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Doubling Down on Diabetes

A novel combination therapy to manage the condition

Glucose level blood testDiabetes mellitus (DM) is increasing in epidemic proportions all across the world. The health risks are well known. DM significantly increases the risk of coronary heart disease, kidney disease, amputation and eye disease in affected people. Fortunately, if the condition is detected early and treated, the risks of developing these complications can be significantly reduced.

Isn’t diabetes just about high sugars?

Yes and no. Although it is well known that the hallmark of diabetes mellitus is the presence of high sugars in the bloodstream, the mechanism of development is complex – a combination of the body’s inability to react to insulin effectively and the failure to produce sufficient amounts of insulin to cope with this need. This develops over time.

The natural history of type 2 diabetes mellitus (T2DM) is well documented. Years before the disease is even diagnosed or detectable from routine blood tests, a cascade of pathologies occur. These include increasing muscle and liver insulin resistance, pancreatic cell hypertrophy, incretin (a group of metabolic hormones) deficiency and relative insulin resistance. By the time most patients develop T2DM biochemically, more than 50% of their pancreatic beta cell function has already been lost.

Worse yet, as the disease is asymptomatic, many people are not diagnosed until much later and may have already developed complications. Immediate action is therefore crucial.

Why do complications develop?

Rather than viewing our health problems as single issues, such as “I have high blood pressure” or “I have high blood sugars”, it is better to view oneself holistically. Before diabetes develops, problems are already developing within the body muscles, liver, pancreas and blood vessels. Studies have shown increased inflammation in the body and changes within metabolic function long before blood sugars start to rise. Perhaps we should view diabetes as a disorder of the body which is characterised by high blood sugars, but is associated with many other physiological abnormalities.

So how should I approach my care of diabetes?

Management of diabetes today is an integration of healthy lifestyle, dietary manipulation and very often, pharmacological therapy. It is important that each individual’s care has an acceptable balance and a tailor-made treatment.

Pharmacological treatment can be complex. There are currently eight different therapies in diabetes therapy, each working in a different manner. Therefore, it is important that the correct medication is used. Medication must be easy to take and not disrupt an individual’s lifestyle – side effects should not impair quality of life.

Many medications in diabetes do not address the disease process, and many are associated with complications such as hypoglycaemia (when blood sugars drop too low) and weight gain.

DPP-IV Inhibitors and Metformin

A common combination therapy prescribed today includes using DPP-IV inhibitors and metformin combinations such as Janumet XR. The advantage is that it can address the main abnormalities in diabetes, including addressing body insulin

resistance and improving pancreas (the organ that produces insulin) function. Whilst many medications only target one abnormality, a combination approach allows

several systems to be targeted. This approach can regress of even halt the progression of rising blood sugars commonly seen in diabetes mellitus.

Studies have shown that DPPIV inhibitors may improve kidney function and possibly protect the pancreas in people with diabetes. The additional benefit of novel therapies such as Janumet XR, other than providing excellent glucose reductions, is that they do not result in hypoglycaemia and weight gain. Administered just once a day, it is also extremely convenient to take.

Diabetes mellitus is a complex multi-system disease characterised by high blood sugars. It is important that the proper treatment is given in an individualised and effective manner when addressing this disease.

The combination metformin and DPP-IV inhibitor (Janumet XR) is a welcome addition to the currently available medications in the fight against diabetes. I advise all people with diabetes who are interested in learning more about this novel treatment to discuss it with their healthcare professional.

Dr Ben Ng Jen Min is a consultant Endocrinologist in Arden Endocrinology Specialist Clinic in Mount Elizabeth Novena and a visiting consultant in Changi General Hospital. He is also an Adjunct Assistant Professor of the Yong Loo Lin School of Medicine, and Adjunct Assistant Professor of DUKE-NUS.
Posted by ezyhealth on Mar 31 2015. Filed under Health. You can follow any responses to this entry through the RSS 2.0. Both comments and pings are currently closed.

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