Treatment Options for Type 2 Diabetes

Recently, I attended a convention of the American Diabetes Association in New York City where the main booth heralded a breakthrough “cure” for diabetes. This form of treatment hasn’t advanced much for nearly a century, so it will come as good news that researchers at the Massachusetts Institute of Technology (MIT) are on the verge of a breakthrough. If it works as well in patients as it has in animals, it would amount to a cure, ending the need for frequent insulin injections and blood sugar testing. For others, taking medication may also be necessary. After all, Type 2 diabetes is looming as the biggest epidemic and public health issue in human history. Type 1 diabetes, which makes up roughly 10 percent of all diabetes cases, is therefore a type of autoimmune disease, and is currently incurable. Researchers at universities and other drug companies also are working toward a diabetes cure, using various strategies.

If your doctor says you need to make these changes, it’s smart to tailor them to your personal preferences so that you’ll be more likely to stick with them. Yes, obesity is a tenacious problem but surgery is only a Band-Aid solution, albeit one that is growing in popularity. Now, a team at MIT has found a way to hide these beta cells from the self-destructive immune system of mice suffering from type 1 diabetes. “It’s like making a new pancreas that makes all the hormones” needed to control blood sugar. He recommends eating healthy carbs, such as vegetables, fruits, legumes, whole grains, and dairy products. I have seen many patients go under the knife for these procedures only to gain back the weight they lost, plus some. Known as triazole-thiomorpholine dioxide (TMTD), this variant was shown to be able to hide from white blood cells within hyperglycemic mice with a very strong immune system.

Without effective treatment, diabetics suffer severe complications: blindness, kidney failure, heart disease, amputations, even premature death. Bariatric surgery is an option for some people with diabetes who are obese and can’t lose weight through diet changes, Sivitz says. At age 40, he had gastric-bypass surgery and shrunk from 450 to 250 pounds. This would essentially cure the disease, and would render regular insulin injections a thing of the past. Meanwhile, the number with Type 2 diabetes, whose bodies make some insulin but don’t use it efficiently, is increasing exponentially due to the global epidemic of obesity and sedentary lifestyles. “I try to give lifestyle strategies a chance to manage type 2 diabetes,” Sivitz says, adding that people with very high blood sugar levels may need to start medication and lifestyle changes at the same time. By the time he landed in my office, he was 60 years old and tired of juggling all the complications of weight-loss surgery.

Metformin is generally the first drug used to treat type 2 diabetes. Johnson & Johnson, based in New Brunswick, New Jersey, is a major ViaCyte investor and has been conducting parallel research for about 13 years, said Diego Miralles, J&J’s head of global innovation. Alpha-glucosidase inhibitors, which prevent the starches in foods like pasta and potatoes from being turned into blood sugar, controlling the rise in blood sugar after a meal. Even more disturbing is the rise in overweight teens choosing weight-loss surgery. Bile acid sequestrants, which remove cholesterol from the body and also may lower blood sugar levels. Another dozen planned patients will soon get the same cell dose in capsules to be implanted in them. Meglitinides, which trigger beta cells in the pancreas to release insulin.

What kind of problems are we passing on to our youth? SGLT2 inhibitors, which slow the kidney’s reabsorption of glucose, allowing more blood sugar to leave your body via urine. Sulfonylureas, which also trigger insulin-releasing beta cells in your pancreas. They are usually taken one to two times a day, before meals. Let me be clear, maintaining a healthy weight is ideal for optimal health. They may also lower blood sugar production in the liver. Exenatide and liraglutide are two injectables that ramp up insulin in response to high blood sugar, at the same time reducing the liver’s blood sugar release.

Pramlintide holds down the usual blood sugar rise after meals by slowing down the digestion of food. Risk of suicide after long-term follow-up from bariatric surgery, Am J Med. But in the case of type 2 diabetes, a person’s body doesn’t use insulin properly. When your pancreas simply can’t make enough insulin or use it well enough to control blood sugar, your doctor is likely to prescribe insulin injections. “For people with diabetes who don’t respond to oral medications or non-insulin injectables, insulin can be started as a long-acting preparation once a day,” Sivitz says. 2011 Nov;77(11):1510-4. If treating your diabetes involves medication, make sure you understand the side effects of everything you take.

Also talk to your doctor about whether your medication regimen could lead to low blood sugar — a risk that Sivitz notes might mean additional changes in your diet and exercise habits.