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Evidence Based Pharmacology- Diabetes Mellitus 2

Introduction

            Diabetes mellitus (type 2 diabetes) is a chronic condition that occurs due to the inability of the body to synthesize insulin in sufficient amounts to meet its’ metabolic requirements. The body’s demand for insulin may be increased due to factors such as obesity and exposure to high levels of glucose. Unlike type 1 diabetes, it manifests later in life, and it is an interaction of several disease processes. Its clinical features may vary within and between populations, and in the recent years, diabetes type 2 has been thought of as a syndrome instead of a disease.

            Statistics show that the disease affects over 300 million people in the world, indicating that it is of significant concern globally. The disease is becoming more common due to factors such as lifestyle changes, poor diet, obesity, and genetic factors, which are associated with the disease. It is related to classical symptoms such as polyuria, increased thirst and weight loss, which signify the presence of the disease. The disease is managed by adopting lifestyle changes that reduce the metabolic demand for insulin as well as various medications. However, as the condition progresses, the patients may require artificial insulin.

            The disease is associated with numerous physical, psychological, and social aspects that make its management critical and necessary. Despite the time and resources spent investigating type 2 diabetes, there are no proper and efficient means of preventing and curing the disease. Therefore, it is important that researchers understand the various aspects of the disease so that they can make progress in their research.

Symptoms and Diagnosis of Type 2 Diabetes

The condition occurs due to the inability of the body to regulate the blood glucose levels. As a result, glucose is excreted in the urine instead of being stored or utilized by the body. Due to the high levels of glucose, the urine draws more fluid and molecules from the body, leading to dehydration and thirst. Since the body cannot utilize dietary glucose, it draws on the fat and protein reserves to supply energy, leading to rapid weight loss. These are the characteristic symptoms, but they may vary between patients depending on factors such as the age. The disease is also associated with conditions such as high blood pressure, obesity, renal failure and other complications (American Diabetes Association, 2013).

Early diagnosis is important to initiate treatment and reduce the complications associated with the disease. According to the WHO, type 2 diabetes can be diagnosed from the mentioned symptoms (polyuria, increased thirst and unexplained rapid weight loss) (Diabetes UK, 2016). If these symptoms are present, the patients can undergo a random, fasting or oral glucose test. For the random blood test, a sample will be taken at a random time and blood sugar levels higher than 11.1 mmol/L indicate diabetes, regardless of when the last meal was consumed. For the fasting blood sugar test, blood samples will be drawn after an overnight fast and glucose levels higher than 7 mmol/L is considered type 2 diabetes. The oral glucose test involves taking the fasting blood glucose levels and giving the patient a sugar drink. The blood glucose levels are measured every two hours after that and levels higher than 11.1 mmol/L is considered type 2 diabetes (Diabetes UK, 2016).

Treatment of Type 2 Diabetes

No cure is available for the disease, but interventions consist of measures that help the patient manage diabetes. They involve techniques that contribute to reducing the metabolic demand for insulin through interventions such as dietary and lifestyle changes, or supplying an external source of insulin through injections. It may include adopting a healthy diet to manage the blood glucose levels or increasing physical activity to control weight. Exercise is also important since it helps insulin work more efficiently, and it reduces the risk of associated complications such as hypertension or cardiac diseases. It is also important to monitor the levels of glucose in the blood to determine if the regime is effective at managing the disease.

These interventions are aimed at keeping the blood glucose levels between 4- 6mmol/L, which is considered safe and does not pose a risk for any complications. However, these are not entirely valid since the disease causes deterioration and the body might become resistant to insulin, or the pancreas might lose its efficiency at converting the blood glucose into energy. In such cases, it may be necessary to take some medication that may help the body utilize the glucose. These medicines should not be considered a replacement for the healthy lifestyle, but they should be used together for them to work effectively.

Non- pharmacological Approaches

            A persons’ lifestyle is a reliable indicator of whether they will develop diabetes later on, and changes to the lifestyle are essential in managing diabetes. Non- pharmacological interventions are focused on controlling body weight and energy intake in the individual. People living with type 2 diabetes are often advised to eat a healthy and balanced diet. They are asked to eliminate processed foods and baked foods such as cakes and pastries and incorporate more vegetables, fruits and whole grains in their diets. The rationale behind this is to reduce the amount of sucrose or sugar that is added in the food from an external source (Diabetes UK, 2016). When one consumes such sugar, it causes a sudden rise in the blood glucose level, which eventually causes type 2 diabetes since the body cannot produce enough insulin to manage the sugar. Whole grains, fruits, and vegetables, on the other hand, contain sugar that is released slowly into the bloodstream and prevents a sugar rush, which the body can easily handle. Based on this, dietary changes are effective at dealing with the disease.

