What's new in diabetes care
Introduction to diabetes
Types of diabetes
Diagnosis
Risk factors & screening

Treatment of diabetes

• Why do we treat diabetes?
• Goal of treating diabetes
• Treatment of diabetes
• Pancreatic and islet cell transplants
• Can type 2 diabetes be prevented?

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Why do we treat diabetes?

There is compelling evidence that tight blood glucose control can reduce the risk of long-term complications or to delay the progression of the chronic complications.
 
The United Kingdom Prospective Diabetes Study (UKPDS), the largest and the longest trial involving over 5000 patients with Type 2 diabetes with a mean 10-year follow-up period, conclusively showed that improved blood glucose control in these patients reduces the risk of developing retinopathy, nephropathy and possibly reduces neuropathy. For every 1% reduction in HbA1c, there was a 35% reduction in the risk of microvascular complications. UKPDS also demonstrated that aggressive control of blood pressure, significantly reduced stroke, heart failure and diabetes-related death.

The Diabetes Control and Complications Trial (DCCT) on Type 1 diabetes, a 9-year follow up study involving 1441 patients, also showed that tight blood glucose control reduces microvascular complications.

Goal of treating diabetes

The main goal of treating diabetes is to control the elevated blood glucose to as near normal as possible without causing abnormally low levels of blood glucose.

Treatment of diabetes

Type 1 diabetes - There is an absolute lack of insulin in type 1 diabetes. Therefore the treatment is lifelong insulin therapy. Starting insulin treatment in Type 1 diabetes quite often restore some beta cell function for a short period of time. This is known as 'honeymoon period'. During this period, only small dose of insulin is needed. (see insulin therapy)

Type 2 diabetes - In type 2 diabetes, the first line treatment is always dietary and physical exercise. Most patients will require the addition of oral medications in order to have a better blood glucose control. Oral agents with different modes of action can be combined to address both fasting and postprandial hyperglycemia. Some patients may eventually require insulin treatment.

Pancreatic and islet cell transplants

Several approaches are currently being studied including the whole or part of pancreas and isolated islet cells. Almost 8000 patients underwent pancreatic transplantation since 1995 Most patients undergo pancreatic transplantation at the time of kidney transplantation for diabetic kidney disease. There is also a chance that diabetes will occur in the transplanted pancreas.

Transplants of islet cells carried out in the 1990s was not quite successful as less than 10 percent of islet cell transplant recipients were able to control blood glucose levels for more than 1 year without insulin injections. Since mid-2000, the introduction of a procedure called the Edmonton protocol to transplant pancreatic islets into people with type 1 diabetes has shown a significant improvement in the success rate with an overall 91 percent of those with transplants showed improvement following transplantation. However, the concern over rejection remains a major issue. A transplant recipient needs to take immunosuppressive drugs to stop the immune system from rejecting the transplanted islets. These drugs have significant side effects, and their long-term effects are still unknown.

Can type 2 diabetes be prevented?

There is substantial evidence that diet and exercise has been associated with reduced incidence of type 2 diabetes. Diabetes Prevention Program in individuals with pre-diabetes has shown that 7% weight reduction and 150 minutes of physical activity per week over an average of 2.8 years reduced the incidence of new diabetes by 58%

In ndividuals with pre-diabetes, apart from lifestyle changes, pharmacological therapy with metformin (biguanide) or acarbose (alpha-glucosidase inhibitor) has also been shown to reduce the risk of type 2 diabetes. However, the lifestyle changes had greater efficacy and are more cost effective when compared to the drug therapy.