Type 2 diabetes mellitus is a very common and ever-prevalent disease that tends to develop in adults over the age of 40 – 50, but can also affect younger patients.
Unlike type 1 diabetes, which is insulin-dependent, as the pancreas is no longer able to produce insulin (i.e. the hormone that keeps the blood glucose level low); in type 2 diabetes, insulin is still present but its mechanism of action is compromised.
To cure this pathology, it is important that the patient undergoes adequate treatment, and in recent years new clinical studies have contributed to significant innovations in clinical practice.
The American Diabetes Association (ADA) recently published the new Standards of Care for 2020 (1), along with a Consensus Report compiled with the European Association for the Study of Diabetes (EASD) on the treatment of hyperglycemia in patients with type 2 diabetes (2). We talked about it with Dr. Marco Mirani, Humanitas diabetes expert.
The importance of new guidelines in the treatment of diabetes
“Over the past few years, the results of clinical trials conducted on new antihyperglycemic drugs have provided very solid evidence regarding their effectiveness in improving cardiovascular and renal outcomes in patients with diabetes. For this reason the most important international and Italian scientific societies, such as the Italian Society of Diabetology and the Association of Diabetologists) recommending the use of these drugs “, explains Dr. Mirani.
“We can therefore state that these new guidelines will change clinical practice in the coming years, both in primary and secondary prevention of cardiovascular diseases in patients with diabetes”.
What are these new drugs?
“They belong to two new drug classes. The first is that of the analogues of GLP-1 (Glucagon-like peptide-1), a hormone normally produced by intestinal cells in response to meals, which promotes insulin secretion and inhibits the secretion of glucagon by the pancreas. These drugs, in addition to improving glycemic control, can also promote weight loss. They are administered subcutaneously even once a week, and this makes them easy and comfortable to use for the patient,” continues the specialist.
“The second class is that of inhibitors of the sodium glucose 2 co-transporter (SGLT2), or gliflozins, which act on a renal receptor favoring the elimination of sugar in the urine (the so-called glycosuria) and thus causing a reduction in glucose in the blood. These drugs, on the other hand, are administered orally.”
A personalized therapeutic approach
“Thanks to these new drugs we can customize the therapeutic approach also in terms of cardiovascular complications, which represent the main cause of mortality in patients with type 2 diabetes. The use of GLP-1 analogues, in fact, is recommended in patients with type 2 diabetes and established atherosclerotic disease, such as previous myocardial infarction, unstable angina, coronary revascularization, and also ischemic stroke or peripheral vessel vascular disease.
SGLT2 inhibitors, on the other hand, are recommended in patients with heart failure, with and without coronary artery disease, and to prevent the progression of chronic kidney disease,” concludes Dr. Mirani.
(1) American Diabetes Association. Standards of Medical Care in Diabetes—2020. Diabetes Care. 2020;43(suppl 1):S1-S212
(2) Buse JB, Wexler DJ, Tsapas A, et al. 2019 update to: management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care. 2020;43:1-7.