            Engaging in physical activity is also effective at controlling diabetes since it lowers the blood glucose levels (Diabetes UK, 2016).  It is important to have an exercise regime that combines aerobics and resistance training, to get the full benefit of this intervention. Aerobics is necessary for increasing cardiac performance and reducing the fat deposits while resistance training helps in building muscles. Increased physical activity increases the body’s metabolic rate and makes it more efficient at utilizing nutrients such as glucose (Tuomilehto, 2009).

These measures should be accompanied by regular monitoring of the blood sugar levels to determine whether they are effective. The patient may also need advice before embarking on some changes, such as the dietary changes. A nutritionist/ dietician may help in monitoring their feed intake to ensure that it is healthy and not deficient in any nutrient. In most cases, the mentioned measures are adequate at controlling the blood glucose levels. If not, medication is usually initiated.

Pharmacological Treatment

            Due to research and development, different classes of drugs are available for pharmacological treatment of diabetes. The first comprises of the intestinal enzyme inhibitors that hinder the absorption of fats and carbohydrates from the intestinal lumen (Diapedia, 2016). Through them, the need for insulin is reduced since the fats and carbohydrates, which are associated with a sharp rise in the blood glucose, spend much more time in the intestines before being absorbed. It includes medicine such as Acarbose, which can reduce the high glucose levels identified after a meal. Another class is the insulin sensitizers. These minimise the amount of insulin required by the body by reducing the amount of glucose released into the bloodstream by the liver. They also increase the body’s sensitivity to insulin, so that the same amount is required to absorb more glucose (Diapedia, 2016). Examples of such drugs include Metformin and Glucophage.

Other than these, we have medication that increases the ability of the pancreas to secrete insulin. Type 2 diabetes manifests when the body does not produce insulin in sufficient amounts and this category of drugs known as sulfonylureas help the body to produce more insulin. These include drugs such as Glynase and DiaBeta. Another class is the meglitinides, which have the same course of action as sulfonylureas though they work faster and their effects are felt for a shorter duration in the body. They include medication such as Prandin and Starlix (ICMR, 2005).

It is also possible to use insulin injections, but only when other forms of therapy are not helpful in regulating the glucose levels. Previously, it was prescribed as a last resort, but due to its benefits, it is usually prescribed much earlier in the disease (ICMR, 2005). There are different forms of insulin, each with a different mode of action, and they are usually prescribed depending on the patient and the progression of their disease. The use of diabetic medication is often accompanied by medicines that lower cholesterol and blood pressure to prevent complications in the heart and blood vessels.

Approaches to Treating Type 2 Diabetes

There is currently no cure for diabetes and treatment goals aim at keeping the blood glucose within normal levels and in reducing the symptoms so that the patient can lead a normal life. This can be done in different ways depending on the patient, and the severity of the disease. The first approach prescribed by doctors when the signs of diabetes are noticed is the non- pharmacological approach. As mentioned earlier, this consists of maintaining the blood glucose levels within the normal range using lifestyle modifications such as exercise and improved diet. The main benefit of this approach is that there are no adverse effects associated with it and if successfully integrated, it can save the patient a lot of time and resources that could be used to procure medication. However, it is useful only if the disease is arrested at an early stage and if it is strictly followed. Otherwise, the patient will not enjoy the full benefits of the approach. This method is also helpful in that it helps to control other diabetes risk factors such as obesity, hypertension and lifestyle activities such as smoking.

However, in many cases, this approach is usually used in combination with medication. As mentioned, type 2 diabetes is a progressive disease that develops over time as the β- cells of the pancreas become inefficient at producing insulin (Diapedia, 2016). Due to this, it may be necessary to incorporate the mentioned pharmacological interventions that will assist the body to either produce more insulin or effectively manage the amount of glucose in the blood stream. This is usually the most effective approach for managing the disease (Diabetes UK, 2016). However, these medicines cannot be used instead of lifestyle changes, since they are not effective on their own. Therefore, they are used in conjunction with the non- therapeutic interventions.

