In today’s world, you are constantly being overloaded with information, especially when it concerns diabetes, since it affects so many people. Believe me, your physician and others involved in your health care are feeling the same way; new medications and treatment protocols are constantly being approved in the diabetes field and we need to stay on top of it. It may not get to you during the office visit since time is so limited but these trends and ideas may be relevant to you and your future care. Let’s explore some of the current ones:
- The American College of Physicians comes out with guidelines to treat patients in a more consistent manner. Often they update these protocols so that treatment can be more uniform when possible. Last month they concluded that “Metformin is more effective compared to other diabetes medicines for type 2 diabetes in reducing blood sugar levels when used alone or in combination with other diabetes medications. Metformin helps reduce body weight, improves cholesterol profiles, is cheap (sometimes provided for free, so check in your local area) and has minimal side effects”. There is some recent evidence that metformin may even lower the risk of certain types of cancer. Most physicians generally allow a 3 month trial period of exercise and eating modification when a new case of diabetes is diagnosed depending on the A1C. If progress is not achieved after the next blood work results, oral medication is added. The possible and most common side effects of Metformin include gas, bloating and diarrhea. If given in a progressive dose over a few week period, this can usually be avoided. There are also long acting formulations of metformin which help decrease side effects. Metformin should not be given if kidneys are not functioning properly or to people with type 1 diabetes. Always consult your physician with questions and concerns about any medication; never change doses on your own.
- In late November 2011, the FDA approved the first medication that combines therapy for type 2 diabetes and elevated cholesterol in a single pill. It is called Juvisync. Since heart disease and diabetes are so connected, most people with diabetes are treated for cholesterol issues. The diabetes component contains sitagliptin or Januvia-a dpp4 inhibitor. It helps preserve beta cell function in the pancreas (cells where insulin is made), decrease appetite, lower post prandial (after eating) blood sugars, lower glucose made in the liver and does not cause hypoglycemia. The side effects are generally minimal and can include stuffy nose, sore throat or headache. The statin component is simvastatin or Zocor, a relatively inexpensive medication. It is a LDL lowering agent (the bad cholesterol) as well as helps reduce chronic internal inflammation, a big concern in heart disease. The side effects of the statin can be muscle aches especially in the legs and elevated liver enzymes. Always check with your physician if you are experiencing any side effects; most medications can have side effects so make sure it is right for you. Patients tend to be more compliant when medications are combined due to the cost and convenience of one pill. There are different strengths of this combined pill as well.
- A study, published in The American Journal of Medicine, was conducted at The Mayo Clinic in Minnesota on 600 adult subjects over a 20 year period. The participants were an average age of 77 when the research was reported. It was found that those with diabetes were 10% more likely to have and die from heart failure than those without diabetes in this age group. It was suggested that people with diabetes in their 70s-80s be automatically evaluated for heart failure. Heart failure symptoms can include weakness, swelling in the lower extremities, and shortness of breath, quick water weight gain, wheezing or suddenly developing a heart arrhythmia. Heart failure is more prevalent in people with high blood pressure, diabetes, thyroid disease, coronary heart disease or sleep apnea. Also heavy alcohol use, decreased kidney function, smoking, and certain viruses or infections can increase the risk of heart failure. The heart muscle weakens and parts become stiff, preventing the blood from pumping properly; the blood backs up into organs like the lungs. Heart failure can become a chronic disability which makes daily life extremely challenging. If diagnosed, positive lifestyle changes can help and should include sodium reduction, decreased stress, moderate weight loss, aerobic exercise, no smoking and taking medications prescribed by your physician properly.
There are always new treatments on the horizon for diabetes management. Current and ongoing studies teach us how to care for our patients in the most effective ways. Always ask questions and gain information from trusted sites. Keep learning!
NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.
She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.
She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.