It is hard to believe, but think about it: Have you ever heard of anyone really getting better once they start taking the diabetic pills? The truth may be “DIABETES CANNOT BE CURED BY MEDICINES”. More than 95 percent of the top selling medicines, do not cure any disease, they are designed to treat signs and symptoms, but not to cure.
Do you have diabetes? The doctor puts you on drugs, and makes you measure your blood sugar daily. None of these things will ever cure diabetes, they are just treatments.
Doctors are not trained in nutrition; they are trained to prescribe drugs and other medicines. They are not allowed by law to even mention natural ways to cure illness or disease using anything other than prescription drugs.
Medications make blood sugars better, but not the diabetes.
Type 2 Diabetes, at its very core, is a disease about too much sugar in the body, not just the blood. Yet most of our drugs, from metformin to insulin do not rid the body of that sugar. It only drives it from the blood and into the body. But if this sugar is toxic in the blood, why would it not be toxic inside the body?
We are only moving the sugar from somewhere we can see it (the blood) to somewhere we cannot (the body) and then pretending things are improved, but all the while knowing that we have not made a difference. Where lifestyle changes clearly improves health, drugs just as clearly do not.
- It should be noted that diabetic patients die mostly not directly from diabetes, but from cardiovascular disease (60-80% of patients) and chronic renal failure (nephropathy, 10-20%).
- Half of the people who lost their vision – because of diabetes.
- One third of all amputations of legs are performed in patients with diabetes.
- Diabetes mellitus is a major cause of renal failure.
- The risk of myocardial infarction and stroke with diabetes is twice than that of people without diabetes.
We split the atom and cracked the genetic code, and at the same time, the level of the state of health of our society is low as never before. By the way, more Than 50% of Americans Now Have Diabetes or Prediabetes, including an unbelievable 83% of 65+ year olds.
What’s the matter?
It turns out that the methods of treatment of diabetes offered by modern medicine are ineffective!
Of course, modern medicine is always comforting “diabetes is not a sentence; diabetes is a way of life!” The “management” of diabetes is a huge industry. The purpose of the industry is to help people live with the disease in the most comfortable manner possible. By accepting that there is no cure, the easy route is taken.
The writer is not against diabetic drugs. He is just pointing out that they will not, by themselves, stop diabetes killing you. They will not, by themselves, stop you developing painful and debilitating diabetic complications.
Diabetes Medications Improving, But Not Blood Sugar Levels
A new study shows that choice of diabetes medications is changing in the U.S. The new drugs are supposedly better, but average blood sugar levels appear to be going up. How do you explain this? Are drugs not the answer?
The study by Kasia J. Lipska, MD, MHS, and colleagues at Yale University, Mayo Clinic, and the University of California, San Francisco, was published in Diabetes Care in September. Researchers reviewed records of over 1.6 million privately insured and Medicare Advantage patients from 2006–2013. They recorded what drugs patients were taking, their HbA1c levels (a measure of average glucose for the last 2–3 months), and the frequency of severe hypoglycemia (HIGH-poe-gly-SEEM-e-uh, or low blood sugar) episodes.
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The insurance records showed that doctors are prescribing more DPP-4 inhibitors, insulin, and metformin. They are using less of the sulfonylureas such as glimepiride, glipizide, and glyburide. Use of another drug category, thiazolidinediones, or TZDs has practically stopped. Only 5.6% of people in the study were receiving these drugs by 2013.
There have been good reasons for cutting back on TZDs and sulfonylureas. TZDs were found in several studies to cause heart failure in vulnerable patients. Sulfonylureas cause the pancreatic beta cells to release insulin whether or not blood sugar levels are rising and so put people at risk for hypos.
The older drugs also had advantages. TZDs reduce insulin resistance and blood pressure. They raise levels of HDL (“good”) cholesterol. Sulfonylureas are cheap and convenient to take, so people are more likely to use them.
People are using more insulin, DPP-4 inhibitors, and metformin now. Are those drugs better, or are they just in fashion?
Their reviews sound good. Insulin lowers blood sugar by taking sugar into cells. Metformin helps the liver hold onto extra glucose instead of spilling it and makes the body’s cells more sensitive to insulin. DPP-4 inhibitors raise levels of hormones called incretins. Incretins improve insulin production, slow stomach emptying, and prevent the liver from releasing glucose. Seems these drugs should be making things better.
Are they helping?
