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diabetes research

TREATMENTS

TREATMENTS FOR TYPE 1 AND TYPE 2 DIABETES

Diabetes treatment options for type 2 diabetes typically focus on lifestyle changes such as healthy eating, regular exercise, and weight loss. Most people with type 2 diabetes do not require insulin therapy but may require other medications, for example metformin, glucagon-like peptide-1 receptor agonists (GLP-1 RAs), dipeptidyl peptidase-4 inhibitors (DDP-4is) or sodium-glucose cotransporter-2 inhibitors (SGLT-2is) as the disease progresses. 2

In comparison, type 1 diabetes is harder to control, and treatment options are a little more complex. People who have type 1 diabetes must follow a strict regimen of daily insulin injections.  2

Treatment for type 1 diabetes 

People with type 1 diabetes are unable to produce enough insulin to regulate blood sugar levels due to their immune system attacking their pancreas. People with type 1 diabetes need daily insulin injections (mimicking the natural response of the pancreas).  2

Types of insulin treatment 

1. Basal insulin

Long-acting insulin that provides a constant and steady release of insulin. Basal insulin keeps a low and consistent level of insulin in your blood over a period of time and is usually administrated once or twice daily.  

2. Mealtime insulin

Fast-acting insulin that brings down spikes in blood sugar after eating. Mealtime insulin is injected before you eat and is sometimes taken in addition to long-acting insulin.  

3. Premix insulins

Combines two insulins in a single injection. Premix insulins help control blood sugar throughout the day (copying the role of basal insulin) and during mealtimes (copying the role of mealtime insulin). Note, premix insulins are more often prescribed to people with type 2 diabetes. 

Ways to take insulin treatments

  • Injections  
    Insulin pens are one of the most common ways to self-administer insulin daily. Many pens are available, including pre-filled disposable pens and refillable durable pens.  6

  • Insulin pumps  
    A small, computerised device, known as an insulin pump, can be used to administer insulin for people with type 1 diabetes. An insulin pump works by gradually releasing insulin over the course of the day.  6

 

Alternative treatments for type 1 diabetes 

Insulin has long been an essential treatment of type 1 diabetes, but are there alternative treatment methods available as science and medicine progress?  

Pancreatic islet transplantation is one experimental treatment for type 1 diabetes, currently undergoing clinical trials in the US. Doctors take islets (from the pancreas) with healthy beta cells and inject them into a vein that carries blood to the liver. The islets begin to make and release insulin inside the recipient’s body. A phase 3 clinical trial conducted by the National Institutes of Health (NIH) found that '1 year after islet transplantation, nearly 9 out of 10 transplant recipients had an A1C level below 7 percent and did not have episodes of severe hypoglycemia' . 7

Once-weekly insulin is another promising research area for treatment of both type 1 and type 2 diabetes. Some companies are looking into developing basal insulin that can be administered once a week, which would make it easier for most to follow treatment plans. In 2021, findings from a trial with type 2 diabetes participants were published with promising results.  14,15

Research into alternative treatment of type 1 diabetes continues, but stem cell-based implants seem to be at the forefront of testing. Natural treatment for diabetes and permanent treatment for diabetes are also progressive research areas.   

Treatment for type 2 diabetes  

Type 2 diabetes treatment guidelines are considerably different to type 1 treatment guidelines. While type 1 is dependent on insulin injections, type 2 diabetes can be treated initially without medication, but may require other medications, for example metformin, GLP-1 RAs, DDP-4is or SGLT-2s as the disease progresses. 2

Diet 

Changing your diet is the first thing you’ll be asked to do when diagnosed with type 2 diabetes. Diabetes diet plans are designed to keep blood glucose, blood pressure and cholesterol at healthy levels.  

Exercise 

An increase in physical activity each day can also make a real difference to your health. Regular diabetes exercise helps control your blood sugar level, lose weight and improve your physical and mental health.

Glucagon-like peptide-1 (GLP-1) receptor agonists (RA) 

GLP-1 is a naturally occurring hormone that increases incretin hormones and helps to produce insulin, thus reducing glucose in the blood. GLP-1 RA treatments aim to mimic the natural function of the GLP-1 hormone and balance your blood sugar levels. There are different types of GLP-1 RAs: 

  • Short-acting GLP-1 RAs - Stay in your body for less than a day and help control blood sugar levels after meals.
  • Long-acting GLP-1 RAs - Continue to work up to 1 week after taking them and help control blood sugar levels both day and night.
SGLT-2 inhibitors

Sodium-glucose cotransporters-2 inhibitors (SLGT-2is) are an oral medication used to lower blood sugar by causing the kidneys to remove sugar from the body through urine. 

Insulin injections  

If a combination of the above treatment methods isn’t working or has stopped working, you may move on to insulin injections. Remember, there are different types of insulin, and they vary depending on how quickly they work, when they have the greatest effect and how long they work.  

