For the reason that variety of younger diabetic sufferers is rising in comparison with the previous, not too long ago the main target of remedy has progressively shifted from aged diabetic sufferers to youthful diabetic sufferers.
Because the variety of instances of diabetes occurring at a youthful age will increase, the significance of long-term blood sugar administration additionally will increase.
Following this transformation in development, Medical Instances met with Professor Jeong In-kyung of Gangdong Kyung Hee College Hospital to study concerning the significance of long-term blood sugar administration in diabetic sufferers and remedy choices for this.
■Rising variety of younger sufferers… Rising significance of long-term blood glucose administration
First, Professor In-Kyung Jeong mentioned: “In response to knowledge from the Korean Diabetes Affiliation, one in six adults over the age of 30 in Korea is diabetic, and among the many aged inhabitants aged 65 and over, one in three endure from diabetes. due to this fact the variety of individuals with diabetes has elevated in comparison with the previous.” “Prior to now there was loads of deal with older individuals with diabetes, however not too long ago the main target has shifted to younger individuals with diabetes,” he started.
Professor Jeong In-kyung, Gangdong Kyung Hee College Hospital
Which means that as weight problems will increase in youngsters and adolescents, the variety of instances of diabetes occurring at a younger age additionally will increase.
The issue is that as a result of diabetes develops at a younger age, issues about problems additionally improve as life expectancy will increase.
Professor Jeong In-kyung mentioned: “The truth is, youthful sufferers who had been recognized with diabetes for the primary time have greater blood sugar ranges than older individuals who had been recognized with diabetes for the primary time. time, and have extreme insulin resistance and inadequate insulin secretion.” the hospital in rather more critical circumstances,” he mentioned.
He continued: “Furthermore, it may be mentioned that a very powerful factor in diabetes administration is problems. The Korea Diabetes Affiliation studied the development of diabetes problems in Korea from the previous to the current and located that arteriosclerotic vascular problems are progressively lowering in comparison with the previous, however kidney problems are nonetheless rising.” He mentioned: “Ultimately, the primary cause it’s essential handle your blood sugar properly in the long run is to cut back problems.”
Professor Jeong additionally mentioned: “Secondly, once we studied the causes of dying amongst diabetic sufferers in Korea, we discovered that the incidence of most cancers was rising past dying from vascular problems.” sugar degree, the upper the incidence of most cancers in comparison with individuals with a standard blood sugar degree. “Finally, it’s a must to handle your blood sugar properly,” he added.
Moreover, from a socioeconomic value perspective, prevention and administration of problems are additionally essential as post-complication prices are certain to be a lot greater than preliminary prices.
Professor Jeong defined: “Finally, the necessity to handle blood sugar in sufferers with sort 2 diabetes is to stop problems or stop worsening. Particularly, because the variety of younger sufferers is rising and their danger is bigger, it may be summed up that administration is much more essential.” he did.
He additionally mentioned, “In the event you take a look at the course of sort 2 diabetes sufferers, there’s a distinction between Westerners and Asians. Within the case of Westerners, diabetes develops when insulin is oversecreted after which decreases to compensate for the ‘elevated insulin resistance in “Insulin secretion is already low, so insulin secretion is weaker than that of Westerners, however as individuals have not too long ago develop into overweight, insulin resistance has develop into extra extreme,. due to this fact it is vitally essential to protect weak insulin secretion whereas lowering insulin resistance in comparison with the previous,” he mentioned.
Finally, the evaluation is that how you can stop the decline of insulin secretion capability, i.e. whether or not it could actually preserve pancreatic beta cell operate, has an essential affect on the selection of drug.
Moreover, it has been underlined that usually of hypertension or hyperlipidemia, the therapeutic objective is well achieved with medicine, whereas within the case of diabetes, even with ample medicine, the proportion of reaching the therapeutic objective is decrease than 7%. glycated hemoglobin is just about 50%.
Professor Jeong mentioned: “This in the end implies that diabetes progresses with insulin secretion turning into weaker over time and that not solely medicines but additionally the affected person’s food plan and train regime are essential and, within the case of diabetes, varied pathophysiological mechanisms are concerned”. the necessity for mixed remedy of medication with totally different mechanisms is turning into increasingly more essential, and with the rise within the variety of medicine, using mixed medicine to enhance therapeutic compliance may be helpful,” he emphasised.
■ Particular person methods tailor-made to the affected person are wanted to stop problems
He mentioned: “There are 9 kinds of medicine at present used for diabetes in our nation, and every drug has its personal execs and cons. Nevertheless, since diabetes is a drug that have to be taken for an extended time period because of the pathophysiology, it’s unclear whether or not it maintains beta cell operate properly and might stop diabetes problems.” “These features additionally must be thought-about,” she recommended.
Accordingly, the mixed use of SGLT-2i and TZD, which has not too long ago acquired consideration, might be thought-about one of many options.
Professor In-Kyung Jeong is specializing in the mix of TZD+SGLT-2i as one of many customized methods that may stop problems.
Professor Jeong mentioned: “To start with, the most important benefit of TZD is that it could actually preserve the operate of pancreatic beta cells for a very long time, and one other benefit is that it could actually stop vascular problems. He added: “It’s at present efficient.” . within the prevention of heart problems and mind infarctions that result in a stroke “It has been proven to stop sufferers from recurring,” he mentioned.
He added: “In different phrases, TZD has the benefit of getting been proven to be wonderful at preserving beta cell operate and long-term cardiovascular security, however the drawback is that it might trigger weight acquire or edema and is contraindicated in sufferers with extreme coronary heart failure.”
He additionally mentioned: “The benefit of SGLT-2i is that the mechanism itself lowers blood sugar by excreting sugar via urine, so it doesn’t immediately have an effect on insulin secretion or resistance, however has the impact of not directly bettering insulin resistance by controlling blood sugar.” properly and reduce weight. “There may be an oblique impact of constructing the insulin-secreting beta cells of the pancreas much less drained, since they don’t must secrete an excessive amount of insulin.”
He continued: “Along with its impact in lowering blood sugar ranges, it has been proven to be protected and superior in defending the kidneys and coronary heart. Particularly, it’s the greatest drug used thus far to cut back coronary heart failure.”
Professor Jeong mentioned: “Due to this fact, when the medicine TZD and SGLT-2i are used on the identical time, the advantages of every drug for blood sugar management, preservation of beta cell operate, and the guts and kidneys improve, and SGLT reduces unintended effects of TZD on edema, weight acquire and coronary heart failure “-2i compensate and complement one another,” he mentioned, including: “It is usually noteworthy that each medicine are extremely efficient in administration. long-term blood sugar management and the prevention of problems”.
Lastly, Professor In-Kyung Jeong mentioned: “Just lately, customized methods have attracted consideration in relation to the remedy of diabetes. Within the case of this drug, the primary impact is to decrease blood sugar ranges, however because it additionally has benefits similar to vascular problems, it may be used as a personalised technique for sufferers who can use it “It’s,” he mentioned.
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