NSG-533 Diabetes/Endocrine Topic Discussion
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Recent data indicates that 85.6% of adults with diagnosed diabetes are treated with Diabetes medication. Results from the National Health and Nutrition Examination Survey (NHANES) indicate that only about 50% of American adults with Diabetes are achieving HbA1c <7.0% (<53 mmol/mol) (Edelman & Polonsky, 2017). Modern day medicine and guidelines from the American Diabetes Association (ADA) have spent an enormous amount of time and resources to prove that certain classes of medications are best served to treat diabetes. It is argued that therapeutic interventions that target hyperglycemia but do not correct the underlying pathogenic disturbances are unlikely to result in a sustained benefit on the disease process, (Abdul-Ghani & DeFronzo, 2017).
Metformin is effective and safe, is inexpensive, and may reduce risk of cardiovascular events and death, (“Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes-2019,” 2018). While Metformin is an effective first line drug that offers several benefits such as cardiovascular protection, it lacks any effect on β-cell function, which is the primary pathophysiological disturbance responsible for progressive hyperglycemia in T2D patients, (Abdul-Ghani & DeFronzo, 2017). Medication and lifestyle changes should be introduced prior to adding a concomitant therapy. If this prescribed regimen is not successful, then other therapies may be introduced. Studies on additional treatments have now been done to get to the root cause of the issue which is hyperglycemia.
Metformin has been found to have additional benefits in its use. The addition of Metformin for patients with type 2 diabetes and a high risk of cardiovascular disease had reduced risk of a cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke relative to those randomized to receive placebo (Edelman & Polonsky, 2017). The use of SGLT2Is is now widely acceptable as a successful therapy to treat. For the first time, SGLT2 inhibitors offer a therapeutic approach acting directly on the kidneys without requiring insulin secretion or action, (Seufert, 2015).
The rate of compliance for a medication is directly correlated on the understanding of its use as well as the access to the medication at hand. Each practitioner and patient must be open to educating themselves on the risks versus the benefits of the medication as well as reading multiple, evidenced based studies that have been completed. These studies should not have been sponsored by organizations that have a stake in monetary gain. Patients need to understand that the medication they are taking is used for their benefit and must not cause additional harm to their physical being nor their finances.
Diabetes, especially Type II Diabetes is a hot topic in my household as well as in my daily practice. I myself was diagnosed with type II Diabetes some years ago while pregnant. Over the course of several years, I was trialed on several therapies until I landed on the treatment that truly worked for me and this treatment, did not include medication therapy at all.
Abdul-Ghani, M., & DeFronzo, R. A. (2017). Is it time to change the type 2 diabetes treatment paradigm? yes! glp-1 ras should replace metformin in the type 2 diabetes algorithm. Diabetes Care, 40(8), 1121–1127. https://doi.org/10.2337/dc16-2368
Edelman, S. V., & Polonsky, W. H. (2017). Type 2 diabetes in the real world: The elusive nature of glycemic control. Diabetes Care, 40(11), 1425–1432. https://doi.org/10.2337/dc16-1974
Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes-2019. (2018). Diabetes Care, 42(Supplement 1), S90-S102. https://doi.org/10.2337/dc19-s009
Seufert, J. (2015). Sglt2 inhibitors — an insulin-independent therapeutic approach for treatment of type 2 diabetes: Focus on canagliflozin. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 543. https://doi.org/10.2147/dmso.s90662
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