Remember, type 2 diabetes is a progressive disease and often a diabetes treatment algorithm is used as a tool to determine treatment. Don’t be disheartened if your treatment plan changes over time.  11

Treatment for gestational and child diabetes  

  • Gestational diabetes treatment  
    Simply changing your diet and exercise routine is enough to combat gestational diabetes for some pregnant women. For others, medication and insulin injections are required to balance blood sugar levels. 2 Metformin and glibenclamide tablets are frequently given to pregnant women; speak with your healthcare professional if you have concerns.  12,13

    Read more

  • Child diabetes type 1 treatment  
    To keep your child’s blood sugar at healthy levels, they’ll need daily insulin injections. Blood sugar monitoring, carbohydrate counting and regular exercise are also strongly recommended.  2

  • Child diabetes type 2 treatment  
    Type 2 diabetes in children is similar to pre-diabetes symptoms and treatment in adults. Healthy eating, regular exercise, blood sugar monitoring and weight loss will all help stay on top of your child’s diabetes. In some instances, medication will need to be administered.  2

Related articles about treatment of diabetes

What is GLP-1 and how does it work?
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What is GLP-1 and how does it work?

Glucagon-like peptide 1 (GLP-1) is a naturally occurring hormone in the body. Although its production is inhibited in people with type 2 diabetes, its function remains possible.

4 tips to help you self-inject without anxiety
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4 tips to help you self-inject without anxiety

Self-injecting is a way for you to manage type 1 and type 2 diabetes. But it does sometimes comes with challenges for those suffering from the fear of self-injecting.

References
  1. WHO. Diabetes. Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes. Last accessed: May 2022. 
  2. International Diabetes Federation. IDF Atlas 10th Edition, 2021. Available from: https://diabetesatlas.org/idfawp/resource-files/2021/07/IDF_Atlas_10th_Edition_2021.pdf. Last accessed: May 2022. 
  3. Almdal T, Scharling H, Jensen JS, Vestergaard H. The independent effect of type 2 diabetes mellitus on ischemic heart disease, stroke, and death: a population-based study of 13,000 men and women with 20 years of follow-up. Arch Intern Med 2004; 164:1422–1426.  
  4. NICE. Insulin. Available from: https://bnf.nice.org.uk/treatment-summary/insulin-2.html. Last accessed: May 2022. 
  5. Eisenberg Center at Oregon Health & Science University. Premixed insulin for type 2 diabetes. Available from: https://www.ncbi.nlm.nih.gov/books/NBK45604/. Last accessed: May 2022. 
  6. Shah RB, Patel M, Maahs DM, Shah VN. Insulin delivery methods: Past, present and future. Int J Pharm Investig 2016; 6:1–9.  
  7. NIDDK. Pancreatic Islet Transplantation. Available from: https://www.niddk.nih.gov/health-information/diabetes/overview/insulin-medicines-treatments/pancreatic-islet-transplantation. Last accessed: May 2022. 
  8. Zhao X, Wang M, Wen Z, et al. GLP-1 Receptor Agonists: Beyond Their Pancreatic Effects. Front Endocrinol (Lausanne) 2021; 12:721135. 
  9. Kim W, Egan JM. The role of incretins in glucose homeostasis and diabetes treatment. Pharmacol Rev.2008; 60:470–512. 
  10. Gordon A, Buch Z, Baute V, et al. Use of Ayurveda in the Treatment of Type 2 Diabetes Mellitus. Glob Adv Health Med 2019; 8:2164956119861094. 
  11. American Diabetes Association. The Big Picture: Checking Your Blood Sugar. Available from: https://www.diabetes.org/healthy-living/medication-treatments/blood-glucose-testing-and-control/checking-your-blood-sugar. Last accessed: May 2022. 
  12. Langer O, Conway DL, Berkus MD, et al. A comparison of glyburide and insulin in women with gestational diabetes mellitus. N Engl J Med 2000; 343:1134–1138. 
  13. NHS UK. Gestational Diabetes Treatment. Available from: https://www.nhs.uk/conditions/gestational-diabetes/treatment/. Last accessed: May 2022.
  14. Frias JP, Chien J, Zhang Q, et al. Once Weekly Basal Insulin Fc (BIF) is Safe and Efficacious in Patients with Type 2 Diabetes Mellitus (T2DM) Previously Treated With Basal Insulin. Journal of the Endocrine Society. 2021;5:A448-A449.
  15. Rosenstock J, Bajaj HS, Janež- A, et al. Once-Weekly Insulin for Type 2 Diabetes without Previous Insulin Treatment N Engl J Med 2020; 383:2107-2116.
  16. Healthline. Type 2-Diabetes. Available from: https://www.healthline.com/health/type-2-diabetes/glp-1-receptor-agonists-treatment#types. Last accessed: May 2022.
  17. FDA. Sodium Glucose Cotransporter. Available from: https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/sodium-glucose-cotransporter-2-sglt2-inhibitors#:~:text=SGLT2%20inhibitors%20are%20a%20class,canagliflozin%2C%20dapagliflozin%2C%20and%20empagliflozin. Last accessed: May 2022.
  18. Mosenzon O, et al. CAPTURE: a multinational, cross-sectional study of cardiovascular disease prevalence in adults with type 2 diabetes across 13 countries. Cardiovasc Diabetol. 2021; 20:154.
  19. Fox CS, Coady S, Sorlie PD, et al. Trends in cardiovascular complications of diabetes. JAMA. 2004;292:2495–2499.
  20. Diabetes UK. Insulin and diabetes. Available from: https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/insulin. Last accessed: May 2022

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