Diabetes mellitus is a medical condition that affects millions of people worldwide. It reduces one’s quality of life. Finger pricks to monitor blood sugar are painful, inconvenient, and costly. Frequent urination disrupts one’s activities.
A diabetic’s weakened immune system makes him vulnerable to infections. Complications lead to reduced productivity, frequent hospitalizations, and shortened life expectancy.
During the initial checkup, a patient with elevated blood sugar is assessed first if the cause is diabetes mellitus type 1 or type 2. This has a bearing on the choice of drug therapy. In patients with type 1 diabetes, intensive treatment with insulin is the standard of care.
The patient’s age, weight, body mass index, life expectancy, kidney function status, and liver function are also recorded. The physician has to check if there are already complications due to diabetes, or if there are other illnesses that are already coexisting. All of these data are needed in formulating drug therapy if the person’s diet and lifestyle modifications fail to control blood sugar or reduce weight in an overweight diabetic patient.
The two goals of treatment in diabetes are to control blood sugar and to manage cardiovascular risk factors. Treatment starts with patient education to explain the goals. The blood tests needed in monitoring, the frequency of testing, and medical checkups.
Success in attaining the goals of blood sugar control, weight loss and prevention of complications depends on the patient’s understanding of the illness and on his compliance to the physician’s instructions.
The choice of a drug is tailored to the patient’s unique clinical data and characteristics. Patient’s choice is allowed if the clinical situation allows it. Some patients refuse to use insulin because it is injected and sometimes because of misconceptions about the drug.
The cost of the medication is also a factor. If it is not contraindicated in a diabetes patient who is asymptomatic, the drug used for initial treatment is metformin.
In recent years there were studies which showed the benefits of certain drugs in type 2 diabetes where management of overweight or obesity is an added treatment goal, or if there are coexisting cardiovascular risk factors or complications. These newer drugs decrease the risk for serious complications of the disease like heart attack, heart failure, kidney damage and kidney failure, stroke, frequent confinement, and the risk of dying from complications. The excellent results of these studies led medical experts to update guidelines and include the drugs as first line choice in the treatment of diabetes mellitus type 2.
The drugs include sodium-glucose cotransporter-2 inhibitors empaglifozin, dapaglifozin, canaglifozin, ertuglifozin, and bexaglifozin. When a physician makes his decision on which drug to use, the principles of evidence-based clinical approach is applied – which drug has good studies that show its benefits. These drugs have shown benefits not only in blood sugar control but also in weight reduction, heart failure, and kidney protection. These are costly and also have their side effects so the decision to use them needs to be discussed and explained to the patient.
Glucagon-like peptide 1 receptor agonists like semaglutide and liraglutide are the other new drugs. The dose for the control of blood sugar and for weight management differs. They are injectable but some brands are available in tablets. Side effects include nausea and diarrhea. In rare cases, pancreatitis or inflammation of the pancreas occurred.
May 6, 2024
