A LOT of individuals with diabetes think or have been made to think that it is their fault that they have diabetes. While this is partly true—because poor lifestyle habits do increase a person’s risk of getting diabetes—research has shown that genetics play a big part. Dr. Ricardo Fernando, the Father of Philippine Diabetology, has often quoted in his lectures that, “genes load the canon, but lifestyle lights the fuse” and “prevention is the key.”
So, what do we do now?
In persons at high risk (with family history of diabetes, overweight/obese, physically inactive, etc.), prevention is still possible. Simply put, this means eating a healthy diet and engaging in 30 minutes of physical activity, five days a week. The Diabetes Prevention Program found that people who did this lifestyle change were able to cut their risk of developing diabetes by more than 50 percent.
For those already diagnosed with diabetes, there is also hope, but some issues have to be addressed. First, patients need to realize that even if diabetes is not entirely their fault, it is their responsibility. Second, complications are caused by high blood sugars in tandem with high blood pressure and abnormal cholesterol levels. These should all be controlled to prevent complications. Third, there should be acceptance that diabetes is a progressive disease and hence, there is a need for progressing therapy. Diabetes is not a stagnant disease, it evolves and therapies have to progress as well. The United Kingdom Prospective Diabetes Study showed that with appropriate and progressive treatment, diabetic complications could be reduced.
We have many proven treatment options for diabetes, but these medications need to be used for it to work. A patient is not getting worse when multiple medications are used and treatment is intensified. We are just addressing the many metabolic defects and the natural history of diabetes. Medications must be allowed to help us share the burden in treating diabetes.
Today, we have many drugs available. Selection depends both on the patient and the drug characteristics. Individualization of therapy to suit each type of patient is important. There is no one drug for all. For example, if the diabetic is obese, then the medication should also help the patient lose weight. Initial treatment options ideally should include agents from drug classes that could help the patient lose weight, like SGLT2 inhibitors or GLP-1 receptor agonists. These are prescription medications and consultation with health care professionals is encouraged.
Evidence supporting such approaches for diabetes is compelling and evolving. The future holds the promise that eventually people with diabetes will have longer and better lives, if they actively and seriously take control of their diabetes early.
Dr. Rima Tandico-Tan is the president of the Diabetes Philippines Inc. and the past president of the Philippine Society of Diabetologists Inc. 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.