When it comes to glucose control, though, the changed prescriptions haven’t made a difference. If anything, average glucose levels measured by HbA1c are going up. “The proportion of patients with HbA1c <7% ["good control"] declined from 56.4 to 54.2%," according to the study. "The proportion with HbA1c ≥9% [poor control] increased from 9.9 to 12.2%."
Control varied by age. Roughly 23.3% of young patients had poor control, compared to about 6.3% of older patients. The study found that rates of hypoglycemia were unchanged at about 1.3 events per 100 person-years. That means that if you followed 50 patients for two years, you would expect to see between 1 and 2 cases of severe hypoglycemia in that time.
Why aren’t better drugs leading to lower glucose levels? It could be that people rely on their medications instead of on their self-management. They get a new drug and think, “Great. Now I can eat whatever I want.” Or maybe, “I don’t need to exercise; these pills have got me covered.”
Or it could be that insulin and metformin are not actually better glucose-lowering drugs than sulfonylureas and TZDs, if those are used correctly. It could even be that, because some of the popular drugs are more expensive, economic stress cuts into some people’s healthy living. TZDs and sulfonylureas are available in generics, and some cost just a few cents a pill. Metformin is also cheap, but DPP-4 inhibitors and synthetic insulin analogs can cost hundreds of dollars a month.
The good news is that rates of complications like heart disease, stroke, and lower-limb amputation have not changed much recently, and they are much lower than they were about 20 years ago. Glucose control isn’t everything, though it is the best indicator we have of diabetes status.
Should data like this new study affect your and your doctor’s choice of medications? Should you stop taking some or all of your medications, if we don’t know which ones are best? I would say not to pay too much attention to large-scale studies and pay more attention to how individual drugs affect you. Not just your glucose numbers, but your overall health and how you feel. Consider side effects, cost, and all your lab numbers, not just glucose.
The main point is that no drug is going to solve diabetes for you, but you can make it much better with good self-management.
How To Lower Your Blood Sugar Without Medications
How To Lower Blood Sugar Naturally: some Actionable Tips
1. Cut Back On Carbohydrates
A diet high in processed carbs adds to the sugar load in your diet. This is because all carbs get broken down into sugars upon digestion. This leads to increased blood sugar and weight gain. Avoid all carbs with a high glycemic index. We recommend a Low Carb-High Fat or LCHF diet to reverse diabetes. Ideally, only 10% of your daily caloric intake should come from carbs. The right carbs for any diabetic are fresh vegetables, fruits and whole grains. Brown rice, quinoa, buckwheat, amaranth and millets are some whole grains that work.
2. You Need More Of The Good Fats
Afraid how will you survive when cutting back on the belly-filling carbs? This is where the good fats step in. Healthy fats that provide Omega 3 fatty acids are your friends. Not only will they keep you full for longer, they will also improve your heart health. They form a steady, slow burning source of fuel that your body can use in place of sugars. Think ghee, grass-fed butter, coconut oil, avocado, nuts, olive oil and oily fish, for example.
3. Try Intermittent Fasting
Intermittent fasting is one of the best ways to improve insulin sensitivity and lower blood sugar levels naturally. Today science has proven that it is not just what we eat that matters. How we eat and “when” we eat it is just as significant. Intermittent fasting is a simple strategy: Eat during a 12-hour window, and fast during the remaining 12 hours. For example, eat between 8 AM to 8 PM only. This effectively mimics the eating habits of our ancestors who lead a hunter-gatherer lifestyle. Eating this way follows the natural body rhythms of the human body, giving the digestive system a much-needed rest for 12 hours. It also helps our cells get more sensitized to insulin during the ‘eating window’.
4. Keep An Eye On Portion Sizes
Eating a large meal puts a sugar load on your already struggling body. Overeating causes further damage to diabetics. An easy way to lower blood sugar levels naturally is to eat smaller portions. Don’t worry; we are not going to ask you to starve yourself! In fact, portion control comes naturally when you choose the right grains, proteins and fats. Strive to eat in moderation. To achieve satiety, eat slowly and chew your food, so your brain has a chance to let you know when you’re full. If you wolf down your food mindlessly, you eat a lot more than you need which stresses out the body.
5. Eat A Fiber-Packed Diet
A diet rich in fiber slows sugar absorption. As your body digests the fiber at a slower pace, it raises your blood sugar levels gradually. A high fiber diet makes blood sugar control a lot easier for you, and also aids in digestion. Get your daily dose of fiber from foods like fruits and vegetables eaten with the skin, beans, legumes, and whole-grains like barley, quinoa and oats.
