Diabetes is one of the greatest medical threats facing our nation as we advance towards 2030.
Type 2 diabetes is a chronic metabolic disorder characterized by high levels of glucose (sugar) in the blood. It occurs when the body becomes resistant to insulin, a hormone that regulates blood sugar levels, or when the pancreas is unable to produce enough insulin to meet the body’s needs.
A Brief History of Diabetes
Type 2 diabetes has been recognized for thousands of years, with ancient texts describing symptoms such as frequent urination and thirst. However, it was not until the early 20th century that scientists began to understand the underlying causes of the disease.
In 1921, Canadian scientists Frederick Banting and Charles Best discovered insulin, a hormone that regulates blood sugar levels. This led to the development of insulin therapy for people with type 1 diabetes, who cannot produce insulin themselves. However, it wasn’t until the 1950s that insulin therapy became widely available for people with type 2 diabetes.
Over the years, research has shown that lifestyle factors such as diet and exercise play a significant role in the development of type 2 diabetes. In the 1970s, the concept of insulin resistance was introduced, which helped explain why some people with type 2 diabetes do not respond well to insulin therapy.
Recent Developments
More recently, advances in genetics and molecular biology have helped researchers understand the complex mechanisms underlying type 2 diabetes, leading to the development of new treatments and approaches to managing the disease. Despite these advances, type 2 diabetes remains a significant public health challenge, affecting millions of people worldwide.
The Increasing Prevalence of Diabetes
According to the Centers for Disease Control and Prevention (CDC), the prevalence of diabetes has been increasing steadily over the past 30 years.
In 1990, an estimated 4.7% of adults in the United States had diabetes, compared to 10.5% in 2018. This increase is thought to be driven in part by rising rates of obesity, physical inactivity, and unhealthy eating habits, all of which are risk factors for type 2 diabetes. Additionally, the aging of the population and improvements in diabetes screening and diagnosis may also be contributing to the increase in prevalence.
What can we do?
The American Diabetes Association recently published their 2023 Standards of Care in Diabetes that details methods for providers to use to treat diabetes. There are many options to drug treatment, such as:
- Metformin
- Thiazolidinediones
- SGLT2 inhibitors (such as Brenzavvy)
- Sulfonylureas
- Insulin
Each year it seems that recommendations regarding the use of GLP-1 receptor agonists is strengthened, which is what we will cover here today.
In adults with type 2 diabetes, a glucagon-like peptide 1 receptor agonist is preferred to insulin when possible.
American Diabetes Association 2023 Standards of Care
GLP-1 Receptor Agonists
GLP-1 receptor agonists are a type of medication used to treat type 2 diabetes. They work by mimicking the effects of a hormone called glucagon-like peptide-1 (GLP-1), which helps regulate blood sugar levels by stimulating the release of insulin and reducing the production of glucose by the liver.
GLP-1 receptor agonists also slow down the rate at which food moves through the stomach, which helps to reduce appetite and promote feelings of fullness. This can lead to weight loss, which is particularly beneficial for people with type 2 diabetes who are overweight or obese.
Overall, they help to improve blood sugar control, promote weight loss, and may also have other beneficial effects on heart health and other aspects of metabolic function. I believe that this improvement in metabolic function can help reduce the symptoms and comorbidities often associated with type 2 diabetes.
Common GLP-1 Receptor Agonists include:
- Mounjaro (tirzepatide)
- Trulicity (dulaglutide)
- Ozempic/Wegovy/Rybelsus (semaglutide)
- Victoza (liraglutide)
- Byetta/Bydureon (exenatide)
It is important to note that while these medications are extremely effective, they are all brand name and usually have a cash price over $1000. For this medication to be effective, patients must be able to afford their deductible and associated copays depending on their insurance formulary.
Conclusion
The prevalence of type 2 diabetes has been steadily increasing over the past few decades, with lifestyle factors such as obesity and physical inactivity contributing to the rise in cases. However, recent developments in genetics and molecular biology have led to the discovery of new treatments for type 2 diabetes, such as GLP-1 receptor agonists, which have shown promising results in improving blood sugar control and promoting weight loss. While these medications are effective, their high cost can be a barrier for many patients, and it is important for healthcare providers to consider the affordability of medications when treating patients with type 2 diabetes.