New medicines and treatment therapies are making diabetes treatments & management better
(Dr Mathews J. Alapatt, MBBS, MD, MRCP (UK), FRCP (Edin), MSc Diabetes (Cardiff UK), is a Specialist in Internal Medicine at JTS Medical Centre, Dubai)
The first major breakthrough in the treatment of diabetes was in 1922 with the discovery of insulin. Since then there has been an explosive increase in the incidence of diabetes. Fortunately, our understanding of diabetes has improved considerably. We now know that good control of diabetes delays complications in diabetes and the benefits of this period of good control continue for the next 10 years. We also know that treatment of diabetes includes the treatment of hypertension and cholesterol. Below mentioned are the newer treatment options for Type 1 and Type 2 diabetes:
Type 1 Diabetes
1) Newer insulin: A new once-daily long-acting insulin called Degludec has been introduced recently. It has a longer duration of action when compared to the long-acting insulins available so far. Using it will help in reducing the incidence of hypoglycemia at night.
2) Glucose monitoring: Blood glucose monitors have been around for some time. They have over time become smaller, more accurate and easier to use. Continuous Glucose monitors currently available are minimally invasive and can provide real-time glucose readings. They can connect to the insulin pump or monitor via Bluetooth. A major advance will be the development of an accurate non-invasive glucose monitor.
3) Insulin pumps: are used to deliver insulin continuously in the subcutaneous space. These have over time shrunk in size and become more sophisticated. The newer versions can suspend insulin delivery when blood-sugar levels drop to dangerous levels.
4) Artificial Pancreas: These de¬vices combine an insulin pump, continuous glucose monitor and a computer algorithm to deliver the appropriate dose of insulin with¬out human intervention. Early versions are available; however, they have not been perfected.
Type 2 Diabetes
1) DPP4 Inhibitors (also called Glipitns) have been around for some time. These protect a natural compound in the body — GLP-1 from breaking down. They tend to work well and are useful because it does not cause hypoglycemia and are weight neutral.
2) GLP1 analogues: These injectable drugs are effective. They use the body’s own signaling system to boost insulin after meals. It also causes weight loss; hence tend to be useful for obese patients. The newer drugs in this group need to be injected only once a week and is a significant advance.
3) SGLT2 inhibitors: These work by blocking glucose from being reabsorbed by the kidneys. Thus, raises the amount of glucose uri¬nated, and lowers the amount of glucose in the blood. The advan¬tage of this class of drugs is that its action is independent of insulin.