6. Get Enough Vitamins
Getting enough vitamins boosts immunity and supports your body’s ability to use insulin. This can help keep your blood sugar at healthy levels. Some of the best vitamins for diabetics include Vitamin B3, B6, B12, C, D, E, and K.
7. Add Probiotics To Your Diet
Probiotics have significant effects on reduction of glucose, HbA1c, insulin levels and insulin resistance in diabetics, according to research. Probiotics encourage a healthy gut microbiome, which improves glucose metabolism. This positively benefits lipid profile, glycemic control, inflammation and blood pressure in diabetes type 2 patients.
8. Lose Some Weight
For those living with diabetes, studies have shown that a loss of 5-10% of body weight can improve fitness levels. Weight loss also helps in reducing HbA1c levels and improves cardiovascular health. It also decreases the use of diabetes, hypertension, and lipid-lowering medications. This is particularly important if you’re carrying excess weight around the abdomen. Eating fewer carbs and healthier fats, along with portion control, will help you lose weight.
9. Exercise Regularly
Not just a great way to lose weight, exercising regularly also improves insulin sensitivity. Studies have found that resistance training coupled with aerobic training enhances glucose disposal in type 2 diabetics. The improved insulin sensitivity is related to loss of abdominal, subcutaneous and visceral fat and to increased muscle density.
10. Ensure A Good Night’s Sleep
Never underestimate the power of a good night’s sleep. A single night of inadequate sleep makes our body react in a manner similar to insulin resistance. It can lead to raised blood sugar levels. A good night’s sleep can improve glucose metabolism. It will also keep you motivated to follow through with your diet and exercise routine.
11. Manage Your Stress Better
Stress, whether physical, mental or emotional, has been proven to contribute towards changes in blood sugar levels. Don’t let work stress follow you home. Similarly, don’t let a stressful relationship worsen your diabetes symptoms. One of the best ways to manage stress is to practice yoga and meditation regularly.
12. Limit Your Alcohol Intake
You don’t have to stop living life only because you’re diabetic. But you should try to limit your alcohol intake. Alcohol contains added sugars and also dehydrates the body. Drink occasionally and in moderation; no more than one drink at a time.
13. Give Up Smoking
As a diabetic, it’s important to quit smoking. Nicotine in cigarettes encourages insulin resistance. Not only does it make blood sugar control harder, it also increases the risk of heart diseases, kidney problems and more.
14. Try Bitter Melon
Naturopath doctors highly recommend bitter melon for diabetes, thanks to its amazing effect of lowering blood glucose levels. Bitter melon extract contains chemicals that act similar to insulin. A number of studies have found that bitter melon juice, fruit and dried powder have a moderate effect on lowering blood glucose.
15. Give Medicinal Essential Oils A Chance
Essential oils can be extremely beneficial for insulin sensitivity. Some essential oils may help relieve the severity of diabetes. And some oils can assist in weight loss, which keeps blood sugar levels more stable. Try cinnamon bark essential oil, coriander seed oil, and davana essential oil.
16. Add Herbs To Your Diet
Some herbs and spices naturally lower blood sugar levels, making them a must-add to your diabetic diet. Both ginseng and fenugreek help lower blood sugar levels. Berberine and cinnamon also have a positive effect on the glycemic control.
17. Dietary Supplements Also Help
The increase your intake of nutrients that support your body’s ability to use insulin and can help keep your blood sugar stable. Besides vitamins, herbs and spices that are good for diabetes, we also highly recommend Magnesium Citrate, CoQ10 supplementation, D-Chiro Inositol, Chromium, ALA, Green Tea Extract and Pomegranate Extract.
Oral semaglutide was found to be superior to both subcutaneous liraglutide and placebo.
