These New Developments Could Transform Type 2 Diabetes Care

Experts often talk about the “burden” of a disease or illness. The word acts as a tidy container for all the unpleasantness people with that condition may experience—from their symptoms, to the cost of their care, to the restrictions imposed on their lifestyle, to the health complications that may arise. This burden is often high for people suffering from Type 2 Diabetes.

Routine management of Type 2 diabetes often involves major changes to one’s diet and physical activity. And for many, especially those taking insulin to manage their blood sugar, the disease can necessitate daily blood-glucose monitoring, a process that entails pricking a finger to draw blood and then dabbing that blood onto a glucose monitor’s test strip. Doing this several times a week—month after month—can present overlapping challenges. A 2013 study in the journal revealed that this can lead to overlapping challenges. Diabetes SpectrumSome people feel that finger-prick glucose monitoring can cause pain. Sometimes, the results are confusing and unhelpful.

“Patients don’t want to prick their fingers, and they come in all the time and say, ‘I’m tired of this,’” says Dr. Francisco Pasquel, a diabetes specialist and associate professor of medicine at Emory University School of Medicine in Atlanta.

There is some relief. Continuous glucose monitors, or CGMs, are small devices-—often about the size of a quarter-—that use a small under-the-skin needle to continuously monitor blood-glucose levels. This information can be transmitted—in some cases wirelessly and automatically—to a smartphone app or other device. “You can look at glucose levels for a single point in time, but you can also look at trends in values over time,” says Dr. Roy Beck, medical director of the nonprofit Jaeb Center for Health Research in Tampa. Beck’s work has found that continuous glucose monitoring may provide a number of benefits for people with Type 2 diabetes.

The monitors represent just one example of the many new advances in Type 2 Diabetes management and care. Medical science continues to make steady, sometimes life-changing advances in treating this disease. Experts share the most recent developments.

Continuous glucose monitors

Type 1 diabetics often have to monitor their sugar levels daily, or multiple times per day. Since testing is so important in managing the disease, continuous glucose monitors research was initiated with patients. CGMs offer multiple benefits. They can reduce hemoglobin (HbA1c), an indicator of good blood glucose control. Research shows that continuous glucose monitoring is beneficial for people suffering from Type 2 diabetes.

A study that was published in 2021 by the Journal of the American Medical AssociationBeck and his associates compared continuous glucose monitors to finger-prick tests for Type 2 diabetes patients who had been using insulin. Continuous monitoring was linked to a significant drop in HbA1c. The continuous monitoring also helped to avoid dangerous and extreme drops in blood sugar. hypoglycemia). “It’s pretty clear that there’s a benefit for people with Type 2 diabetes who are using insulin,” he says.

Beck states that over 90% of diabetes sufferers have Type 2 diabetes. Beck claims that 30% are diabetics and use insulin. This means that there is a lot of people suffering from Type 2 diabetes who can benefit greatly from continuous glucose monitoring. These monitors are only available to Type 1 diabetics. “Use is slowly increasing in Type 2 patients, but I think it’s still too low considering this is a non-pharmacological approach”—something many people prefer because it avoids the side effects of medications—“that can help people,” he says.

Beck suggests continuous glucose monitoring for those with Type 2 diabetes, even if they aren’t taking insulin. “There’s a need for more studies to prove it, but it makes sense that it would likely have benefits,” he says. Monitoring blood sugar could be used to help individuals make lifestyle or diet changes to reduce the risk of developing long-term complications. “Normally, blood glucose following a meal shouldn’t go above 140 [mg/dL],” he says. Type 2 diabetics may have blood sugar spikes after meals that exceed 200 mg/dL. This is due to factors such as diet and meal timing. Although these spikes may not cause any symptoms, Beck states that they could lead to long-term complications like kidney disease, heart disease or diabetes retinopathy. This is an eye condition which can result in blurry vision and blindness. “The first time people use these continuous monitors, it can be a real eye-opener,” he adds. “I think they could be most helpful for self-management, and Type 2 diabetes is a disease where self-management through diet and exercise can make a huge difference.”

This is supported by other experts. “Patients using these devices can receive a graph of their glucose values over time, which helps them understand the effects of nutrition on glucose control, or how they could modify their exercise to make improvements,” says Dr. Ilias Spanakis, an associate professor of medicine in the division of endocrinology, diabetes, and nutrition at the University of Maryland School of Medicine.

