Sunday December 2, 2012
Ensuring sweet control
A once-a-day drug for diabetes can improve medication adherence amongst those with type 2 diabetes, say experts.
MALAYSIA is a sweet nation. Every nook and cranny, you are lured by the temptations from mamak stalls, bubble tea joints, fast food outlets... sugar is cheap, and people die for it, and from it.
“Malaysia is the champion in diabetes, for all the wrong reasons,” notes senior consultant endocrinologist Prof Datuk Dr Wan Mohamad Wan Bebakar. Face it, 20.8% of Malaysians are now diabetic.
However, the most alarming detail is that Malaysia has one of the world’s youngest type 2 diabetic patients, with over 5% of the total diabetic population between the ages of 20 and 25 years old.
“In comparison to that, even in the United States, where supersize is in fact an acceptable way of life, only 2% of people aged 20 to 25 years are diabetic,” he adds.
Malaysians are indeed wrong to think that diabetes is a Western disease.
According to Prof Dr Harold Lebovitz, Professor of Medicine in the Division of Endocrinology, The State University of New York Health Science Center, says: “It all boils down to diet and lifestyle factors... dietary and lifestyle habits have changed dramatically over the past 10 years.”
“Diabetes is now recognised as a progressive disease. The longer someone is afflicted with diabetes, the more difficult is it for that individual to control the disease.
“As such, doctors must recognise that treatment must be aggressive from the time of diagnosis, in terms of medication,” states consultant endocrinologist Prof Dr SP Chan.
This aggressive treatment referred to is the need for combination drug therapy in the treatment of type 2 diabetes. This fact is backed by numerous studies, such as the United Kingdom Prospective Diabetes Study (UKPDS).
Patients who were put on one anti-diabetic drug (monotherapy) and diet-control demonstrated drastic worsening of their HBA1c levels within a three year period, as compared to patients who were on combination drug therapy from the beginning.
HBA1c is an indicator for how well-controlled your blood glucose level is.
High HBA1c reflects that your diabetes is poorly controlled. Amongst the Asian nations, Malaysia has the highest HBA1c levels, on par with Bangladesh.
In line with this, a novel drug, a once-a-day combination of two diabetes medications has been launched, for adult patients with type 2 diabetes.
All three experts, Prof Dr Chan, Prof Dr Wan and Prof Dr Lebovitz were speaking in the launch of the drug.
The drug is a combination of saxagliptin, a DPP-4 inhibitor and metformin XR.
The drug provides patients with the a once-a-day DPP-4 inhibitor and metformin XR combination tablet containing two complementary therapies that can help improve key measures of glucose control, including glycosylated haemoglobin levels, fasting plasma glucose and postprandial glucose, in a convenient once-a-day treatment regimen.
Type 2 diabetes melilitus (T2DM) has an estimated worldwide prevalence of over 230 million people and is projected to rise to 440 million people by 2030.
According to the latest National Health & Morbidity Survey 2011 (NHMS 2011), one in five Malaysians are diabetic. Across the South East Asian region, Malaysia ranks number one in terms of the number of people with diabetes and pre-diabetes.
Diabetes is for life. And it kills. As such, once diagnosed, a diabetic patient must be given prompt and adequate treatment to prevent or delay complications.
“Sometimes, lifestyle treatment alone is often not sufficient. Very often, it is an arduous challenge to get patients to adhere to diet regimes and exercise routines.
“I think to a certain extent, we have to be realistic and practical,” states Prof Dr Chan.
“Despite the constant barrage of knowledge and even a wide array of agents to treat T2DM, achieving tight glycaemic control remains elusive and less than half of our patients manage to achieve their glucose goal, demonstrating the need for new treatment options”, adds Prof Dr Chan.
The co-administration of saxagliptin and metformin has been well-studied in adult patients with type 2 diabetes inadequately controlled on metformin alone and in treatment-naïve patients inadequately controlled on diet and exercise alone.
The most commonly occurring adverse events include diarrhoea and headache.
The drug, as seen in results from clinical studies, demonstrated tolerability similar to metformin alone, with a low incidence of gastrointestinal related adverse events.
As a once-a-day medication, it can improve medication adherence amongst those with type 2 diabetes.
“With the drug now available in Malaysia, physicians have the opportunity to use a new approach to treat diabetic patients whilst successfully improving adherence to treatment,” says Prof Dr Lebovitz.
“Patient do not like taking many pills. They ‘forget’. One tablet, once a day improves patients’ compliance dramatically, thus achieving positive glycaemic control.”
Being a chronic illness with many complications if not controlled well, diabetes has an impact on not only the health of individuals, but also the family, the community, and thus the nation.
Effective glycaemic control can help reduce the risk of serious complications, including heart disease – a leading cause of death among people with type 2 diabetes.
With good management, life can be sweet for the diabetic. “Many patients tell me that being diagnosed with diabetes is their silver lining. It is their body’s way of telling them to pay attention and love to themselves by taking action to improve their lifestyle,” says Prof Dr Wan. “Most importantly, don’t lose hope.”
Diabetes patients will find that with proper planning, they can still live a long and productive life. The key is to embrace these changes with a positive outlook.