Among patients with type 2 diabetes recruited from 100 sites in 12 countries, researchers compared oral semaglutide [a novel glucagon-like peptide-1 (GLP-1) agonist] to subcutaneous liraglutide and placebo. According to the eligibility criteria for inclusion in this study, participants were required to be of 18 years of age or older, with glycated haemoglobin (HbA1c) of 7·0–9·5% (53–80·3 mmol/mol), on a stable dose of metformin (≥1500 mg or maximum tolerated) with or without a sodium-glucose co-transporter-2 inhibitor. In a random manner (2:2:1), once-daily oral semaglutide (dose escalated to 14 mg), once-daily subcutaneous liraglutide (dose escalated to 1·8 mg), or placebo was administered to participants for 52 weeks. As for efficacy in reducing HbA1c, non-inferiority of oral semaglutide to subcutaneous liraglutide and superiority to placebo was evident, and oral semaglutide was found to be superior to both liraglutide and placebo in terms of efficacy in decreasing bodyweight at week 26. Compared to subcutaneous liraglutide, similar safety and tolerability were displayed by oral semaglutide. Earlier start of GLP-1 receptor agonist therapy in the diabetes treatment continuum of care might result from the use of oral semaglutide.
Should I Worry About Diabetes Drugs Side Effects or Interactions?
Different types of diabetes drugs have their own side effects and ways they interact with other medicines.
Biguanides: Metformin (Glucophage, Glucophage XR, Glumetza, Fortamet, Riomet). Metformin is usually the first drug that doctors suggest you try to treat type 2 diabetes. It cuts blood sugar by improving the way your body uses insulin. It also lowers the amount of sugar that the liver makes.
What are the side effects? You may have nausea, gas, bloating, diarrhea, and an upset stomach. These problems usually go away in a few weeks, as your body gets used to the medicine. It may also help to take the drug with food.
In rare cases, metformin may cause a serious condition called lactic acidosis. That’s when too much lactic acid builds up. Call your doctor right away if you get any of these symptoms:
Unusual weakness, tiredness, or sleepiness
Trouble breathing
Muscle pain that’s not normal
Sudden stomach problems, such as vomiting
Do they clash with other drugs? Some drugs may interfere with some of the enzymes that metformin uses to work. Your doctor may need to monitor your blood sugar or adjust your metformin dose if you take any of these:
Amiloride
Cephalexin
Cimetidine
Digoxin
Procainamide
Pyrimethamine
Quinidine
Quinine
Ranitidine
Trimethoprim
Vancomycin
Anticholinergic drugs, such as dicyclomine and oxybutynin, may raise the amount of metformin your body absorbs. This may lead to low blood sugar.
Sulfonylureas: Glipizide (Glucotrol, Glucotrol XL), glimepride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase). These drugs lower your blood sugar by helping your pancreas make more insulin.
What are the side effects? The most common one is low blood sugar. This can make you feel shaky, sweaty, dizzy, and confused.
Severe low blood sugar can be life-threatening. To prevent it, eat regularly and don’t skip meals.
Other side effects that you might get are weight gain, dark urine, and an upset stomach. Sulfonylureas can also cause skin rashes and reactions to the sun.
Do they clash with other drugs? About 100 drugs can change the way sulfonylureas work. Some can make them work too well, which may lead to dangerously low blood sugar. Others may cause the medication to be less effective. Your doctor may need to keep tabs on your blood sugar or adjust your sulfonylurea dose.
The medicines that may affect how sulfonylureas work include:
Azole antifungals, including ketoconazole and fluconazole
Some antibiotics, such as ciprofloxacin, chloramphenicol, sulfonamide, clarithromycin, rifampin, and isoniazid
Cholesterol-lowering drugs, such as gemfibrozil, clofibrate
Tricyclic antidepressants
H2 blockers
Gout medications, such as sulfinpyrazone and probenecid
Some high blood pressure medicines, including ACE inhibitors and bosentan
Beta-blockers
Corticosteroids
Calcium channel blockers
Oral contraceptives
Thiazide diuretics
Thyroid medicines
Meglitinides: Repaglinide (Prandin), nateglinide (Starlix). They help your pancreas make more insulin. Although these drugs work faster, they don’t last as long in the body.
What are the side effects? These medications can lead to low blood sugar and weight gain.
Do they clash with other drugs? Some drugs can affect how your body processes meglitinides. This may cause your blood sugar to become too low or too high. Your doctor may need to keep an eye on your blood sugar levels, adjust your dose, or change your medicine.
The drugs that might not mix well with meglitinides include:
Azole antifungals
Certain antibiotics, including rifampin and isoniazid
Some high blood pressure medicines, such as calcium channel blockers, beta-blockers, and thiazide diuretics
Corticosteroids
Estrogen
Nicotinic acid
Oral contraceptives
Phenothiazines
Phenytoin
Thyroid supplements
Monoamine oxidase inhibitors
NSAIDs
Probenecid
Salicylic acid
Sulfonamides
Thiazolidinediones (TZDs): Pioglitazone (Actos), rosiglitazone (Avandia). These drugs boost the way insulin works in the body.
