Innovative therapy for Type 2 diabetes management

According to the latest estimates, a whopping 537 million adults or 1 in 10 people are living with diabetes globally. India, unfortunately, is home to the world’s second-largest population of people with diabetes at 74.2 million. While Type 2 diabetes mellitus or T2DM, the most prevalent form of diabetes, is one of the most common health problems today, we often fail to take into consideration the seriousness of the disease. Compared to those without diabetes, people with this disorder are at a higher risk of developing several disabling and life-threatening health problems.

Uncontrolled Type 2 diabetes enhances the risk of complications

T2DM occurs when the body doesn't produce enough insulin or when it is unable to use the insulin it produces effectively. Since insulin is responsible for converting the sugar (glucose) in your food into energy, its insufficiency and underutilisation lead to high blood glucose levels. Patients with T2DM need to control their blood glucose levels since consistently high levels can lead to serious diseases that affect the kidney, eye, nerves, heart, blood vessels and brain.  Nearly 0.6 million deaths in India are attributed to diabetes. Compared to individuals without diabetes, the risk of cardiovascular complications such as unstable angina (pain in the chest), heart attack, heart failure and stroke increases by 53 per cent, 54 per cent, 56 per cent and 72 per cent, respectively in those with T2DM.

Additionally, diabetes coexists with several other disorders, increasing the overall risk of complications. The combination of diabetes and obesity is termed ‘diabesity’ and mortality risk in such individuals increases by 7 times. While weight gain is common in T2DM, the reverse is also true i.e. every kilogram gained increases diabetes risk by 4.5%. Obesity also affects the kidney with individuals living with obesity being 2.5 times more likely to suffer from kidney problems. Similarly, nearly 40 per cent of individuals with T2DM have kidney complications. Hypertension, itself a risk factor for heart disease, is also 2 times more common in those with T2DM than in individuals without diabetes.

Type 2 diabetes management in the current era of multiple comorbidities

Though T2DM therapy is primarily aimed towards controlling blood glucose levels, holistic management of the condition is the need of the hour. Though lifestyle changes such as weight control, appropriate diet and cessation of smoking and alcohol consumption can make a difference, most T2DM patients eventually need treatment with antidiabetic medications (ADMs). Though older agents such as sulphonylureas, insulin and thiazolidinediones help control blood glucose, they also result in side effects such as hypoglycaemia (glucose levels lower than normal) and weight gain which offset their beneficial effects.

The need to explore other avenues of treatment has led to the development of drugs such as sodium-glucose cotransporter-2 (SGLT2) inhibitors, dipeptidyl peptidase (DPP)-4 inhibitors and Glucose-like peptide (GLP-1) receptor agonists (RAs). GLP-1 RAs especially offer blood glucose control coupled with weight loss and lack of hypoglycaemia, tackling the twin hurdles of T2DM and obesity safely while reducing the overall risk of complications. However, their availability as injectables was a challenge for T2DM patients.

Making an innovative leap in comprehensive Type 2 diabetes management

The need to bridge the gap between comprehensive T2DM management and convenience led to the development of an oral form of the GLP-1 RA, semaglutide. Oral semaglutide provides patients with efficacy, safety, weight loss and minimal side effects, all in a convenient pill form. Clinical studies conducted with oral semaglutide affirmed its impact on blood glucose levels and weight loss (up to 5 kgs) along with cardiovascular safety. Moreover, the effect was greater than that seen with other ADMs. The product of 15 years of research, oral semaglutide offers a novel and efficacious option for the holistic treatment of T2DM, thereby improving patient outcomes.

The writer is MBBS, MD- General Medicine, DM- Endocrinology. Views are personal.

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