Where are we now, where are we going in diabetes treatment?
Our understanding of diabetes especially the mechanism why it develops and progresses made great leaps in diagnosis and treatment. From 1921, when Banting and Best discovered insulin, to 1955, when the first oral medication called the sulfonylureas was discovered, several other discoveries have been made that offered better ways to manage diabetes and prevent complications.
In 1993, the landmark trial Diabetes Control and Complications Trial provided us insights that diabetes complications can be prevented provided good control of sugar is achieved. Aggressive control of blood sugar was then possible due to newer modalities available including longer-acting human insulin and insulin pumps.
By mid 1990, metformin became available in our country, followed by acarbose and the thiazolinediones. Later in 1990s, the discovery of the incretin hormone, the glucagon-like peptide-1 led to the discovery of better and safer drugs.
The injectable GLP1 drugs that are available in the market are exenatide and liraglutide. They work by increasing insulin production in response to a meal, and have the advantage of suppressing appetite and therefore weight loss.
The oral forms of incretin therapy are the DPP4 Inhibitors. They inhibit the protein dipeptidyl peptidase-4 that breaks down GLP1 in circulation and therefore increases the level of GLP1 in circulation that results in glucose-lowering effect. They are safer than sulfonylureas, with lesser risk of hypoglycemia and are weight-neutral.
The newest kid on the block is the drug dapagliflozin. At present this is the only available SGLT2 inhibitor in the country that acts by blocking sodium-glucose transporter 2 that mediates the reabsorption of glucose in the kidney. By its action, one pees out approximately 70 grams of glucose, or equivalent to 280 calories, per day. It helps patient get better glucose control, has a good safety profile and has one big advantage over other medications as it can help patients lose weight.
Recently, the inhaled form of insulin has been approved and launched in the US market, which promises to be fast-acting and more convenient than daily injections. However, concerns exist regarding risks of breathing powdered insulin. It is likewise costlier than injectables. What I really hope that will become a reality soon, is now in the early phase of research, which is the oral form of insulin.
The future in diabetes treatment choices is bright as more and newer drugs are being developed. However, diabetes treatment will continue to rely on the holistic approach to managing the disease including lifestyle modification and weight management. Together with patient education and patient empowerment, they will continue to be the keys to developing a more productive and successful treatment regimen that will ensure a complication-free quality of life to every Filipino.
Dr. Gerry Tan is an endocrinologist, chief and professor of Medicine, Section of Endocrinology, Diabetes and Metabolism, Cebu Doctors University Hospital-Cebu Doctors’ University College of Medicine. 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.
