Type 2 diabetes (once called dietary diabetes or senile diabetes) is the paradigm of modern diseases. Mainly due to hereditary causes (a relative with diabetes even in a mild form is enough to be at risk) but triggered by our bad lifestyle: sedentary lifestyle and unhealthy diet (resulting in overweight). Precisely the link with the incorrect lifestyle has led to the recent dizzying increase in cases, anticipating the age of onset. But research has made great strides. If, of course, maintaining a healthy lifestyle removes the risk of diabetes, it is good to take appropriate action once diabetes has set in. First, the right therapy. In fact, there are drugs that do not have the simple purpose of reducing blood sugar, but also of exploiting the normal functions of our body to minimize the risks deriving from the presence of diabetes.
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Take advantage of the insulin that is in the body
Let’s start with the kidneys. When blood glucose is very high (at least 200 mg / dl) the kidneys excrete glucose in the urine to try to reduce it. It’s a natural defense mechanism we all have, but it only works if your blood sugar is high. A simple tablet (if the kidney is working well) allows the kidneys to eliminate glucose as soon as the blood sugar rises, even slightly. In addition, the same mechanism protects the kidneys, so much so that very recent research has shown the efficacy of nephro-protection even in those who do not have diabetes. Let’s continue with the insulin. People with type 2 diabetes fear when insulin is needed. But another class of drugs makes it possible to “make better use” of the insulin that people with diabetes often still have, by making it produce only when it is needed. In addition, these drugs also cause weight loss, so much so that some of them are approved to treat obesity even in those who do not have diabetes at all. It is not uncommon (at least in my personal experience) that people with type 2 diabetes are able (with these two drugs) to go back on their disease path and reduce or even stop insulin.
However, the diet is needed
That might sound like a lot already, but that’s just the fraction of what the research has brought us. In recent years these drugs have also (or mainly) been shown to provide cardio-vascular protection. In other words, those who take these drugs, even with the same diabetes and blood sugar levels, also obtain a reduction in the risk of cardiovascular events. The scientific evidence is so strong that the Italian and international guidelines, both of cardiologists and diabetologists, “require” the use of these drugs in all people with type 2 diabetes at high cardio-vascular risk, whatever the glycaemia. In other words, if a person has diabetes and is at risk (for example, has ischemic heart disease, has had a heart attack, stroke, has carotid occlusion problems, etc.) they should use these diabetes medications even if diabetes is under perfect control with diet alone. For the heart, not for diabetes.
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Treatment by the general practitioner
In the face of such strong scientific evidence, AIFA has deemed it right to open the prescription of these drugs also to general practitioners. In theory, therefore, it is not essential to go to the diabetes specialist to get the right drug to protect your heart (and kidneys). But it is not easy. The search goes so fast that the specialists themselves find it difficult to follow it. While general practitioners are making tremendous efforts to quickly update themselves (and, in my experience, they are doing so with great professionalism) they have to follow up with many other diseases. Therefore, it is better to address the issue of diabetes therapy with a specialist.
But it doesn’t stop there. Research still goes on. A new weekly drug should soon arrive in Italy, capable of leading people with diabetes to have perfectly normal blood sugar levels. A new insulin is in the pipeline and only needs to be administered once a week. Perhaps others will arrive that do not need to be injected. And many other innovations that will truly disrupt the world of diabetes and its therapy.
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Science goes on, always. What to do in the meantime? Meanwhile, inquire if we are doing the right therapy. Without waiting, because the future is today.