Despite its benefits, this approach is associated with numerous complications due to the side effects of the drugs used. For instance, Metformin, one of the more common drugs used to manage type 2 diabetes is associated with nausea or loose stools before the body adjusts to the medication. Others such as DiaBeta are related to low blood sugar, and consequently weight gain. Patients on this type of medication may experience low levels of sugar in the blood, which may cause they to feel hungry frequently and end up overeating, defeating the purpose of the drug. The lifestyle changes become necessary since the patients will only consume wholesome foods such as fruits and vegetables that will prevent the blood sugar from spiking. Other medicines are associated with more severe complications such as heart failure, and they are not prescribed as the first line of treatment.

This treatment option is preferred, and it has been recommended in recent peer reviewed articles. West and colleagues published one such paper in 2016 in the American Psychologist. They state that most victims of type 2 diabetes are overweight, which predisposes them to numerous diseases such as diabetes and hypertension. They further suggest that lifestyle changes that include a change of diet and increased exercise may be useful in reducing the prevalence of diseases such as diabetes in such populations. West (2016) quotes from work done by the Look Ahead Research Group (2013) that outlines the benefits of lifestyle intervention when treating type 2 diabetes. They state that both approaches (non- pharmacological and medicinal) are most effective when used together. Recent research by the American Diabetes Association (2013) also outlines the standards of care for patients with type 2 diabetes, which includes the lifestyle changes mentioned as well as prescribed medication depending on the patient’s symptoms. This supports the approach and suggests that it is effective in managing type 2 diabetes.

The mentioned articles are from reputable peer-reviewed journals, and they have been published in recent years showing the status of research on management of the disease. The articles are also valid since they have been published by groups and authors qualified and experienced in diabetes research. For instance, the American Diabetes Association is a reputable organization that provides information, standards and up to date knowledge concerning diabetes in the world.  Based on this the information from the articles is credible and can be used to approve the recommended approach for managing type 2 diabetes.

Follow-up and Referral

As mentioned, diabetes is a chronic condition that requires constant management to regulate its symptoms. Patients with the disease are needed to initiate the proper lifestyle changes and to take the necessary medication to keep their blood glucose levels normal. It is also important to monitor blood sugar on a regular basis, and it is usually done every 2- 6 months depending on the severity of the disease (American Diabetes Association, 2013). The procedure can be done by the patient or at the hospital and it an important way of monitoring the condition.

The patient will also need regular advice from the health care professionals, which is necessary to make adjustments to their diet, lifestyle or medication. The approach, medicine, and dosage will keep changing throughout the course of the disease depending on the symptoms and the state of the patient. It is also important to have regular check- ups since it helps to identify and treat or prevent any complications that could arise such as foot or eye problems.

Conclusion

            Type 2 diabetes is a significant global disease that affects over 300 million of the worlds’ population. It occurs when the body cannot produce enough insulin to regulate the amount of glucose in the bloodstream. This occurs due to many factors, but lifestyle choices and genetics seem to play a significant role. It is characterized by frequent urination, increased thirst, and unexplained weight loss, among other symptoms. There is no sure treatment for type 2 diabetes and interventions focus on regulating blood glucose and managing the symptoms of the disease. Therapy can involve lifestyle modification or the use of medication. Credible literature shows that the desired approach is a combination of the two methods that is guaranteed to give the patients the best outcomes. It is also important for the patient to have mechanisms in place that help monitor the progress of the disease such as determining their blood glucose at specified intervals and having regular visits with their doctors. With these in place, the patient will be able to lead a normal life despite their condition.

References

American Diabetes Association. (2013). Standards of medical care for patients with diabetes mellitus. Puerto Rico Health Sciences Journal, 20(2).

Diabetes UK. (2016). Diagnostic criteria for diabetes: WHO recommendations. Retrieved from https://www.diabetes.org.uk/Professionals/Position-statements-reports/Diagnosis-ongoing-management-monitoring/New_diagnostic_criteria_for_diabetes/

Diapedia. (2016). Type 2 diabetes mellitus. Retrieved from: http://www.diapedia.org/type-2-diabetes-mellitus/3104085114

ICMR. (2005). Guidelines for management of type 2 diabetes. Retrieved from: http://icmr.nic.in/guidelines_diabetes/section7.pdf

Look AHEAD Research Group. (2013). Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes. New England Journal of Medicine, 2013(369), 145-154.

Tuomilehto, J. (2009). Nonpharmacologic therapy and exercise in the prevention of type 2 diabetes. Diabetes Care, 32(suppl 2), S189-S193.

West, D. S., Coulon, S. M., Monroe, C. M., & Wilson, D. K. (2016). Evidence-based lifestyle interventions for obesity and Type 2 diabetes: The Look AHEAD intensive lifestyle intervention as exemplar. American Psychologist, 71(7), 614.

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