By Susan B. Sloane,B.S.,Rph.,C.D.E.,Nutritionist
As we progress ever more deeply into the 21st century, a disease that has been lurking in the background is rapidly increasing in prevalence putting it at the forefront of health news. Type 2 diabetes affects over 17 million people in the United States, and it is estimated that nearly 60 million Americans have a condition known as pre-diabetes. It is important now more than ever to be aware of Type 2 diabetes and all of the potential treatments in order to reduce the risk of possible complications from prolonged high blood glucose levels. Type 2 diabetes results from insulin resistance or the inability of a pancreas to produce sufficient levels of insulin. Without insulin, glucose cannot enter cells, and therefore it builds up in the blood causing cells to not function properly. Our understanding of Type 2 diabetes has grown by leaps and bounds; and with this understanding comes newer and better ways to treat the disease.
The oldest class of medication used to treat type 2 diabetes is known as sulfonylureas. These medications work by stimulating the pancreas to produce more insulin. Due to the fact these drugs increase systemic levels of insulin, there is a risk of hypoglycemia. These drugs are effective in treating type 2 diabetes, but due to a range of potential adverse effects they were not ideal.
In the early 1990s, the FDA approved the use of a medication called Metformin for the treatment of type 2 diabetes. Metformin, part of the biguanide class of medications, was effective at controlling blood glucose levels with relatively few side effects. Since its introduction, it has become one of the major staples of diabetes management. Metformin works mainly by suppressing glucose production by the liver but also increases insulin sensitivity and decreases glucose absorption from the gastrointestinal tract. Metformin has been a vital part of the arsenal of potential treatments for diabetes, but the disease is complex and therefore requires a variety of treatment options.
One of the newer treatment options is a class of drugs known as Thiazolidinediones (TZDs). These medications address insulin resistance experienced by some people with type 2 diabetes. Addressing this resistance has been difficult in the past. If a patient is resistant to insulin, increasing insulin levels is not a sufficient means of controlling blood glucose levels and as a result managing people with resistance has been challenging. TZDs bind to cell receptors and decrease insulin resistance. In addition these medications alter fatty acid metabolism to prevent plaque buildup in blood vessels.
In recent years the “buzz” word in diabetes has been incretins. We now understand that diabetes is not merely a defect in insulin secretion and absorption, but is a multifaceted illness that affects several areas of the body. The evolution of medicine to treat diabetes has focused on these different areas; and in this way the approach to treatment can be individualized and ultimately more effective. In the next millennium, treatment can even be more tailored to a patient with the advent of gene therapy. We certainly have come a long way in our quest for treating diabetes more effectively. Patients with diabetes today face less complications and a brighter, healthier future.
November, 2009 is American Diabetes Month. RxSchool will introduce 2 new live one (1) CPE webinars on Diabetes in November: Type 2 Diabetes, Growing Waistlines, Growing Problem on November 10, 2009 and Oral Medications for Diabetes: Making the most out of the Treatment on November 22, 2009. See the RxSchool live calendar for further details.
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