By Reema Patel, MD, as told to Alyson Powell Key
Back in the day, all we talked about was how to get patients' blood sugars lower because that's the only way we knew how to help. But in the past decade, there’s new research that shows that we shouldn’t treat diabetes using tunnel vision and just focus on blood sugar.
We also need to see what other medical conditions people have because they impact our decision in choosing what treatments we should use to manage diabetes. If a person has cardiovascular disease, there are a lot of diabetes medications for diabetes available to reduce their risk of death from cardiovascular disease.
An Evolving Approach to Diabetes Management
A decade or two ago, we had a handful of medications and classes of drugs. We’re lucky to now live in a time where we have so many treatment options to choose from.
There’s been a tremendous surge in research and availability of many new drugs and classes, particularly SGLT2 inhibitors, and noninsulin injectables like the GLP-1 and combined GLP-1 and GIP inhibitors. There are also new insulin analogs, which are lab-created forms of insulin that are altered to act faster or longer than injections of human insulin. All these drug classes have been a game changer for diabetes.
There’s also been a complete change in how people check their blood sugars and how much information doctors are able to have with the new CGMs, or continuous glucose monitors. This information regarding their blood sugar empowers people to make decisions regarding their health on a day-to-day basis.
In the world of insulin pumps, a majority of the ones now available have smart technology. They use dynamic, real-time data from your body and the CGM to continuously adjust how much insulin the insulin pump provides. The pump stops, continues, increases, or decreases the amount of insulin that you receive.
This has enabled more diabetes control for people, prevents hypoglycemia, or low blood sugar, and also significantly increases quality of life. People are now able to prevent severe hyperglycemic and hypoglycemic episodes to a much better extent. Our outlook is really changing from being reactive to proactive.
How GLP1s Have Changed Outcomes
These drugs have completely changed the face of diabetes management in the past decade. They not only help diabetes management but also help people lose weight. This in turn helps their other metabolic measurements like blood pressure, cholesterol, and sleep apnea. There’s a substantial improvement in A1c, which is the hemoglobin A1c or average blood sugar over the previous three months. We also see their systolic blood pressure go down.
Some of these medications are approved and indicated for weight loss, and we do see people lose weight. Studies are ongoing for some of these drugs, but they also have the potential to protect against fatty liver disease, which is now known as MASH, or metabolic dysfunction-associated steatohepatitis. So these drugs protect your heart and overall metabolic health as well as your A1c.
The Role of Technology in Diabetes Management
Continuous glucose monitors have been an absolute game changer for patients as well as providers. There are remote blood pressure and weight monitoring devices available that can help provide and transmit important information about your health to your doctor.
We offer telemedicine services in place of in-person visits when needed. We started using this in 2020 during the pandemic and there’s no going back. This has helped a lot of people to keep their follow-up visits who otherwise may have missed them because they’re physically unable to come into the office.
There is a lot of genomic testing and metabolic data that reveals hidden information that otherwise may be missed. Coronary artery CTA can be used to analyze plaques. This uses an AI technology for analyzing the data. These tests have saved the lives of people who otherwise may have suffered a major and or acute and life-threatening cardiovascular event.
Diabetes Research or Innovations to Watch
There’s a lot of exciting stuff coming up; diabetes research is evolving. A couple of things I’m watching closely are the triple agonists — GLP-1, GIP, and glucagon. Although studies are still ongoing for them, they’re expected to provide even better A1c and weight reductions. Along with this, they can offer more improved metabolic benefits like improved blood pressure and cholesterol than the agents currently available.
The thing I’m most excited about, however, is the artificial pancreas or the closed-loop system, which will have an AI-powered algorithm. The insulin pump will be able to contain both insulin and glucagon.
Knowledge Is Power
One of the biggest problems with diabetes is that it’s a silent disease, just like high blood pressure and high cholesterol. Chronic diseases, unfortunately, don't cause symptoms unless they become very severe or complications arise. For example, if your sugars are high but you’re not checking them, it doesn't necessarily mean that you're OK. The issue won’t go away.
Use your knowledge as power. Use the various tools that we have in this day and age and gather data regarding your sugars, weight, and blood pressure. Be your body's own scientist and researcher since you’re the one that can best figure out on a day-to-day basis how your body is reacting to different foods, stress, change of sleep pattern, etc.
One of my biggest challenges in working with people with diabetes is to help them realize that it’s not only important to get to a goal A1c, but to stay there for as long as possible. Next comes learning that not only do you need a goal A1c, but also to understand and manage other conditions you may have that also play a role in increasing the risk of cardiovascular disease and stroke.
Also, side effects are part and parcel of any medication that we give. So if one drug or one dose of a drug fails or causes side effects. I tell my patients, “Don't give up.” If plan A doesn't suit you, we'll try plan B. If that doesn't work, we'll try plan C. We’re lucky to live in a decade where so many treatment options are available.
And lastly, I always tell them I can do more. Every visit, we analyze and reanalyze since the human body changes over time. So keeping up with follow-up visits is as important as making that initial one.
Show Sources
Photo Credit: Westend61/Getty Images
SOURCES:
Reema Patel, MD, diabetes and metabolism endocrinologist, Old Bridge Medical Center, Old Bridge, NJ.
JAMA: “GLP-1 Medications May Lower Dementia Risk, Research Shows.”
International Journal of Molecular Sciences: “GLP-1 Receptor Agonists in Non-Alcoholic Fatty Liver Disease: Current Evidence and Future Perspectives.”
FDA: “FDA Clears New Insulin Pump and Algorithm-Based Software to Support Enhanced Automatic Insulin Delivery.”
American Journal of Kidney Diseases: “Glucagon-like Peptide-1 Receptor Agonists: New Evidence of Kidney and Cardiovascular Protection From the FLOW and SELECT Trials.”
Diabetes UK: “Analogue Insulin.”
Endocrinology and Metabolism: “The Road towards Triple Agonists: Glucagon-Like Peptide 1, Glucose-Dependent Insulinotropic Polypeptide and Glucagon Receptor - An Update.”
