These new developments could change type 2 diabetes care

Experts often talk about the “burden” of disease. The word acts as an organized container for all the discomforts people with that condition may experience — from their symptoms, to the cost of their care, the restrictions imposed on them. their lifestyle, to the health complications that may arise. For those who have Type 2 diabetesThis burden can be high.

Routine management of Type 2 diabetes often involves major changes to Diet and physical activity. And for many people, especially those who take insulin to control blood sugar, the disease can require daily blood glucose monitoring, a process that requires a finger prick to draw blood. and then dab that blood on the test strip of the blood glucose meter. Doing this several times a week – month after month – can lead to overlapping challenges. According to a 2013 survey in the journal diabetes spectrum, People find finger-tracking blood sugar painful, and the results can be confusing or unhelpful.

Dr Francisco Pasquel, a diabetes expert and associate professor of medicine at Emory University, said: “Patients don’t want to burn their fingers and they always come in and say, ‘I’m tired of it. this. Medicine in Atlanta.

But relief is on its way. Continuous blood glucose monitors, or CGMs, are small devices – usually about the size of a quarter – that use a tiny needle under the skin to continuously monitor blood glucose levels. This information may be transmitted — in some cases wirelessly and automatically — to a smartphone application or other device. “You can look at blood glucose levels at a single point in time, but you can also look at values ​​trending over time,” says Dr. Roy Beck, medical director of the Jaeb Center for Health Research in Tampa. time. Beck’s research has found that continuous glucose monitoring may offer several benefits for people with type 2 diabetes.

These monitors are just one of a number of new advances in the management and care of type 2 diabetes. From connected technologies to new drug treatments, medical science is gaining ground. steady and sometimes life-changing advances in the treatment of this condition. Here, the experts describe some of the latest and greatest developments.

Continuous blood sugar monitor

People with type 1 diabetes often have to check their blood sugar daily, or even several times per day. Because testing is such an important part of controlling that disease, research on continuous blood glucose meter Start with these patients. That research has shown that CGM offers many benefits, including lowering hemoglobin A1C (HbA1c) levels, which is an important metric for evaluating healthy blood sugar. Continuous blood glucose monitors are currently being studied in people with Type 2 diabetes, and research points to many benefits.

For a study published in 2021 in Journal of the American Medical Association, Beck and his colleagues compared continuous glucose monitoring with standard finger prick tests in people with type 2 diabetes who were using insulin. They found that ongoing monitoring was associated with a significantly greater reduction in HbA1c. They also found that continuous monitoring helped people avoid severe drops and risks in blood sugar (aka hypoglycemia). “Clearly there is a benefit for people with type 2 diabetes who are using insulin,” he said.

More than 90% of people with diabetes have Type 2 diabetes, and Beck says about 30% of these people are using insulin. In other words, there are many people with Type 2 diabetes who would benefit from continuous glucose monitoring. However, the use of these screens is still largely limited to people with Type 1 diabetes. “Usage is steadily increasing in Type 2 patients, but I think it’s still too low to consider this. is a non-drug approach” — something many people like because it avoids the side effects of drugs — “that can help people,” he said.

Even for people with type 2 diabetes who don’t take insulin, Beck says that continuous glucose monitoring can be helpful. “More research is needed to prove that, but that means it could have benefits,” he said. For example, real-time blood sugar monitoring can help people make dietary or lifestyle changes to reduce their risk of long-term health complications. “Normally, blood sugar after a meal should not exceed 140 [mg/dL]But based on factors like diet, timing of meals, and exercise habits, someone with Type 2 diabetes can experience a spike in blood sugar after a meal in excess of 200 or Even 300 mg/dL, Beck says, these spikes may cause few symptoms or short-term consequences, but over time they can contribute to the development of common diabetes-related complications such as kidney failure, heart disease, or diabetic retinopathy (an eye condition that can cause blurred vision or blindness) “The first time people use these continuous screens, it can be an eye-opener. really,” he adds, “I think they may be most helpful for self-management, and type 2 diabetes is a disease where self-management through diet and exercise can be makes a huge difference.”

Other experts second this. Ilias Spanakis, associate professor of medicine in the department of endocrinology, diabetes, and nutrition at the University of Maryland School of Medicine.

