Diabetes mellitus has mankind firmly in its grip. The disease is among the fastest growing health challenges of our time. For this reason, research is being carried out at full speed not only to get a grip on the possible consequences of diabetes, but also to be as successful as possible in prevention. With regard to therapy, promising developments have already been established in recent years with GLP-1 receptor agonists and SGLT2 inhibitors.
In Switzerland, it is estimated that approximately 500,000 people suffer from diabetes. Despite all efforts, the prevalence is expected to continue to increase in the future. Current surveys do not indicate that the continuously rising rate of new cases could be curbed. However, people with diabetes have fewer healthy life years and reduced life expectancy. The good news is that much has happened in the management of type 2 diabetes in recent years. As Prof. Jens Aberle, MD, Hamburg (D), pointed out, several studies show that a weight reduction of about 10 kilograms can lead to remission in about 50% of people with newly-manifested type 2 diabetes. It is irrelevant in which way the weight reduction has taken place. Low caloric diets as well as new pharmacological preparations and surgical interventions can achieve this effect.
More than just treating diabetes
Great progress has been made in drug treatment in recent years. Not only an effective weight reduction and good effect on blood glucose levels, but furthermore cardio- and nephroprotective consequences could be observed with the new preparations. Both GLP-1 receptor agonists and SGLT2 inhibitors reduce cardiovascular outcomes and mortality. SGLT2 inhibitors also showed a consistent and notable reduction in hospitalizations for heart failure and slowed the decline in renal function, including progression to end-stage renal disease and renal death. Interestingly, the positive effects occur largely independently of the improvement in blood glucose control, the expert stated.
Treatment management of type 2 diabetes can now be much more individualized due to the availability of the new drugs on the one hand and non-drug therapy options on the other. Depending on the disease state, comorbidities, efficacy and safety profile of medications, patient preferences, and cost, other therapeutic regimens may come into play. Personalized medicine can better tailor therapeutic interventions to individual patients, maximizing benefits and minimizing harms, Aberle summed up.
The disease over time
Prof. Dr. med. Petra-Maria Schumm-Draeger, Munich (D), dealt with the special challenges of the climacteric for women with diabetes. This is because a pronounced tendency to gain weight, especially an increase in visceral fat, combined with hormonal fluctuations, makes stable, near-normal blood glucose control extremely difficult. The fact that the menopausal transition often begins earlier in diabetic women should not be ignored. The cause is probably an accelerated aging process of the ovaries due to diabetes-associated vascular changes. Increased estrogen levels lead to an improvement in insulin sensitivity, whereas higher progesterone levels increase insulin resistance. As a result, both drops and intermittent surges in hormones lead to fluctuations in insulin sensitivity – with resulting blood glucose fluctuations to both hypo- and hyperglycemia. Therefore, it is necessary to perform significantly more close-meshed blood glucose self-monitoring or continuous blood glucose measurement in order to be able to carefully adjust insulin therapy to the current situation of menopausal transition with the corresponding hormonal fluctuations. Preparations that prevent weight gain or support weight reduction without the risk of hypoglycemia are then indicated for treatment, according to the expert.
However, it is not only women with diabetes who suffer more clearly from the disease in the course of their lives. In men, too, Ty-2 diabetes with increasing age can lead to metabolic disorders a testosterone deficiency, reported Dr. Cornelia Jaursch-Hancke, Wiesbaden (D). Actually, this occurs very rarely. However, in men with type 2 diabetes, testosterone deficiency affects nearly 50% and up to 90% of those affected suffer from sexual dysfunction. This is due to the characteristic visceral obesity. Adipokines have a negative influence on testosterone production and reduce the effect of existing insulin by forming insulin resistance. Therefore, this testosterone deficiency is reversible by weight loss with reduction of pathological fat cells. In this case, testosterone therapy is not recommended, but conventional diabetes treatment with GLP-1 analogue is recommended to improve metabolic parameters and quality of life.
Congress: Diabetes without borders
CARDIOVASC 2022; 21(1): 24
