Dr Miriam Stoppard on the difficulty of treating type 2 diabetes in those who are obese, and how two new drugs may help lower the risk of major disease in patients
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Type 2 diabetes can be difficult to treat if the patient has a high BMI. It’s important to stabilise blood sugar levels in the normal range to protect the heart and kidneys, but now hope has arrived with the advent of two drugs advocated by US, European and Asian health authorities.
These drugs, when added to existing treatments, have benefits in regard to heart attack, heart failure, kidney failure, stroke and mortality.
That’s quite an array of claims, so it’s puzzling why these drugs have seldom been used.
An international panel has come up with practical guidelines on the use of two drug types, SGLT-2 and SGLT-1 inhibitors, and GLP-1 receptor agonists (GLPRA) for patients suffering with type 2 diabetes.
The main thrust of the study is on lowering the risk of major disease.
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It looks at both kinds of drugs in four different patient categories:
(a) those without cardiovascular or chronic kidney disease and three or fewer cardiovascular risk factors; (b) those without established disease but with more than three risk factors; (c) those with either cardiovascular disease or chronic kidney disease, and; (d) those with both cardiovascular and chronic kidney disease.
One of the aspects of this study that interests me greatly is the participation of patients, something doctors are paying increasing attention to.
So, importantly, the recommendations considered were heavily influenced by patient preferences, gathered through several approaches.
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First, the international panel itself included four patients with type 2 diabetes. Second, a separate focus group evaluated preferences of people living with type 2 diabetes, as well as, third, incorporating a review of existing research that had been carried out on patient preferences.
Patients are the ultimate end users of all policies, so it’s only logical they should help develop guidelines.
It should be said lifestyle improvements (weight loss and a healthy balanced diet plus upping physical activity) and effective blood sugar control are essential to reduce cardiovascular risk, as well as active management of blood pressure and cholesterol.
People with type 2 diabetes, their families and their healthcare providers, need to be given clear messages to support shared decisions.
Practical guidelines, developed by patients and clinicians, can provide a roadmap to guide these potentially lifesaving therapies into patient care.
Getting patients involved in planning guidelines seems to me logical if you want them to stick to treatment.
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