Treatment of Diabetes Mellitus

Diabetes mellitus is a disease which is as a result of the body failing to break down sugar into energy leading to excessive sugar or glucose in the body. The hormone responsible for breaking down glucose into energy is insulin. Diabetes can occur as a result of the body not producing enough insulin or the body not responding adequately to the insulin produced. There are three types of diabetes mellitus- Type-1 Diabetes, Type-2 Diabetes and Gestational diabetes. Gestational diabetes happens in pregnant mothers as they can develop resistance to insulin but this can resolve itself after pregnancy. The problem with gestational diabetes is that it increases the risk of getting type-2 diabetes. Type-1 diabetes is insulin-dependent diabetes where the pancreas fails to produce enough insulin; this begins during childhood and is referred to as juvenile-onset diabetes. Type-1 diabetes can be treated by injecting more diabetes. Type-2 diabetes is caused by the resistive response by the body to insulin produced. Tyep-2 diabetes is not dependent on insulin, therefore, untreatable. The leading causes of Type-2 diabetes are a lack of physical activity and overweight. More than 90% of the entire population diagnosed with Diabetes Mellitus has type-2 diabetes, and this is why Pratley (2013) researched on several interventions that can be used to prevent type-2 diabetes or those living with type-2 diabetes. 

     Type-2 diabetes has both short-term and long-terms burden. Type-2 diabetes increases mortality and morbidity rates across the globes. The disease can cause disorders such as diabetic retinopathy (causes blindness), diabetic nephropathy (causes chronic kidney disease) and diabetic neuropathy (leads to foot ulcers and limb amputation). If an individual has high glucose level in the body for a long time, they have increased chances of having cardiovascular diseases (CVD). One of the interventions proposed by Pratley (2013) is intensive glycemic control which can be used to reduce microvascular complications that can be brought about by hyperglycemia. The use of glycemic control was supported by a study carried out by Ohkubo et al., (1995) on 110 Japanese patients with type-2 diabetes. The randomly selected patients were assigned to a multiple insulin injection treatment group (MIT) and a conventional injection treatment group (CIT).  The results showed those in CIT group showed deterioration in their nerve conduction velocities while those in MIT group showed an improvement in the same. The research concluded that intensive glycemic control by MIT therapy can delay the progression and onset of microvascular conditions. The article by Nunnelee (2008) though provides a caution that short-term intensive treatment can lead to detrimental effects, especially to high-risk patients. 

     Early intervention has been suggested by Pratley (2013) in addressing issues of pre-diabetes. Pre-diabetes is a condition where an individual has high blood sugar levels but it has not reached the threshold to be referred to as type-2 diabetes. Without any intervention, pre-diabetes transforms to type-2 diabetes with time. The probability of an individual with pre-diabetes getting type-2 diabetes is high compared to those who have normal glucose levels. Early interventions such as pharmacotherapy and lifestyle modifications can play a huge role in slowing down the progression of type-2 diabetes for people with pre-diabetes. The research carried out by Nathan et al., (2007) support the fact that early interventions can be used to slow the progress of Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT) which are pre-diabetic states. The authors found out that lifestyle modification therapy is the best intervention for people with IFG/IGT. They proposed maintaining a moderate weight and also moderate physical activity. The lifestyle modification therapy can be supplemented with drugs which are efficient and have minimum side effects such as metformin. 

     Pratley (2013) suggests a multi-factorial approach should be used where pharmacotherapy should be used to support lifestyle modification therapy. Antihyperglycemic agents can be used to prevent people with pre-diabetes from contracting overt diabetes. Some of the common and recommended pharmacotherapy drugs are metformin, thiazolidinediones, and acarbose. Even though these anti-hyperglycemic agents might be having side effects, safety issues, tolerability issues and might not be effective they can slow down the progression oof type-2 diabetes. Metmorfin is the best and most recommended initial pharmacotherapy that can be used in combination with lifestyle modification therapies. Bolen (2007) carried out research to determine the benefits and limitations of new oral agents that are emerging in the market in treatment for adults with type-2 diabetes. The results of the clinical trial indicate that oral agents such as repaglinide, metformin and thiazolidinediones improved glycemic control in individuals with type-2 diabetes the same as second-generation sulfonylureas. The research concluded that older oral agents such as metformin and second-generation sulfonylureas had similar or even better effects on lipids and glycemic control. Different oral agents have unique side effects, for instance, is associated with increased risk of gastrointestinal problems while sulfonylureas are associated with increased risk of hypoglycemia. 

    In conclusion, there has been an increase in the number of interventions in the past two decades with regards to treatment of type-2 diabetes, before there were only two available interventions i.e. sulfonylureas and insulin. There has been the proliferation of empirical evidence regarding pathophysiology of the illness as well as treatment approaches. The best intervention for type-2 diabetes is people should be empowered and enlightened so that they can be screened to identify their blood sugar levels. Early detection, especially for pre-diabetes, is critical so that necessary steps can be taken to avoid type-2 diabetes.  Type-2 diabetes cannot be treated but can be contained and control, therefore; the best approach to this is a multi-factorial approach where and individual uses lifestyle modification therapy (such as dieting and physical activity) and pharmacotherapy which involves the use of drugs e.g. metformin. These interventions or their combinations should be used with the advice and monitoring of a qualified medical practitioner.


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