Doctors advocate the combination of drugs at the beginning of diabetes treatment – Where is the cure?

Initial approaches usually involve changes in dietary habits and the introduction or intensification of exercise. Sometimes, however, it may be advantageous to use drug combinations soon after the diagnosis, say the doctors. This was one of the topics discussed at the annual meeting of the American Diabetes Association (ADA), which was held in Orlando at the end of June.

The disease kills about 61,000 Brazilians a year, a number that is comparable to murder (about 60,000 per year) and almost double the number of people killed in road crashes (33,000 per year).

With more effective treatment soon after the diagnosis, contrary to what is happening are used on the basis of trial and error, the patient would be more likely to keep the disease under control, in avoiding complications.

For those who have the disease, the main goal is to maintain glycated hemoglobin, a blood test, below 7% (preferably below 6, 5%, but this may be more flexible in patients with severe complications, the normal range for unaffected patients is 4% to 5.6%). Maintaining this low index is the purpose of the different treatment modalities and, as a rule, what will determine the dosage and number of drugs to be taken or applied.

The problem, says Levimar Rocha Araújo, a professor at the Faculty of Medical Sciences of Minas Gerais, is the great resistance of patients, who do not like taking medicine right away to cure a condition apparently initial, as well as doctors who are afraid of losing their clientele. Another problem is that, especially in the public system, professionals have little time to teach the patient how to cope with diabetes, a complex disease.

"The essential is the lack of education about diabetes. Said Araújo, who is also a diabetic, promotes youth camps with the idea of ​​teaching them how to cope with the disease in everyday situations: an example: in a day of activity Intense physical, it is possible to reduce the amount of insulin (hormone whose activity is impaired by the disease) to administer, since exercise also has a hypoglycemic effect, that is, to reduce the concentration of glucose in the blood "As often the diabetic patient has no symptoms, it is not logical to start taking drugs," says Solange Travbados, vice president of the Brazilian Society of Diabetes, diagnosed with type 1 diabetes, 14. She and Araújo claim that it is necessary to evaluate the possibility of using at an early stage all the weapons that can help the patient.

"The body has a te of metabolic memory, ie the beginning of the treatment and the way the body reacts is a very important factor for the prognosis. If the body is forced to live with the disease for a long time, it will deplete, losing the ability to recover, "says Araújo.

Pharmacological alternatives include traditional metformin (for over 60 years on the market) and insulin supplementation by injections, to try to normalize hormonal function, to reduce blood sugar levels and to prevent effects such as impotence, stroke and amputations.

Some options can help patients simplify care. injection. This is the case of Xultophy, a combination of insulin and liraglutide, the active ingredient in the drug Victoza, which has been successful in reducing blood sugar, with a good chance of avoiding gain of weight, something common in the disease

still in the experimental stage, is a new formulation of insulin to be administered orally. Scientists from the University of California at Santa Barbara and Harvard have recently published an article in the PNAS journal explaining how this could happen.

A liquid could prevent the degradation of the molecule in the digestive system and promote its absorption by the paracellular pathway, that is to say, between the cells lining the gastrointestinal tract. One of the barriers to adherence to insulin treatment is precisely the need for injection.

Able to monitor the level of glucose and even inject insulin, monitoring equipment and pumps also gained space. Some devices produce a graph with the change in blood sugar throughout the day, which allows to adjust the insulin dose and refine the treatment. In late June, the FDA approved an implantable sensor that could be immersed in the skin for 90 consecutive days.

A Abbott study presented in the ADA showed that frequent monitoring can help reduce the time of hypoglycemia, another ghost for those who depend on insulin .

Pumps are particularly useful for type 1 diabetic patients In the country, many people have had access to them through court decisions.

Many health professionals, however, tend to avoid medications because of the danger of interactions with other medications and side effects. The standard path is always the change in lifestyle: eat better (and generally less) and exercise; Obesity also aggravates the condition.

In favor of this approach is the fact that the muscle contraction favored in the exercises and weight loss make the body respond better to insulin, that is to say can delay the The introduction of drugs or reducing the dose, although doctors agree that lifestyle changes are only the bare minimum.

Finally, there is the possibility of bariatric surgery (called metabolic surgery when the goal is to fight diabetes) to solve the problem. Despite the aggressiveness and the high chances of resolution, the patient must deploy a lot of effort to achieve the various proposed goals, which also include vitamin intake and mental health management, as well as the treatment of diabetes

] The journalist traveled at the invitation of Sanofi

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