Beware of Diabesity

With normal Diabetes and obese Diabetes becoming widespread, innovative Diabetes management techniques have become necessary

Dr. Joseph Kunnirickal Joseph MD (MED), CCEBDM (Diabetes) Consultant Internal medicine and Diabetology VPS Lakeshore hospital Kochi.

Diabetes afflicts about 450 million people worldwide. in 2017, it resulted in healthcare expenditure to the tune of USD 727 billion dollars. Obesity is another worrying condition. Over 600 million adults and 100 million children across 195 countries were obese in 2015. What happens if the two occur together? Diabesity! Are the treatment options same for normal Diabetes and obese Diabetes? The answer is no!

A revolutionary change has occurred in the field of Diabetes therapeutics in the past five years. Sodium-glucoseco-transporter-2 (SGLT-2) inhibitors, a new group of oral medications used for treating type 2 Diabetes, like Canagliflozin, Dapagliflozin and Empagliflozin are increasingly used by medical practitioners. They work by preventing kidneys from reabsorbing glucose back into the blood. The SGLT-2 inhibitors block sodium-glucose transport proteins, the protins that reabsorb glucose.

It results in reduced blood sugars, weight loss and helps in minimising adverse events (Mace) in Cardiac Diabetes patients. It also exists as a combination with Gliptins (DPP-4 ), most commonly, Empagliflozin with Linagliptin.

Another revolution is the advent of the GLP1 agonist injections (a new group of injectable drugs to treat type 2 Diabetes), namely Dulaglutide (once a week) and Liraglutide (daily injection). The drug reduces appetite by augmenting the action of glucagon receptor. It can reduce both weight and sugars drastically if administered to the right patient.

The new treatment options come as a huge relief for scores of Diabetes patients who, for long, had to depend solely on Insulin. Now if a Diabetes patient is treated by a doctor well-versed in newer therapeutics, it can go a long way in preventing complications like Neuropathy, Nephropathy, Cardiac disease, Retinopathy and Fatty Liver disease.

Presently, medical practitioners are being trained in newer insulin pumps and smart technologies that mimics artificial pancreas and also devices that monitor sugars without repeated pricking. Physicians can monitor patient sugars on his mobile or laptop by getting alerts on a patient dashboard. As newer molecules like oral GLP 1 agonist are on the anvil, the days of managing Diabetes with vials, syringes, older

regular Insulin and drugs like Glibenclamide are well and truly over. There are some who may argue against cost- lier newer molecules but the outcomes are too good and potent to be ignored. It is just that the government needs to step in and subsidise the newer game changing molecules and bring relief to millions of diabetes patients. An Institute for Excellence in Promoting Yoga and Yoga Training Presenting Arogya Yogshala a unique center promoting Yoga with customized training programs for Individuals, Corporate Houses, Schools and NGO's.

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