. If this prescribed regimen is not successful, then other therapies may be introduced. Studies on additional treatments have now been done to get to the root cause of the issue which is hyperglycemia.
Metformin has been found to have additional benefits in its use. The addition of Metformin for patients with type 2 diabetes and a high risk of cardiovascular disease had reduced risk of a cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke relative to those randomized to receive placebo (Edelman & Polonsky, 2017). The use of SGLT2Is is now widely acceptable as a successful therapy to treat. For the first time, SGLT2 inhibitors offer a therapeutic approach acting directly on the kidneys without requiring insulin secretion or action, (Seufert, 2015).
The rate of compliance for a medication is directly correlated on the understanding of its use as well as the access to the medication at hand. Each practitioner and patient must be open to educating themselves on the risks versus the benefits of the medication as well as reading multiple, evidenced based studies that have been completed. These studies should not have been sponsored by organizations that have a stake in monetary gain. Patients need to understand that the medication they are taking is used for their benefit and must not cause additional harm to their physical being nor their finances.
Diabetes, especially Type II Diabetes is a hot topic in my household as well as in my daily practice. I myself was diagnosed with type II Diabetes some years ago while pregnant. Over the course of several years, I was trialed on several therapies until I landed on the treatment that truly worked for me and this treatment, did not include medication therapy at all.
References
Abdul-Ghani, M., & DeFronzo, R. A. (2017). Is it time to change the type 2 diabetes treatment paradigm? yes! glp-1 ras should replace metformin in the type 2 diabetes algorithm. Diabetes Care, 40(8), 1121–1127. https://doi.org/10.2337/dc16-2368
Edelman, S. V., & Polonsky, W. H. (2017). Type 2 diabetes in the real world: The elusive nature of glycemic control. Diabetes Care, 40(11), 1425–1432. https://doi.org/10.2337/dc16-1974
Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes—2019. (2018). Diabetes Care, 42(Supplement 1), S90–S102. https://doi.org/10.2337/dc19-s009
Seufert, J. (2015). Sglt2 inhibitors – an insulin-independent therapeutic approach for treatment of type 2 diabetes: Focus on canagliflozin. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 543. https://doi.org/10.2147/dmso.s90662
