Diabetes research has been making headlines recently as hundreds of millions of dollars are spent in search of a cure for a set of diseases considered the world’s seventh biggest killer. These promising new methods combine both traditional approaches such as weight management with more drastic ideas, offering a look at future treatment trends.
In Vienna last month Dutch scientists from Amsterdam UMC, where the study was conducted, announced that destroying the small intestine’s mucus membrane through an hour-long oral procedure and causing a new one to develop could potentially end the daily insulin injections that many patients with type 2 diabetes endure.
At the International Diabetes Federation Congress in Abu Dhabi last year, researchers from Newcastle and Glasgow Universities explained how weight loss may reverse diabetes. They studied only about 300 patients, but more than half of those who slimmed down on a radical 800-calorie diet saw their condition go into remission.
The illness has been called the major epidemic of the 21st century, affecting more than 425 million people around the world. Here in the UAE, the Emirates Diabetic Association says that last year there were 1.18 million people battling the diseases and their devastating effect on the body’s organs — that’s about one in nine residents.
Diabetes is a group of chronic conditions — now thought to be as many as five — characterised by elevated levels of blood sugar in the urine. An abnormal response to insulin distinguishes type 2 diabetes. The production of little to no insulin is associated with type 1, an auto-immune form initially only thought to be confined to children and teenagers, but increasingly being diagnosed in mature adults.
With type 2 so prevalent, we asked doctors in the UAE how they’re treating the epidemic.
Diabetics are at higher risk of having heart attacks and strokes, and a higher chance of dying from such events.
“Diabetics are at higher risk of having heart attacks and strokes, and a higher chance of dying from such events,” says Dr Katia Al Sibai, Consultant in Endocrinology, Diabetes and Metabolism at HealthBay Polyclinic in Dubai. “Since this is a major concern, there has been a lot of research about modalities of treatment to help reduce this high mortality rate.”
Heart disease is the leading cause of death worldwide, and having diabetes exacerbates that risk. “It has only been recently proven that some of the new anti-diabetic medication may reduce death from cardiovascular causes, heart attacks and strokes in diabetics with pre-existing cardiovascular disease,” Dr Al Sibai adds. “This is a major revolutionary finding that will add a significant consideration when choosing treatment options. There are [also] studies with promising findings about some medications lowering the chance of cardiovascular mortality in diabetic patients who did not have a previous history of heart attack or strokes.”
Lifestyle changes are imperative to slowing diabetes’ progression, and every diabetologist will prescribe dietary adjustments and at least half an hour’s physical exercise five times a week in addition to weight management steps.
The first line of treatment for type 2 diabetes consists of dietary changes and exercise, which help people with diabetes lose weight, improve the way their bodies make and use insulin, and lower blood glucose levels
“The first line of treatment for type 2 diabetes consists of dietary changes and exercise, which help people with diabetes lose weight, improve the way their bodies make and use insulin, and lower blood glucose levels,” says Dr Sarla Kumari, Specialist Physician and Diabetologist at Canadian Specialist Hospital. “Unfortunately, despite their best efforts, many people either cannot lose weight or cannot maintain their weight loss, or their blood glucose levels are poorly controlled in spite of weight loss. For these people, drugs are the only alternative.”
With diabetes’ complex nature and its wide impact on the body, medical approaches are now determined on a case-by-case basis, so treatments suited to one person may not be prescribed for another, experts say. Depending on the severity of the disease, patients may need to consult a veritable phalanx of specialists, from endocrinologists or diabetes specialists to eye experts, foot doctors and nutritionists.
In type 2 diabetes, which comprises more than 90 per cent of cases, onset is dangerous and diagnosis is often delayed. As a result, complications may be present at the time of diagnosis and their frequency may increase over time.
Current treatment lines seek to keep blood sugar levels under control, while mitigating the impact of the disease on the body’s different organs. “Morbidity from diabetes is [largely] due to diseases affecting the eyes, kidneys and nerves,” Dr Igbal Mubarak Sirag, Specialist — Internal Medicine at Bareen International Hospital in MBZ City, Abu Dhabi. “In type 2 diabetes, which comprises more than 90 per cent of cases, onset is dangerous and diagnosis is often delayed. As a result, complications may be present at the time of diagnosis and their frequency may increase over time. Once present, the progression of these complications can be slowed with interventions such as aggressive management of blood pressure, lipids and sugar level. In addition to laser therapy for advanced eye disease linked with diabetes.”
Once medication is required, doctors usually turn to injectable drugs called GLP-1 receptor agonists, which can help control glucose levels by many ways including increasing insulin secretion, slowing the emptying of the stomach, reducing appetite and improving weight loss, Dr Sirag says.
Doctors may advise tablets in other cases. “Another more recent class of medication is in the form of an oral tablet taken once a day, called an SGLT2 inhibitor,” adds Dr Al Sibai. “It will reduce the amount of glucose being absorbed in the kidneys so more glucose will be passed in the urine; this reduces blood glucose levels and induces weight loss.”
Dr Kumari points to a new class of oral diabetes drugs introduced in 2006 and prescribed for people with type 2 diabetes who have not responded well to older formulations such as metformin, which reduces glucose production in the liver, and sulphonylureas, which stimulate the pancreas to produce more insulin. “DPP-4 inhibitors also known as gliptins are effective in lowering blood glucose levels and, because they can help reduce appetite, may be beneficial for people needing to lose weight. [They are effective], if combined with metformin,” explains Dr Kumari.
Both classes are available in the UAE, and are advocated depending on the severity of the case. Yet another modality is surgical intervention to reduce the size of the stomach.
However, whether or not in combination with drugs or surgery, lifestyle modifications remain fundamental to managing diabetes, as does continued self-education about the chronic disease and its progression. “Patients should have follow-ups every three months and need to have their blood pressure and cholesterol under good control to reduce the complications of diabetes,” says Dr Al Sibai.