Good medicine on Diabetes

The treatment of diabetes depends on the type of diabetes. It is aimed to decrease symptoms and prevent complications such as low blood sugar levels (hypoglycemia), eye problems, kidney disease, and nerve damage.

WHEN it comes to prescription drugs, newer is not necessarily better. And that's especially true when treating diabetes.

One in 10 Americans has Type 2 diabetes. If the trend continues, one in three will suffer from the disease by the year 2050, according to the federal Centers for Disease Control and Prevention.

Most Type 2 diabetes patients take one or more drugs to control blood sugar. They spent an estimated $12.5 billion on medication in 2007, twice the amount spent in 2001, according to a study by the University of Chicago. (That figure does not including drugs that diabetics are often prescribed for related health conditions, like high blood pressure and high cholesterol.)

Why the increase? More diagnosed patients, more drugs per patient and an onslaught of expensive new drugs, according to Dr. G. Caleb Alexander, assistant professor of medicine at the University of Chicago and lead author of the study. Since 1995, several new classes of diabetes medications have come on the market. Diabetes drugs are important to the pharmaceutical industry, more lucrative than drugs for many other chronic diseases, Dr. Alexander noted in an interview.

Simply put, many of these drugs help the body produce less glucose or more insulin, the hormone that shuttles glucose into cells for use as energy, or they increase the body's sensitivity to its own insulin.

Patients and health care professionals have long hoped that as pharmaceutical companies found ways to help the body lower blood sugar, they would produce safer and more efficient alternatives to older medications. But a true breakthrough doesn't seem to have happened yet.

A report released in March by the federal Agency for Healthcare Research and Quality and conducted by researchers at Johns Hopkins University reviewed data from 166 studies to evaluate the effectiveness and risks of various diabetes medicines. The researchers concluded that drugs that have been around for years are more effective at lowering blood sugar and often work with fewer side effects than the newest drugs. And because so many older drugs now are available as generics, they often cost just a fraction of the price of newer brand-name drugs.

Low-cost treatment is imperative to turning back the diabetes epidemic, said Dr. Wendy L. Bennett, assistant professor of medicine at Johns Hopkins University School of Medicine and the lead author of the A.H.R.Q. study. Experts estimate that only 25 percent of diabetic patients are getting the treatment they need, and expense is a big reason. Even well-insured patients may reel when confronted with the $6,000 a year it takes on average to manage the disease (not counting the costs of such complications as heart disease, stroke, and liver and kidney damage).

Becoming educated is the most important thing a person with diabetes can do to help stem the cost of medications as well as avoid complications, said Dr. Bennett. Here, three crucial things you should know.

DM1 needs treatment with insulin injections to replace the insulin that is not produced in the body. There are several types of insulin available. The most commonly used are the genetically engineered that are similar to human insulin. The difference in the various types of insulin is the times at which they "peak" or are most effective. Insulin schedule depends upon the meal pattern of the individual. This is required to avoid low blood glucose levels, causing hypoglycaemia. Insulin is administered with a syringe, and newer devices such as insulin pens and insulin pumps. The latter devices control diabetes more efficiently.

DM2 (earlier called NIDDM) is initially treated with weight reduction, diet control and regular exercises. When these measures fail to control the blood sugar levels, oral medicines are used. Sulphonylureas are a group of drugs that stimulate the release of insulin from the pancreas. Metformin reduces insulin resistance, and the production of glucose by the liver. Thiazolidenediones also increase insulin efficiency and sensitivity. Acarbose delays the absorption of glucose by the intestines. When the action of oral drugs is insufficient, insulin injections are added.

Exercise: It is an important component of diabetes therapy. Exercise utilizes blood sugar and makes the body more sensitive to insulin. It also reduces high blood pressure and high lipid levels, which are often associated with diabetes.

Diet: There is no such thing as a "diabetic diet". Persons with diabetes should eat a normal, balanced diet, which is designed to meet their nutritional requirements, maintain normal blood sugar levels and at the same time to help in achieving appropriate weight (i.e. reduction in case of obese persons, regain in case of very lean persons). It is also important to eat meals at regular time intervals, especially if insulin is used.