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September 20, 2015

The Ups and Downs of a Diabetic’s Life

Managing type 2 diabetes can be a tall order for anyone — but help has arrived

With the various risks and complications associated with the condition, a type 2diabetes diagnosis imposes a heavy burden on patients and their families. Itmeans that many things about the patient’s way of lifewill have to change, and that the host of challenges brought on by the disease will have to be handled head on.

Patients will first have to deal with the various symptoms of type 2 diabetes such as increased thirst, frequent urination, increased hunger, weight loss, fatigue, blurred vision, slow healing sores or frequent infections, and patches of darkened skin known as acanthosis nigricans.

Thehealth complications that may be caused by the disease are another source of worry. Among these are a number of life-threatening illnesses frequently associated with diabetes such as kidney disease and various cardiovascular diseases that can lead to heart attack and stroke.

“Between managing the condition each day, the sometimes overwhelming symptoms, and worrying about cardiovascular complications, patients with type 2 diabetes have a lot to deal with,”saysDr. Mary Anne Lim Abrahan, Professor at the Section of Endocrinology, Diabetes and Metabolism of the University of the Philippines College of Medicine. “It’s important for patients to be as positive and as disciplined as possible.”


The big challenge

Many physicians recommendthat patients commit to a number of lifestyle-related changes to manage the disease. These include maintaining a healthy body weight; avoiding fatty, non-nutrient dense foods; replacing refined carbohydrates with fiber-rich wholegrain foods; and exercising at least 150 minutes each week.

These adjustments are meant to address certain treatment goals for patients with type 2 diabetes – achieving near-normal blood sugar levels; attaining healthy lipid levels in the heart; preventing complications such as heart and kidney disease; achieving healthy weight; and promoting overall good health.

And of course, there is the need to take any possible medication prescribed by doctors. 


TECOS – a source of comfort and reassurance 

There however has been some concern on the part of doctors about any additional risk that might be posed on the cardiovascular system of type 2 diabetics by anti-diabetes drugs. This is understandable, as the disease itself already increases a patient’s risk for cardiovascular events. For this reason, the United States Food and Drug Administration, in 2008, started requiring new anti-diabetic medications to conduct studies on cardiovascular safety.

The University of Oxford Diabetes Trials Unit and the Duke University Clinical Research Institute recently released the results from one of such studies. Known as TECOS (Trial Evaluating Cardiovascular Outcomes with Sitagliptin) to its proponents, it assessed the long-term cardiovascular safety of Sitagliptin, a dipeptidyl peptidase-4 (DPP-4) inhibitor. 

DPP-4 inhibitors work by prolonging the activity of the hormones called incretins, which are released in the gut in response to a meal. These incretin hormones help control blood sugar by signaling the pancreas to release appropriate amounts of insulin that are needed by the patient. At the same time, incretins also direct the liver to regulate sugar production. These actions help patients control blood glucose with a lower risk for hypoglycemia (very low blood sugar level), which itself could be harmful.

For TECOS, 14,671 type 2 diabetic patients with documented cardiovascular disease from 38 countries were given either Sitagliptin or a placebo on top of their usual anti-diabetic medications. After an observation period of about 3 years, results showed that sitagliptin did not increase the combined occurrence of cardiovascular events (death, heart attack, stroke, hospitalization due to angina) versus the placebo. Moreover, rates of hospitalization due to heart failure, an increasing concern among diabetic patients, did not increase compared to the placebo group.

“The results of TECOS reassures us that Sitagliptin can be safely used by patients with type 2 diabetes to lower blood glucose,”says Dr. Leni Iboleon, chair of the Philippine Heart Association Council on Women’s Cardiovascular Health. “Because these patients already face great risk for cardiovascular complications, a good understanding of the safety of these medicines is very important.”

“These findings are a great boon for patients with type 2 diabetes,” adds Dr. Abrahan. “To rest easy with the knowledge that their medicines are effective and safe makes the disease much more manageable. This is a very important thing, as it directly affects the quality of life of patients.”

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