Diabetes mellitus: A type of treatment for each kind of patient

Are you diabetic? Do you have any relative or friend with high glucose in blood? Is he/she taking any medication? Is it the right treatment?

Diabetes mellitus is a chronic disease highly associated to obesity and other vascular risk factors such as hypertension and hypercholesterolemia. Diabetes incidence is getting higher, to the point of starting talking about it as an epidemy growing fast in regions such as India, China or Latinoamerica (World Health Organization). Besides, it is as worrying the increasing number of cases as the earlier age in which the disease shows up. We must remember that nearly 50% of diabetic subjects do not know they have the disease.

Diabetes treatment is like a four-legged table: if one of those legs is missing, the table may fall down. Medical treatment should be added to the three main pillars of treatment: diet, physical activity and diabetologist education.

Until a few years ago, the basic aim of diabetes treatment was to lower the levels of glucose in blood. Other objectives were that treatments were well tolerated, easy to take or could prevent an excessive decrease of the glucose levels (hypoglycemias). However, nowadays there is a huge group of treatments for the diabetes with the objective not only of lowering the glucose levels, but also of fighting the remaining cardiovascular risk factors usually associated to the disease. This way, for example, there are antidiabetics capable of reducing the body weight (some of them may help losing more than 8 kg!), others can lower the blood pressure values and other ones help reducing the cholesterol levels... and much more.

Initial treatment for most type 2 diabetics (type 2 diabetes is the most usual one, with over 85% of the cases) is mainly metformin. Metformin is a safe, efficient and economic drug capable of controlling glucose in many patients. However, metformin is often associated to gastrointestinal issues (flatulence, swelling sensation, diarrhea) and has no significant effect on the forementioned rest of factors.

A still very used anti-diabetic treatment is sulfonylureas (glimepiride, glicazide,...). They are very efficient medications in lowering glucose, but with a potential risk of hypoglycemia, with no significant effect on weight or blood pressure and, what is most alarming, associated to a possible increasing cardiovascular mortality rate, as the FDA has warned.

Pioglitazone has a beneficial effect in triglyceride reduction and HDLc (good cholesterol) increasing. New oral antidiabetics such as the glycosuric agents (e.g. Dapagliflozin) can reduce glucose levels and, at the same time, lower the blood pressure values and the body weight moderately. DPP4 inhibitors (gliptins) can reduce glucose in an efficient way with hardly any risk of hypoglycemia but not body weight.

When it comes to anti-diabetic injectables, there is a real revolution with GLP-1 analogues (e.g. exenatide, liraglutide,...) which are, without a doubt, the antidiabetic medication that achieves a greater weight loss without important risk of hypoglycemias and with very convenient formulations when it comes to administration (one injection a week!).

Finally, the most powerful antidiabetics, new formulas based on insulin. One of them is insulin degludec, long-acting type, which highly reduces the risk of hypoglycemia; however all of them tend to increase the body weight.

Definitely,there are a lot and very different ways to treat diabetes mellitus, allowing a better blood glucose control with less risk of side effects. Nevertheless, do not forget that drug treatment is still only one of the four legs of the table and that the other three ones (diet, physical activity and diabetologist education) cannot be neglected; if so, the treatment will never work. You must not forget either that these are general recommendations and that treatment must always be individualised, that is, adjusted to your particular case. Therefore, we recommend medical supervision before any change in your treatment.