For patients who depend on insulin for blood sugar control, combining a continuous blood glucose monitor with an insulin pump — a device that automatically injects insulin when needed — can also lead to improvements. great. “Smart algorithms that connect the two can automatically adjust sugar levels based on blood glucose values,” says Spanakis. This is already possible and it is likely to become much more common,” he added.

For many people with diabetes, continuous glucose monitoring can provide a safer and simpler route.

Read more: The link between type 2 diabetes and mental disorders

Vaginal surgery for type 2 diabetes

Historically, bariatric surgery (weight loss) was primarily used to help people manage severe obesity, which the U.S. Centers for Disease Control and Prevention defines as a BMI of 40 or more. up. Many people who are severely obese also have diabetes, and research has found that these surgical procedures can help reduce the burden of Type 2 diabetes or even put it in remission.

A 2018 study from researchers at the University of Oklahoma found that Roux-en-Y gastrectomy, a common procedure, is far superior to typical medical management techniques — such as dietary changes, doctor visits, and prescription drugs — in people with Type 2 Diabetes. According to the study results, surgery led to a remission of diabetes in about 28% of patients, compared with a remission rate of just 4% in the non-surgery group, according to the study results. Many studies have found that cystectomy can effectively put type 2 diabetes into remission.

Pasquel of Emory, who has published research on the benefits of tomography for patients with type 2 diabetes, says: “The surgery not only led to weight loss but also improved glycemic control, This happens even before weight loss. Exactly how the surgery takes place, he said, is still not well understood. However, vaginal surgery affects appetite, food intake, caloric absorption, and numerous neuroendocrine pathways — all of which may contribute to beneficial actions for sufferers. type 2 diabetes.

In the future, Pasquel said these procedures could become more common even among people with Type 2 diabetes who aren’t severely obese.

New medicine

There are many different diabetes medications on the market, each with their own risks and benefits. But experts say two are emerging as potential “game changers” when it comes to treating Type 2 diabetes.

Glucagon-like peptide 1 (GLP-1) is a hormone released in the intestines during digestion – a hormone that plays a role in blood sugar homeostasis. A class of drugs known as GLP-1 receptor agonists can interact with GLP-1 receptors in ways that reduce appetite, slow digestion, and provide other benefits for people with diabetes. Type 2 sugar. These GLP-1 drugs are not new. But Pasquel says the latest versions are different in that they act on two different receptors, not one. “Recent evidence suggests that activating both receptors has a significant impact on weight loss and glycemic control,” he said. Especially for people with Type 2 diabetes who are at high risk for heart or artery disease, he says these new drugs appear to be a big upgrade over previous drugs.

A second class of drugs has also emerged as a prominent product in the treatment of Type 2 diabetes. Called sodium-glucose cotransporter-2 (SGLT-2) inhibitors, these drugs help the kidneys get rid of sugar. from a person’s blood. This not only improves blood sugar control in people with Type 2 diabetes, but it also helps protect them from heart failure and kidney disease – two common and serious complications. Pasquel says these drugs are so effective that they are now being used by people with heart failure or kidney disease who don’t have Type 2 diabetes.

Read more: The truth about fasting and type 2 diabetes

Emerging ways of thinking about weight loss

Experts have long understood that weight loss can help people reduce symptoms and risk of type 2 diabetes. This recognition has led to research on a number of weight loss diet. More research is needed, but some of the latest research suggests that a fasting plan — specifically, intermittent fasting — may be especially beneficial for people with Type 2 diabetes.

Intermittent fasting involves cutting out calorie-dense foods and drinks for an extended period of time — anywhere from 12 hours to two days depending on which method a person chooses. A 2019 research review in the journal Nutrients found that intermittent fasting promoted weight loss, increased insulin sensitivity, and decreased blood insulin levels. All of these things are helpful for people with Type 2 diabetes. Benjamin Horne, director of cardiovascular and genetic epidemiology at Intermountain Healthcare in Utah, said: “Basically, fasting is what it does. we prescribe diabetes medicine, that is to improve insulin sensitivity.

It is not yet clear which form of intermittent fasting is best. But Horne says time-limited eating — a style of fasting that involves squeezing all of the day’s calories into single feeding windows of six or eight hours — is leading the pack, largely because Patients can stick with it.

There are many new advances in type 2 diabetes care. The interventions described here — from continuous blood glucose monitors to new drugs — are some of the most promising, but they have a company. It’s safe to say that, looking ahead, many people with Type 2 diabetes will be able to effectively control or alleviate their symptoms.

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