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New Developments in Management of Diabetic Medicines

Latest progress in diabetes medicine and technology.

Diabetes is a lifelong ‘lifestyle disease’ affecting more than 380 million people all over the world, more than 65 million of these live in India. Only China has higher number of diabetic people (more than 95 million) than India. By the year 2030, India will have 109 million diabetic people.

The lifespan of diabetics is about 5-10 years shorter than that of general population. This is due to early cardio vascular mortality, particularly in those who are unable to control their blood sugar and associated conditions such as blood pressure and blood cholesterol. About 2/3rd of diabetics die due to macro vascular diseases, which are diseases of large blood vessels such as,

 

  • coronary artery disease  resulting in heart attacks and heart failure
  • cerebro vascular disease resulting in paralytic stroke
  • peripheral vascular disease resulting in gangrene of leg and foot.

 

Among those who die from macro vascular diseases, 2/3rds die due to coronary artery disease and remaining 1/3rd due to cerebro vascular disease and peripheral vascular disease.

 

The understanding of this disease has increased by leaps and bounds and medical research has identified multiple causes for its origins and hence there are many intervention tools available with the physician. Obviously all new tools are not the best for a given patient and age old remedies are still going to stay put. Before we go to these tools we must understand the peculiarity of the patients. They are as follows:

 

  • Trunkal and visceral obesity 
  • High post prandial sugar largely due to carbs-centric diet
  • Early onset of diabetes related complications of blood vessels 
  • Changing life style, affluence and lack of exercise.

 

The New Drugs

Addressing these issues becomes a challenge in treating Indian diabetics with conventional drugs and hence newer molecules have been researched upon:

 

1. Glitazones

They address insulin resistance. Some of the drugs under it are excellent, such as  Pioglitazone and Rosiglitazone but create a major problem of weight gain and water retention. Rosiglitazone is not available for use in India now.

 

2. Gliptins

These drugs act through a mechanism which enhances the action of a gut hormone known as GLP-1. They not only make the insulin more efficient but also suppress glucagon, hence prevent over production of sugar by the liver. They are also known as DPP4 inhibitors. Examples of this class of drugs are Sitagliptin, Vildagliptin, Saxagliptin,Linagliptin and Telenigliptin. These drugs have been in use for quite some time and do not produce weight gain. 

 

3. GLP- 1 agonist analogues

These are novel drugs but available only in injection form. The drugs formally available, like Exanatide and Liraglutide were successful in controlling blood as well reducing weight and needed to be given daily. A new drug which belongs to the same class is known as Dulaglutide, which is effective even if given once a week, recently marketed by Lilly. Many trials done on this drug show promising results both in terms of blood sugar and weight reduction. Truly basal insulin which give a 24hour control of blood sugar have been available for quite some time and because of its properties of long term control of diabetes resulting into reduction of HbA1C and lesser chances of hypoglycaemia in the night have made them quite popular. The devises for injection of insulin have increased the compliance of the patients. The basal analogues are known as Glargin and Degludec.

 

4. SGLT-2 INHIBITORS

These agents are novel in the way that they make a diabetic pass more urine and throw away the excess sugar in the urine. SGLT 2 is an enzyme that is responsible to reabsorb the glucose which is eliminated by the kidney. Almost 180 gm of glucose is lost by these drugs and along with that a lot of water is also lost. In a diabetic glucose reabsorption is increased, thereby adding extra load to the body. Examples of these drugs are Dapagiflosin, Cana Gliflosin and Empagliflosin.  
The only problem with them is frequency of urination and increased chances of urinary infection in people who are known to have tendency for these infections. These drugs can produce weight loss and systolic BP reduction which may be desirable.

 

CGMS (continuous glucose monitoring system) is an amazing technology, but it only measures interstitial blood sugar and not capillary blood sugar. There is a lag of 20 minutes between these 2 sugars. It is very tempting for the patient to use this small disc which is attached to the arm and reading is observed on a computer graph, which gives you 15 day readings taken every 15 minutes. This gives you good information about the time, action profiles of various drugs and insulin, and their inter play with patient activities and food intake.

 

Diet still remains the corner stone of the treatment and there are lot of new advances in nutritional management. Life style modifications with increased physical activity and stress management are equally important tools which cannot be forgotten.

 

Dr. Anil Bhoraskar, Honorary Diabetologist, S.L. Raheja Fortis Hospital, Mahim

 

Box:

 

A Diabetes Companion app

 

This app allows users to manage their diabetes and enables them to regularly monitor and track their vital health parameters like receive reminders to track blood sugar, blood pressure, HbA1c, insulin intake, meal deviations and activity duration. Also, users can add doctor and have their vitals and medical reports reviewed by them on-the-go, and receive their response to any question on diabetes care. Using HealthPlix, doctors can closely monitor the blood sugar values entered by their patients, and zero-in on the right combination/dosage of oral anti-diabetic medicine and/or insulin. In a nutshell, it aids the doctors in identifying the treatment plan that works for a patient.

 

Raghuraj Sunder Raj, CEO and Founder of HealthPlix tells us that around 900 patients are connected to doctors through the app for their everyday management of blood sugar (patients include GDM, Type 1 diabetes and Type 2 diabetes who are insulin dependent among others).

 

“HealthPlix is not an online consultation platform in the conventional sense. It is a platform designed to augment the existing care setup and make it well-suited for the needs of management of chronic diabetes,” says Raj. 

 

 

Administrator

Diabetic Living is the only lifestyle magazine that demonstrates how to live fully each and every day while managing diabetes.