What are the side effects? It may cause you to hang on to fluids in your body, which can lead to swelling. TZDs can also make you gain weight and raise your levels of LDL “bad” cholesterol. They are also linked with serious side effects, such as bone fractures and heart failure.
Do they clash with other drugs? Some drugs block the enzyme that processes TZDs. Your doctor may want to prescribe another medicine if you take one of these medications:
Fluvoxamine
Gemfibrozil
Ketoconazole
Rifampicin
Trimethoprin
Other medicines, when combined with a TZD, may raise your chance of having heart problems:
NSAIDs
Sulfonylureas
Nitrates
Alpha-glucosidase inhibitors: Acarbose (Precose,) miglitol (Glyset). You take alpha-glucosidase inhibitors with the first bite of each meal. They slow the breakdown of carbohydrates.
What are the side effects? Because these medicines affect your digestion, you may have gas, diarrhea, and stomach pain.
Do they clash with other drugs? Alpha-glucosidase inhibitors may not work as well if you also take digestive enzymes and activated charcoal supplements.
Alpha-glucosidase inhibitors can also make it harder for the body to absorb digoxin. They may also change the way warfarin works. Talk to your doctor if you take either of these drugs.
DPP-4 inhibitors: Sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta), alogliptin (Nesina). These medicines help your pancreas release more insulin after meals. They also lower the amount of sugar you make.
What are the side effects? You could get a sore throat, stuffy nose, upset stomach, and diarrhea.
Do they clash with other drugs? Some drugs may affect how much DPP-4 inhibitors are absorbed in the body. Your doctor will want to track your blood sugar levels carefully and watch for potential side effects if you take these medicines:
Atazanavir and ritonavir
Clarithromycin and rifampin
Diltiazem
Ketoconazole
ACE inhibitors combined with DPP-4 may raise your chance of swelling.
SGLT2 inhibitors: Canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance).
They work in the kidneys and remove extra sugar from your blood through urine.
What are the side effects? These drugs raise your chances of having urinary tract and yeast infections. They may also cause low blood sugar.
Do they clash with other drugs? SGLT2 inhibitors don’t interact with many drugs. Rifampin may make the drug less effective. SGLT2 inhibitors may also raise the amount of digoxin in the body.
Insulin therapy: Insulin glulisine (Apidra), insulin lispro (Humalog), insulin aspart (Novolog), insulin glargine (Lantus), insulin detemir (Levemir), insulin isophane (Humulin N, Novolin N).
If other medicines aren’t doing enough, you may need insulin therapy. You’ll need to inject insulin using a needle and syringe or a pen injector.
What are the side effects? The most common side effect is low blood sugar. You may also have a wide variety of symptoms, such as headaches, rashes, dizziness, anxiety, cough, and dry mouth. Talk to your doctor. Some may go away as your body gets used to the medicine.
Do they clash with other drugs? Some drugs affect the way that insulin works in the body. This may cause your blood sugar to become too low or high. Your doctor may need to monitor your blood sugar level, adjust your dose, or change your medicine if you take some of these:
Diabetes medicines
Salicylic acid
Certain antidepressants, such as fluoxetine and monoamine oxidase inhibitors
Some antibiotics, including isoniazid and sulfonamide
Fibrates
Some high blood pressure medicines, such as ACE inhibitors and angiotensin II receptor blocking agents
Certain cholesterol-lowering drugs, including fibrates and niacin
Propoxyphene, pentoxifylline and somatostatin analogs
Corticosteroids
Oral contraceptives
Estrogens
Diuretics
Phenothiazines
Danazol
Protease inhibitors
Glucagon
Thyroid medicine
Diabetes drugs may sometimes do more harm than good
“First do no harm” is the maxim that doctors try to live by. For people with type 2 diabetes, this could mean a rethink of the treatment they receive.
The side effects of diabetes medication and the necessity for frequent injections mean that taking the drugs could be counterproductive, especially for older people, suggests a study published yesterday.
The researchers conclude that doctors should stop automatically recommending drug treatment for the two-thirds of diabetics whose blood sugar is only slightly raised. Instead, patients should be able to decide for themselves if they think the hassle and side effects are worth it.
