Woman 2 Woman - Diabetes – hope post Metformin

At a family medicine conference recently I was alarmed to hear the latest statistics on Diabetes in this country which now ranks 16th worldwide with 19% of its population afflicted. According to the International Diabetes foundation (Nov 14, 2014). One of every five persons in UAE aged 20-19 lives with this disease. In sheer numbers, 750K people are diabetic , 900K are at high risk while 300K are undiagnosed. Even more shocking is the fact that the total estimated cost of diagnosed diabetes is 60.7 billion dirhams annually. Whew, that’s a lot of money. An Emirati colleague is doing genome wide study to identify what genes make the Arabs & Asians living in this region so prone to this devastating disease. Can we really blame it on our genes or is it really this gross life of indulgence and plenty that is taking its toll.

 

In my experience, most people consider Diabetes as a trivial disease & dismiss it lightly by saying ‘Oh, my blood sugar is fine’, without realizing the devastating toll it takes on their entire body systems from brain, to heart to eyes to kidneys to poor ovaries and for men, even impotency. You just have to see the sheer numbers of young women lining up at the fertility and dermatology centers doorsteps to see the damage to the poor innocent bystander ovaries ridden with multiple cysts and the hairy faces ridden with acne. And of course who can even comment on the sensitive issue of men with erectile dysfunction. So really what is being done in the medical world to prevent and treat this malady.

One can of course write reams on the importance of lifestyle modification, healthy diet and exercise but we physicians love our pills. On the pill front fortunately, there is hope after insulin sensitizers (Metformin). After years of taking Metformin, when the blood sugar levels continue to rise and fluctuate , it’s time to add the new and not so new agents. After all, diabetes is not just a simple disease due to lack of Insulin secretion from the pancreas but also an increased secretion of Glucagon from pancreas, with increased production of glucose in the liver, neurotransmitter dysfunction, decreased glucose uptake(insulin resistance), disturbed lipid metabolism and increased glucose reabsorption from the kidney tubules. High sounding words but really a complex malfunctioning of many organs. So the hope is now to tackle the malfunctioning organs like kidneys and us newer agents like Dipeptidyl peptidase IV DPP-4 inhibitors (Sitagliptin), Glucagon like peptide–1 (GLP-1) agonists(Exenatide), Selective sodium-glucose transporter-2 (SGLT-2) inhibitors which acts by preventing the reabsorption of glucose from the kidneys. This not only allows a better maintenance of blood glucose levels and also allows energy loss. This is beneficial in most diabetics who are usually overweight. It’s clearly time to wake up and not just hit the road to jog every day to control your blood sugar level but also demand from your treating physician a better management of your disease otherwise you may end up dropping dead on the track with either a stroke or heart attack or worse still blind with irreversible damage to your eyes.