Improvements in diabetes management
If you or someone you know has diabetes, you know the drill. Every day revolves around pills, injections, diet and exercise. Then there's the drudge of eating at certain times and always having medication handy. There's the worry of needing an injection and not having a private place to administer it and of skyrocketing blood sugar during work, family outings or social events. And, of course, there's the fear of complications like blindness or the threat of amputation.
New approaches
Improved medications
Devices that will make a difference
Diet and exercise are a must
New approaches
Diabetes management, however, is entering a new era — one of longer-lasting medications, more convenient devices and fewer complications. Times have changed already. "We've come a long way from the day when patients were prescribed a single drug and, if necessary, insulin — an approach that didn't always control blood sugar and often resulted in complications," says Joseph Fallon, MD, chief of endocrinology at Virtua West Jersey Hospitals.
Now physicians have an entire arsenal of medications and devices. Dr. Fallon says there's been an "explosion" in pharmacology and monitoring tools, making diabetes much easier to control than it was 15 years ago. "The diabetes complication rate has steadily declined. And, we expect this to continue as new products and medications come to market."
Jonathan Anolik, MD, chief of endocrinology at Virtual Memorial Hospital, agrees. He sees first hand how improved diabetes products have benefited his patients. He says: It's easier to control blood sugar levels than it was even a year ago."
Today, the standard in diabetes management is to use not one drug but several added one at a time. This multi-step approach to pharmacology allows physicians to make adjustments that yield much tighter control of blood sugar levels.
Improved medications
There are also a number of new medications available to help physicians craft a highly tailored treatment plan. New medications include rosiglitazone maleate and pioglitazone hydrochloride, which are part of the class of drugs called thiazolidinediones (TZDs). These drugs make the body more sensitive to endogenous insulin and, according to Dr. Fallon, work synergistically with other medications or by themselves.
Another medication advance is the combination of two glucose-lowering drugs, glyburide and metformin, which are the two most commonly prescribed medications for type 2 diabetes. "Studies show that when used together at the lowest dose they are more effective than if either one is used alone," says Dr. Anolik.
Insulin has also taken a turn for the better. Glargine, a long-lasting insulin that is used once a day, reduces the risk of low blood sugar reactions, particularly during sleep. And, there's a new pre-mixed insulin, which combines long-acting insulin with rapid-acting insulin. The beauty of this combination is that the person using it only needs to dose within 15 minutes of mealtime, so unexpected delays in meals are less likely to result in low blood sugar reactions.
Devices that will make a difference
Though a year or two away from general use, the insulin inhaler will allow powdered insulin to be delivered through an aerosol inhaler, much like some asthma medications. This is good news for those who currently require daily insulin injections.
Meters, too, are becoming more sophisticated and easier to use. A new watch-like device currently under investigation uses EKG-like electrodes to provide a series of readings at regular intervals over a 12-hour period. Other meters allow the user to obtain blood from the forearm instead of the fingertip.
Diet and exercise are a must
Even with all these scientific and technological advances, the main obstacle to controlling diabetes is still out of reach. "The hard part is the battle with diet and exercise," says Dr. Anolik. "We just don't exercise enough." Virtua Health provides a wide range of fitness, nutrition and support programs to help people with diabetes cope with the illness and develop strategies to incorporate exercise and healthy diets into their lives.
With so many new advances in diabetes and so many others on the way, people with diabetes now have many choices when it comes to treatment. "For the diabetic patient who wants to manage his or her condition better," says Dr. Fallon, "there are tremendous improvements and options and the opportunity to limit complications substantially."