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The Evolution of Diabetes Treatment

Patricia Bononi, MD
Medical Director
The Center for Diabetes and Endocrine Health
Allegheny Health Network
Pittsburgh, PA

It’s been a pretty exciting time in Diabetes. Over the past 20 years, the number of new diabetes medications has really exploded. In the past, we had one or two pills that we could use for diabetes and then everyone went on to insulin. But now we have a multitude of modalities that attack diabetes in many ways and may have some other benefits beyond blood sugar control.

For example, there’s a group of medications called GLP1 agonists, and they work to lower glucose, but they also have been shown to have benefits in terms of heart disease and lowering risk of having heart attack and stroke, which is a big risk for a patient that has diabetes. And they’re all in injectable form at this point, either daily or weekly, although there will be a new medication coming out that will be an oral form of this.

The other big group has been SGLT2 inhibitors that work in the kidney. They’re pills and they lower glucose, but have been shown to help with reducing the risk of heart failure. They also lower blood pressure and have been shown to assist in weight loss.

Whether a patient receives one of these 2 classes of medication depends on a number of factors. It depends on how well or how not well, your blood sugars have been controlled. What other conditions you may have, whether you have liver disease or kidney disease and whether or not you’re having symptoms. For example, if you’re having thirst or frequent urination that may lead a physician to choose one option or another. And we generally use guidelines that have been put out by some of the larger diabetes organizations that also help physicians choose the right treatment for patients.

Prior to these two groups of medications, most of the medications for diabetes either kept your weight the same or caused weight gain, which is not good when you have diabetes. The newer agents do help with weight loss probably about the same degree, but although it is a side effect, it’s truly a benefit for patients. Some of the other side effects of the GLP1s are nausea and sometimes it limits the use of that, but generally people get used to it over time and they’re able to tolerate it. With the SGLT2s, there has been some increased risk of infection, so you just have to be aware of that when you’re prescribed one of those medications.

What Patients Should Know About Managing Diabetes

For patients with diabetes, their loved ones, or caregivers, I think being informed is very helpful. And when they go to visit with their provider, they should come prepared with questions and they understand and leave understanding why a particular treatment was chosen for them and that they agreed to with their provider. If they have any questions, they always need to ask. The other thing I really like my patients to do is make sure they stay up with the maintenance part of diabetes. That includes getting their eyes examined once a year, having their feet evaluated at least once a year. They should look at them daily to help identify and prevent any complications from diabetes.

The Allegheny Health Network—Addressing Diabetes

At the Allegheny Health Network, we’ve recently launched several big initiatives. We know that over 90% of patients with diabetes are taken care of by their primary care physician and that access to specialists called endocrinologists is, at times, difficult. So we’ve provided a program to help support the primary care doctors in the care of patients with diabetes by providing education to the staff of primary care providers, by giving them tools to help their patients learn more about diabetes, including classes to help with diabetes education. Patients can get appropriate and timely care for their diabetes right in their primary care provider’s office to assist with managing their diabetes leading to improved patient outcomes.

As part of that effort, we also have this comprehensive team-based approach to diabetes management where patients who are struggling with their diabetes or haven’t been able to get their diabetes under control come for a comprehensive visit. They meet with not only an endocrinologist but with a pharmacist, a dietician, a social worker in case they have difficulty paying for medications or getting adequate food, and a behavioral health specialist. This is because many patients with diabetes struggle with depression and anxiety, which can interfere with them managing their diabetes. The Allegheny Health Network is at the forefront of Diabetes Management.

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