“We need to rethink our whole treatment strategy,” says Richard Lehman, a family doctor in Banbury, UK, who was not involved in the study.
Type 2 diabetes usually develops in middle age, often in people who are overweight, when their bodies stop responding properly to insulin. This hormone controls the amount of glucose in the blood, so when things go awry, blood sugar levels can skyrocket. People with the condition are more likely to suffer heart attacks, kidney and nerve damage, and blindness.
If people can’t lose weight through diet and exercise to regain their insulin function, doctors usually prescribe an oral drug called metformin. If this doesn’t lower blood sugar sufficiently, insulin injections and drugs called incretins are also prescribed.
Hypo danger
Metformin’s side effects tend to be mild and temporary but insulin and incretins can cause longer-term problems, such as weight gain and nausea.
More dangerously, they can also cause “hypos”, when blood sugar drops too low, causing disorientation and fainting. In severe cases, people can fall into a coma. “More people are now admitted to hospital in the US for low blood sugar than for high,” says John Yudkin of University College London, who co-authored the latest work.
People taking insulin also have to inject themselves several times a day, as well as carry out regular finger-prick tests of blood sugar, a burden that can weigh heavy on some people, says Lehman.
Despite these issues, doctors have increasingly prescribed insulin and incretins over the past decade, reflecting the consensus that blood sugar levels should be kept under tight control.
For example, in the UK, the number of people with type 2 diabetes injecting insulin increased from 37,000 in 1991 to 277,400 in 2010.
However, there is little evidence that strict blood sugar control prevents health problems linked with diabetes. One trial showed the approach reduced heart attacks by 15 per cent, but the participants were younger on average than a typical person with diabetes. Three trials done in relatively older people have shown no benefits. One even showed the approach increased deaths.
Net gain for life?
In the latest study, a team led by Sandeep Vijan at the University of Michigan, Ann Arbor, used the data from those four trials, as well as other information about the drugs, to work out the net gains or losses to people’s quality of life.
Their model suggests that a 45-year-old with only slightly raised blood sugar who begins drug treatment would gain up to 10 months of healthy life. A 75-year-old, on the other hand, would gain only about an extra three weeks.
Age matters because the chance of an older person, with perhaps five years of life ahead of them, developing one of the health complications of diabetes is lower than that of a younger person with, say, 35 years. Therefore older people taking diabetes medication get less benefit from taking it, but all the side effects and hassle. “The person who’s best able to decide whether or not [the extra weeks or months of lifespan] are worth years of pills and injections is the patient,” says Yudkin.
“This study highlights the importance of looking at the individual needs of the person with type 2 diabetes, rather than adopting a blanket approach,” says Simon O’Neill, director for health intelligence for Diabetes UK. “It also underlines how vital it is that healthcare professionals and people with diabetes work closely together to jointly decide what the best treatment options are for that person and weighing up the potential benefits and side effects, which will vary from person-to-person”.
The previous studies had aroused the suspicion people were being overmedicated, says Lehman. This latest meta-analysis could be the clincher. “This really will change practice,” he says.
Journal reference: JAMA Internal Medicine, DOI: 10.1001/jamainternmed.2014.2894
Type 2 diabetic drugs do not work, and they never will
It bears repeating: Type 2 diabetic drugs do not work, and they never will.
You read that headline right, but, before I go any further, let me explain what I mean by “work.”
If you define “work” as lowering blood sugars then, sure, Type 2 diabetic drugs do a pretty good job in that area. But, if you define “work” as providing a remedy or cure for diabetes, that isn’t possible.
Doctors routinely instruct patients to take their meds, diet, lose weight and exercise to control their Type 2 diabetes, and yet their diabetes continues to get worse. If you’ve been diabetic for even just a few years, you likely recognize the downward spiral. Every time you go to the doctor and your numbers are worse, the most common solution is to prescribe more or stronger drugs to manage the symptoms.
It is heartbreaking to see a Type 2 diabetic advance unnecessarily into erectile dysfunction, amputations, kidney failure, heart disease, stroke, neuropathy, poor sleep, etc.
DPP-4 Inhibitors Linked to Risk for Pancreatitis, Pancreatic Cancer
Use of dipeptidyl peptidase-4 inhibitors (DPP-4is) is associated with an increased risk for pancreatitis and pancreatic cancer in patients with newly diagnosed type 2 diabetes, according to study results published in Diabetes Care.
