Defying diabetes: Living better through breakthrough medicine

MANILA, Philippines - Today, over 230 million people in the world suffer from diabetes, and more than three million of them are Filipinos. But despite the prevalence of diabetes, it is still a widely misunderstood disease.

For instance, many still define diabetes as a disease caused by “having too much blood sugar.” In fact, diabetes is a disease of not having enough insulin, the hormone that controls the blood sugar level.

It is either the lack of insulin or the inability of the body to respond well to insulin that causes blood sugar levels to skyrocket. In other words, high blood sugar is merely an effect, not a cause or innate nature, of diabetes.

Nonetheless, that does not make sugar an innocent party because it is this high level of sugar in the blood that causes the most terrible complications of diabetes: damage of the nerves and blood vessels, which lead to heart disease, loss of feeling and mobility, neuropathic pain, blindness, kidney disease, stroke, and amputations.

The focus of diabetes management, therefore, has been to control blood sugar levels, through lifestyle changes such as having more exercise and changing one’s diet, and through medication.

Common treatments

Common treatments for type 2 diabetes, or the so-called “adult” diabetes, involve the use of drugs such as meglitinides and sulfonylureas, which work by stimulating the body to release more insulin, to lower the levels of blood sugar circulating in the body.

Now, while these drugs are effective, they have a tendency to overshoot their target, so to speak, causing an overproduction of insulin, resulting in side effects such as low blood sugar (hypoglycemia), nausea, headache, and even weight gain. The end-result is that the patient’s overall quality of life is adversely affected.

Other drugs, such as biguanides and thiazolidinediones, have a different mechanism of action: instead of increasing insulin production, they simply make the body more sensitive to insulin. They also lower the sugar production of the liver.

Because these drugs remove the possibility of insulin overproduction, the possible side effects of insulin stimulants are avoided. However, other side effects come to take their place: people taking these drugs might experience diarrhea or rarely, lactic acid buildup. Thiazolidinediones have been associated with increased risks of heart attack, stroke, or liver disease.

New medicine line

Now in recent years, a new line of medicine have been studied and developed — the DPP4 (Dipeptidyl peptidase-4) inhibitors. Here is how they work: after a meal, the body releases gut hormones called incretins, which cause the body to produce more insulin and make the liver release less sugar. This controls the blood sugar level of the body.

But DPP4 enzymes break down these incretins. When the incretins are gone, the body produces less insulin again, and the hepatic release of sugar increases, so blood sugar levels start to rise.

To allow the body to continue producing insulin for a longer time, there’s a need to block the enzymes that destroy the insulin-stimulating incretins. There’s a need to block DPP4. That’s what DPP4 inhibitors, such as sitagliptin, do.

Now, when the diabetic patient’s blood level has reached acceptable levels, the body itself reacts by slowly halting insulin production naturally. In other words, the process is self-controlling. This way, the tendency of old drugs to result in too much insulin in the body is still avoided, and hypoglycemia and its related side effects do not occur.

Today, DPP4 inhibitors have already changed the lives of many diabetic patients, allowing them to live more comfortably with their disease. Nonetheless, the study and development of this class of drugs continues.

Pharmaceutical groups, such as MSD, continues to work toward creating safer, more effective, and more convenient medications for diabetic patients, while educating people all over the world on how to avoid contracting this potentially debilitating disease in the first place.