“We can’t put our heads in the sand any longer with regard to aggressively treating diabetes,” said Dr. William T. Cefalu, chief, Division of Nutrition and Chronic Diseases, Pennington Biomedical Research Center of the Louisiana State University System, USA, during his recent lecture before the officers and members of the Philippine Lipid and Atherosclerosis Society (PLAS) and the Philippine Society of Hypertension (PSH) entitled “Changing Paradigm: Need for Early Aggressive Management in Type 2 Diabetes.”

"Diabetes is marked by the progressive decline in insulin (hormone that lowers glucose or blood sugar levels) production or beta-cell function. The islets in the pancreas have two main cells for the control of sugar – the beta-cell that secretes insulin (to lower blood sugar), and the alpha-cell that secretes glucagon (to raise blood sugar when the body needs more). So when a person is diagnosed to have diabetes, 50% of the beta-cell function has been compromised," Dr. Cefalu explained. Experts today are now paying more attention to the role of controlling glucagon (hormone that causes the liver to produce glucose or blood sugar) in the  management of type 2 diabetes.

“Type 2 diabetes is a problem of the pancreatic islet cells (beta- and alpha- cells). When you have type 2 diabetes, you under-produce insulin but you also don’t suppress the glucagon, secreted by the alpha cell. Thus, there is reduced beta-cell function (insulin production) and unsuppressed alpha-cell function (glucagon production). Studies have shown that incretins (such as Glucose-dependent GLP-1) are able to restore islet-cell physiology. It can improve beta-cell function by increasing insulin secretion, yet suppresses the glucagon which contributes to the elevated glucose after a meal,” Dr. Cefalu pointed out.

He added that "In one comparative study, patients on metformin (the gold standard in diabetes management) were given either sitagliptin or glipizide. Results showed that sitagliptin once-daily had a similar glycemic efficacy (ability to lower blood sugar levels) to glipizide when added to metformin with a significant reduction in glucose A1C levels (-0.67%)."

"Although sitagliptin’s and glipizide’s performances were similar in terms of lowering glucose levels, the study showed that sitagliptin had a better safety and tolerability profile. Over the 52-weeks, patients using glipizide-metformin gained body weight, while those on sitagliptin-metformin maintained or even lost some body weight. As to hypoglycemic events (sudden drop in blood sugar level), the study revealed that only 4.9% of those on sitagliptin-metformin therapy experienced hypoglycemia, as compared to a much higher 32% of those on glipizide-metformin."

Dr. Cefalu added that aggressive control of blood sugar is needed to reduce the complications of diabetes, and that use of the newer medications, which have potential to have less adverse effects, will most likely be used earlier in the management regimen.  He reiterated that doctors around the world acknowledge that weight gain and hypoglycemia (sudden drop in blood sugar level) are two common problems in diabetes management so he encouraged the Filipino doctors to look for new and better treatment options in managing type 2 diabetes which offer better safety and tolerability profiles.

New direction in managing diabetes

Diabetes remains to be a growing global burden. According to statistics, there are 246 million people with diabetes worldwide. By year 2025, it is expected to affect 380 million.  Based on current figures, the projected increase would be 108% in South East Asia, 79% in Western Pacific. According to Dr. William T. Cefalu, chief, Division of Nutrition and Chronic Disease, Pennington Biomedical Research Center of the Louisiana State University, that given this alarming diabetes statistics,  the objective is not just to manage diabetes, but to prevent it. He added that there is a new direction in diabetes management, particularly with incretin enhancers to manage type 2 diabetes.

New direction in managing diabetes

Diabetes remains to be growing global burden. According to statistics, there are 246 million people with diabetes worldwide. By year 2025, it is expected to affect 380 million.  Based on current figures, the projected increase would be 108% in South East Asia, 79% in Western Pacific. Given this alarming diabetes statistics, the objective is not just to manage diabetes but to prevent it, said Dr. William T. Cefalu, chief, Division of Nutrition and Chronic Disease, Pennington Biomedical Research Center of the Louisiana State University. He added that there is a new direction in diabetes management, particularly with incretin enhancers to manage type 2 diabetes. Photo shows (from left): Cardiologist and symposium moderator Dr. Louie Go; symposium reactor Sjoberg Kho; guest lecturer Dr. William Cefalu; and MSD Philippines business unit director Dr. Beaver Tamesis.