Revised national guidelines for the treatment of type 2 diabetes will allow doctors to prescribe a new class of medication which avoids the side effects of weight gain and hypoglycaemia (low blood sugar) associated with some of the conventional diabetes treatments.
The first line of defence in the battle to control type 2 diabetes is still to encourage lifestyle changes, such as following a healthy diet and regular exercise, as well as by blood sugar moderation using glucose lowering Metformin that stem the liver’s glucose production.
Until now, when this medication failed, the next step was either to stabilise a patient’s blood sugars using medication which increases the body’s natural insulin production, called sulphonylureas; or to artificially raise insulin levels by injecting the hormone. But these medications often cause significant weight gain and hypoglycaemia, a condition in which blood sugar levels dip too low, causing varying symptoms such as blurred vision, elevated heart rate and agitation that may result in confusion, coma or even death.
The new guidelines, drawn up in consultation with government and published by the Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) in April this year, allow doctors to prescribe a new type of medication which uses incretin hormones to stimulate the amount of insulin released by the pancreas. Incretin therapy doesn’t have the same adverse effects of weight gain and plummeting blood sugar levels.
“The old guidelines were policy-centric, prescriptive and inflexible,” said Prof Jeffrey Wing from the Charlotte Maxeke Johannesburg Hospital speaking at the Incretin Leadership Summit, hosted by global healthcare company Novo Nordisk in early May, on the use of incretins in diabetes treatment.
“The new guidelines are democratic, they’re more patient-centric, he said. They also allow for doctors to prescribe incretin therapy before moving on to the use of sulphonylureas or insulin”.
“Type 2 diabetes mellitus and obesity are parallel epidemics," explained specialist physician Dr Adri Kok from the faculty of consulting physicians of South Africa, who treats some 8 000 diabetic patients in her Johannesburg-based practice.
“Incretin treatment allows for the control of diabetes, without exacerbating the obesity problem, along with the associated risks of arthritis, sleep apnoea, high blood pressure, cholesterol and certain cancers. Switching from traditional second-step medicines onto the new incretins often comes with significant weight loss and no risk of low blood sugars”.
“I’ve seen firsthand (how incretins) improve patients’ lives because of the weight loss. They feel more energetic. They don’t fear low blood sugars. They have better control of their diabetes.”
The Incretin Leadership Summit was hosted in Cape Town by global healthcare company Novo Nordisk.
(Novo Nordisk press release)
Diabetes, diet and obesity
Treatment: type 2 diabetes