The International Diabetes Federation reports the increasing prevalence of diabetes worldwide, particularly in Asia, and the morbid finding that 44.9 percent of Asian patients with diabetes mellitus type 2 will die before the age of 60.
The deaths are largely due to heart disease, although diabetic patients are also at increased risk for kidney disease, stroke, severe infections, blindness, amputation and cancer.
All patients with diabetes need to understand this lifelong and progressive endocrine disease, so they will develop the discipline for healthy lifestyle, proper nutrition, strict adherence to medications, regular consultation and monitoring.
Doctors have the responsibility to keep up with developments in diabetes research. Huge efforts are dedicated to discovering approaches that improve the survival and quality of life of patients with diabetes.
The importance of combining strategies for lowering blood sugar to levels suited for each patient, controlling blood pressure, cholesterol, preventing blood clots and maintaining proper weight upon diagnosis of diabetes, and as it progresses, has already been proven to reduce rates of death and complications in long term trials.
Various diabetes drugs are well studied:
Metformin reduces heart disease and it appears to have a role for cancer prevention.
Insulin and sulphonylureas like gliclazide have been shown to prevent kidney disease, blindness, amputations.
Pioglitazone benefits patients who had prior stroke and those with inflamed liver.
Other classes of diabetes drugs, such as glucagon like peptide-1 receptor agonists, have been shown to also reduce death among those with heart disease and improve inflamed liver, while the dipeptidyl peptidase-4 inhibitors have at least been shown to be safe for the heart, kidneys and liver.
Recently, the medical field has been impressed by the protective effects of a new class of diabetes drugs—the sodium-glucose transporter 2 (SGLT-2) inhibitors. This class of drugs can lower blood sugar, lower blood pressure and lead to weight loss.
Results of studies on diabetic patients already suffering from heart disease show that empagliflozin can reduce death rates.
Strategy
The more recent and exciting information coming from the real-world experience in the United States, Germany, Sweden and the United Kingdom with 1.4 million diabetic patients show that canagliflozin in the US, and dapagliflozin in Europe (and Asia) also reduce death rates among diabetic patients with heart disease and even among those with no established heart disease.
These data will hopefully still be confirmed by stricter studies with longer follow ups.
The strategy in managing diabetes should be individualized to cover the patient’s needs, so different drugs may be given alone or in combinations.
Both the doctor and the patient should discuss options and use best judgment based on published, recognized scientific evidence instead of testimonies.
For now, with the SGLT-2 inhibitors, there is hope that prolonging the lives of our diabetic patients—making them live well beyond 60 years old with decent quality of life—is within our reach.
This article does not replace the advice of a health care professional. For symptoms related to type 2 diabetes, please seek consult of a physician.
Dr. Aimee Andag-Silva is a board certified internist and endocrinologist, and chief, endocrinology, diabetes and metabolism, De La Salle University Medical Center.
The A to Z of Health Information Advocacy is a joint initiative of a group of medical specialists and supported by AstraZeneca Philippines aimed at raising public awareness on various diseases and providing health information and updates to the healthcare community.