For patients who are reliant on insulin to manage their blood glucose, combining continuous glucose monitors with insulin pumps—devices that automatically inject insulin as needed—could also lead to major improvements. “Smart algorithms that connect the two can automatically adjust glucose based on glucose values,” Spanakis says. This is already possible, and it’s likely to become much more commonplace, he adds.

Continuous glucose monitoring may be a better and safer option for many diabetics.

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Type 2 diabetes can be managed with bariatric surgery

Bariatric surgery (weight loss) has traditionally been performed to treat severe obesity. The U.S. Centers for Disease Control and Prevention define this as a person with a BMI greater than 40. Research has shown that Type 2 diabetes can be reduced or even reversed by these procedures.

A 2018 study from researchers at the University of Oklahoma found that Roux-en-Y gastric bypass surgery, a common bariatric procedure, vastly outperformed typical medical management techniques—such as diet changes, doctor’s visits, and prescription drugs—among people with Type 2 diabetes. The study found that surgery resulted in diabetes remission in approximately 28% of the patients. In comparison, the remission rate for the non-surgery patient group was only 4%. Research has shown that Type 2 diabetes may be put into remission by bariatric surgery.

“Surgery does not just lead to weight loss, but also to an improvement in glycemic control, which happens even before the weight loss occurs,” says Emory’s Pasquel, who has published work on the benefits of bariatric surgery for people with Type 2 diabetes. Exactly how the surgery does this isn’t well understood, he says. However, bariatric surgery affects appetite, food intake, caloric absorption, and multiple neuroendocrine pathways—all of which could contribute to its beneficial actions for people with Type 2 diabetes.

Pasquel predicts that these types of procedures will become increasingly common even in Type 2 Diabetes patients who aren’t very obese.

Pharmaceutical drugs are now available

There are many diabetes drugs available, each one with different risks and benefits. But experts say two types are emerging as potential “game changers” when it comes to Type 2 diabetes treatment.

Glucagon-like peptide 1 (GLP-1) is a hormone released in the gut during digestion—one that plays a role in blood-sugar homeostasis. GLP-1 receptor-agonist drugs can be used to interact with GLP-1. This will lower the appetite and slow digestion as well as provide benefits for Type 2 diabetics. These GLP-1 drugs aren’t new. Pasquel says that newer GLP-1 medications work on two distinct receptors. “Recent evidence shows that activating both receptors has a remarkable impact on weight loss and glycemic control,” he says. These new medications are an improvement over the previous ones, especially for Type 2 patients who are highly susceptible to heart attack or stroke.

The treatment of type 2 diabetes has seen a second class of drugs emerge as an outstanding option. Known as sodium-glucose cotransporter-2 (SGLT-2) inhibitors, these drugs help the kidneys remove sugar from a person’s blood. Not only does this improve blood-sugar control in people with Type 2 diabetes, but it also helps protect them from heart failure and kidney disease—two common and serious complications. Pasquel says these drugs are so effective that they’re now being used in people with heart failure or kidney disease who do not have Type 2 diabetes.

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New ways of thinking About weight loss

Weight loss is a proven way to lower Type 2 diabetes risk and symptoms. Experts know this for a long time. There are many diets that can help you lose weight. This has been the subject of research. More research is needed, but some of the latest studies suggest that fasting plans—in particular, intermittent fasting—may be particularly beneficial for people with Type 2 diabetes.

Intermittent fasting involves cutting out calorie-containing foods and drinks for an extended period of time—anywhere from 12 hours to two days depending on the approach a person chooses. Review of 2019 research in the journal NutrientsResearchers found intermittent fasting promoted weight loss, increased insulin sensitivity and reduced insulin levels. This is good news for Type 2 diabetics. “Essentially, fasting is doing what we prescribe diabetes medications to do, which is to improve insulin sensitivity,” says Benjamin Horne, director of cardiovascular and genetic epidemiology at Intermountain Healthcare in Utah.

It’s not yet clear which form of intermittent fasting is best. But Horne says that time-restricted eating—a type of fasting that involves squeezing all the day’s calories into single six- or eight-hour feeding windows—is leading the pack, largely because patients are able to stick with it.

The field of Type 2 diabetes management has seen more advances. The interventions described here—from continuous glucose monitors to novel drugs—are some of the most promising, but they have company. It’s safe to say that, looking ahead, more people with Type 2 diabetes will be able to effectively manage or mitigate their symptoms.

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