Kidneys: The new targets for type 2 diabetes mellitus treatment?
By:SjobergKho
Diabetes
undoubtedly is one of the most dreaded diseases. This lifelong illness can come
with a host of debilitating complications, including blindness, kidney failure,
heart attack and stroke. However, the good news is that these are largely
preventable through good control of blood glucose, blood pressure and
cholesterol levels.
The battle to
achieve good glycemic control is a major therapeutic challenge both for
healthcare professionals and their patients. The treatment starts with
healthy-living habits that include a balanced diet, 30-minute daily exercise
and 5- to 10-percent weight loss for overweight patients.
For decades,
medication to control blood glucose levels has centered on improving insulin
supply together with regimen that improves insulin sensitivity by the body.
Side effects like weight gain, hypoglycemia (low sugars), gastrointestinal
symptoms and edema have limited the optimal use of these older drugs. Over this
past decade, newer drugs that help regulate food intake and promote better
communication between the gut and the pancreas have led to improved glycemic
control. The latest drugs to join the market are a group of oral tablets that
make patients release excess sugars into the urine.
Yes, you read
that right! Where the kidneys just used to be candidates for complications,
they are now targets for treatment. For years, experts knew that high blood
glucose is partly due to difficulty in expelling excess glucose into the urine.
They have discovered the major route by which glucose is reabsorbed by the
kidneys, called sodium-glucose transporter-2 (SGLT-2). Blocking this pathway
increases glucose excretion; hence the SGLT-2 inhibitors were invented.The
SGLT-2 inhibitors or the “gliflozins” excrete about 70 grams a day of glucose
into the urine. Seventy grams of glucose translate to a loss of almost 300
calories a day leading to an average of 2- to 3.5-kilogram weight reduction in
most clinical investigations. The weight loss includes some reduction in body
fat. Hypoglycemia is rare and mild with the gliflozins. They also have the
benefit of modest blood pressure reduction of 3 to 5 mm Hg. The excess sugar in
the urine however has been associated with a slight increase in genital yeast
infection and urinary tract infection, both of which are easily treatable with
a low chance of recurrence.
They can be
used alone or in combination with insulin or other oral antidiabetic
medications. Dapagliflozin, the first SGLT-2 inhibitor in the Philippines, has
been a welcome addition to the list of pharmacologic choices available for
patients with type 2 diabetes but not approved for use in type 1. It is
currently available only through prescription by a physician after an
evaluation. These are exciting times as we expect and watch out for more
medications that will soon be available.Dr. SjobergKho is the immediate past
president of the Philippine Society of Endocrinology, Diabetes and Metabolism.
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.
Reference:
12:12 AM
August 08, 2015
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Reaction
paper:
It’s really
great that researchers had found a new medication for the management of
Diabetes Mellitus. We’ve known that this chronic condition causes a host of
complications such as blindness, amputation, cardiovascular disease and chronic
kidney damage due to poor glycemic control. The standard pharmacologic
management of this condition has always been insulin (Type 1 DM) and oral /
injectable hypoglycemic agents (Type 2 DM).Long- term complications of diabetes
develop gradually. The longer you have diabetes (not controlling your blood
sugar), the higher the risk of complications. Eventually it may be disabling or
life-threatening. This new type of drug promotes the excretion of excess sugar
in the blood, enabling diabetic patients to maintain normal blood sugar levels.
My grandfather from the maternal sidehad Type 2 Diabetes Mellitusfor many
years. He is very fond of sweets so my aunt needs to monitor his blood sugar
level regularly and regularly take his oral hypoglycemic medications. But, unfortunately
he died early this year due to pneumonia which is difficult to treat because of
his condition. I can truly relate to this condition because it runs in our
blood and we must really watch what we eat and have a balanced lifestyle.
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