DPP-4is are incretin-based agents known to have effects on pancreatic function. Researchers aimed to investigate the risk for pancreatitis and pancreatic cancer associated with the use of DPP-4is in patients newly diagnosed with type 2 diabetes from the Korean National Health Insurance Service–Health Screening Cohort database.
Data were obtained from a total of 33,208 patients (42.2% women), including 10,218 DPP-4i users and 22,990 individuals treated with other antidiabetic drugs (DPP-4i nonusers). The DPP-4is prescribed included sitagliptin, vildagliptin, linagliptin, saxagliptin, and gemigliptin. Primary outcomes were the incidence of pancreatitis and pancreatic cancer. Additional data including age, sex, body mass index, smoking status, alcohol intake, and medical history were also obtained for use in subgroup analyses.
A total of 1084 cases of pancreatitis were observed, with an incidence rate of 1073 per 100,000 person-years for DPP-4i users and 935 per 100,000 person-years for DPP-4i nonusers. After adjusting for confounding factors, the use of DPP-4is was associated with a significantly higher risk for pancreatitis (adjusted hazard ratio, 1.27; P =.007). A Cox proportional hazards model analysis found no significant effect on the risk for pancreatitis based on the duration of DPP-4i exposure. Subgroup analyses also indicated that potential confounding factors did not significantly affect the association between DPP-4is and pancreatitis.
Alpha-glucosidase inhibitor (AGI) use may increase the risk of psoriatic disease in patients with type 2 diabetes (T2D)
Alpha-glucosidase inhibitor (AGI) use may increase the risk of psoriatic disease in patients with type 2 diabetes (T2D), according to study findings published this week in The International Journal of Clinical Practice.
As recent studies have shown that diabetes and psoriasis share a common pathogenesis, researchers note that the use of antidiabetic drugs may thus be considered in the treatment of psoriasis.
Investigations on the use of antidiabetic therapies in these patient populations have generated some positive findings, with metformin use shown to be safe and effective for the prevention and treatment of psoriasis in patients with an underlying metabolic disease or diabetes. Conversely, insulin has been found in prior case studies to potentially increase risk of psoriasis in patients with diabetes.
“In an animal model, AGI can alleviate psoriasis-like dermatitis lesions,” said researchers. “The influence of AGIs on psoriatic disease risk has not been investigated in humans with T2D.”
Seeking to evaluate the association between AGI use and psoriatic disease risk, including both psoriasis and psoriatic arthritis, researchers conducted a retrospective, population-based cohort study of patients with T2D registered in the 1999-2013 Taiwanese Longitudinal Cohort of Diabetes Patients Database who initiated hypoglycemic treatment between 2003 and 2012.
Participants without a history of psoriatic disease before T2D diagnosis who received metformin in combination with AGIs (n = 1390) or metformin alone (n = 47,514) were compared via the primary outcome of duration from the index date of diabetes treatment to the first date of psoriatic disease diagnosis.
Both groups were matched at a 1:10 ratio for age, sex, and index date of T2D drug use. The effect of AGI interruption at 30, 90, and 180 days was also assessed.
After matching both cohorts, the overall incidence rates of psoriatic disease were 349.25 in the AGI exposure group and 38.83 in the comparison group (incidence rate ratio, 9.00; 95% CI, 1.82-44.57; P = .007). Notably, patients in the AGI exposure group whose AGI use was discontinued for 30 days were found to be 8.77 times more likely to be diagnosed with psoriatic disease than those given metformin only (HR, 8.77; 95% CI, 1.58-48.58).
Risk of psoriatic disease was substantially increased in patients with higher-than-median AGI use when AGI was discontinued after 30 days (HR, 36.11; 95% CI, 5.60-232.80). Risk was shown to decline after AGI exposure discontinuation.
“These results can aid the clinical application of AGIs in patients with T2D at risk of psoriatic disease,” concluded the study authors. “Further studies on the effects of the alteration of gut microbiota and inflammatory activities on patients with T2D receiving AGIs and different AGI categories.”
Reference
Huang PJ, Wei JCC, Liu YT, Lin CH, Lin CC, Chen HH. Association between α-glucosidase inhibitor use and psoriatic disease risk in patients with type 2 diabetes mellitus: a population-based cohort study. Int J Clin Pract. Published online September 7, 2021. doi:10.1111/ijcp.14819