Half of the over 37 million people worldwide with type 2 diabetes have no idea they have the disease. That’s because type 2 diabetes often has no noticeable symptoms. Its telltale signs usually appear when the disease is already fairly advanced: frequent urination, excessive thirst, increased hunger, weight loss, tiredness, a tingling sensation or numbness in the hands or feet, blurred vision, frequent infections and slow-healing wounds.
Risk factors include poor diet, lack of physical activity, overweight and obesity, first degree relative with type 2 diabetes, and hypertension. Individuals with prediabetes (also called impaired fasting glucose or IFG) and women who developed gestational diabetes during pregnancy are also at increased risk for type 2 diabetes.
Type 2 diabetes can be prevented by adopting a healthy lifestyle, particularly maintaining a healthy weight and being physically active. Aim for at least 30 minutes of daily exercise, such as brisk walking, swimming, cycling or dancing. Regular walking for at least 30 minutes per day has been shown to reduce the risk of type 2 diabetes by 35 to 40 percent.
Early detection is crucial in preventing the serious, multi-organ complications of diabetes. Doctors should evaluate all their patients annually for risk factors for prediabetes and type 2 diabetes. Laboratory testing for diabetes and prediabetes is recommended for individuals with any of the risk factors for type 2 diabetes mellitus. Testing should be considered for all adults over 40 years old; consider earlier testing if the individual has at least one other risk factor.
Treatment requires lifelong blood sugar treatment, healthy eating and regular exercise. Diabetes medications and insulin will be prescribed if diet and exercise are not able to achieve target blood glucose levels. People who are newly diagnosed will be prescribed metformin, which improves body tissue sensitivity to insulin and lowers glucose production in the liver. When metformin is not enough to control blood sugar levels, other oral or injectable diabetes medications may be added.
There are a variety of oral diabetes medications that can be combined with metformin. Sulfonlyureas such as glipizide, glyburide and glimepiride, stimulate the pancreas to produce and release more insulin. Acarbose blocks the action of enzymes that break down carbohydrates in the intestine. Pioglitazone reduces insulin resistance and improves insulin sensitivity. Gliptins (e.g. sitagliptin, saxagliptin, linagliptin) block an enzyme that destroys incretin, a hormone that helps the body produce more insulin only when it is needed and suppresses insulin when it is not needed (when glucose falls too low). Incretins also suppresses glucagon production from the alpha cells of the pancreas. Glucagon contributes to increases in blood glucose in diabetics by increasing hepatic glucose production in the fasting and postprandial states. When blood glucose levels fall too low, the alpha cells of the pancreas secrete glucagon to make the liver convert stored glycogen into glucose which is then released into the bloodstream. These two complementary effects of incretin on the beta cells and alpha cells of the pancreatic islets prevent hypoglycemia, making it favorable for use in most type 2 diabetic patients including the elderly.
A new class of injectable, non-insulin diabetes medicine with an innovative mechanism of action has recently been developed. Incretin mimetics increase the levels of incretins while reducing the rate at which the stomach digests food and empties, which can help reduce appetite. Victoza (liraglutide) is a once-a-day injectable incretin mimetic developed by diabetes care leader Novo Nordisk.
In clinical studies, most people taking liraglutide were able to reach the recommended A1C goal of less than 7 percent. The A1C test measures average blood sugar level over the previous two to three months. A 2-year clinical study has demonstrated that liraglutide helps lower blood sugar as soon as two weeks—and keeps it down. Liraglutide taken alone or in combination with other diabetes medications has been shown to lower A1C by an average of 1.0 to 1.5 points. Even a 1-point drop in A1C is important in the management of type 2 diabetes.
(Dr. Mary Anne Lim-Abrahan is an endocrine and metabolism specialist. The “Changing Diabetes” column commemorates the 92nd anniversary of insulin’s discovery. It aims to increase awareness on diabetes prevention, diagnosis and management. Novo Nordisk supports “Changing Diabetes.” Headquartered in Denmark, Novo Nordisk is a global healthcare company with 90 years of innovation and leadership in diabetes care. For questions or comments, e-mail changingdiabetesph@gmail.com.)