A San Antonio doctor is challenging a long-held methodology for treating Type 2 diabetes and says he received a grant from the American Diabetes Association (ADA) to test out his theory,
People with Type 2 diabetes are considered insulin resistant, meaning their bodies produce insulin but do not use it efficiently.
Typically, the ADA recommends that doctors and patients try and control their Type 2 diabetes through exercise, weight loss and lifestyle modification. If that doesn’t work, most patients take the widely-used drug Metformin. If that still doesn’t work, doctors generally prescribe an additional drug from a class of drugs known as sulfonylureas, which push the pancreas to produce more insulin. If those measures fail to bring the diabetes under control, insulin is prescribed (However, insulin is not always seen as a last resort for Type 2 diabetics).
Dr. Ralph DeFronzo, a researcher with the Texas Diabetes Institute, says that year after year this process is proven to be ineffective. Instead he says doctors should be prescribing two other kinds of drugs: thiazolidinediones and a GLP-1 agonist.
People that want to join the study, which will follow the two methods over a three year period, should call the Texas Diabetes Institute at 210-358-7200.
Well I know for several years Metformin with Avandia combined with working out and eating right was all I needed to keep my levels under control, then I had to go off of the Avandia and my numbers started to rise despite picking up on what I was doing (hitting the gym more often, etc).
Then I had an emergency OP and in hospital they couldn’t get my levels down, not till they started giving me insulin injections … that was my start of being put on insulin, a year later the single injection of insulin wasn’t working and it was combined with a does of Glumateza … the day before I got married I was put on meal time insulin, plus the nightly injection of lantus and the Glumetza but it took almost 9 months for that combo to take effect, I’m still not 100% under control, but the past 3 weeks my numbers have been closer to norman then they have been in the past 3 years.
My mom on the other hand, controlled her type 2 diabetes by working out and eating right … no drugs or insulin was needed at all for her … almost 30 years after she was told she was a type 2 diabetic, she was discharged from our endro and back to the care of our GP. Why? simple her A1Cs where now normal and every blood test she was doing she was now getting normal readings despite her stays in hospital and what not her readings where now normal. She still tests from time to time, but when she does she still gets normal readings.
Dr. DeFronzo recieved the Banting award in 2008 and in his lecture described his basic view. Namely that the stepwise incremental approach to treatment of t2s was harmful. He advocated immediately moving to a three drug approach, metformin, a GLP-1 antagonist (like Byetta) and a thiazolidinedione (like Actos or Avandia). He argued that this triumvirate has been shown to be maximally effective, and if it works, great, then it has the greatest promise for continued treatment through medication and that when it fails, then you should just move expeditiously to insulin. He further argued that the ADA stepwise treatment never achieves good control, exposes T2s to ongoing high blood sugars and in the end burns out their pancreas before they ever get to insulin. He describes his treatment in his paper “Banting Lecture. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus” (http://www.ncbi.nlm.nih.gov/pubmed/19336687).
My endo has me currently on this treatment regime. I don’t actually it to be successful for very long, I’ve been the victim of a range of ineffective incremental regimes for some years, but I am pleased that we have at least gotten to the limit of the most powerful approach available and stopped mucking around.
I do recommend his paper, it is a good read and he seems very sound. Although he might appear to be an outsider to the ADA he is not, after all he got the 2008 Banting award and is now the recipient of some fairly generous grants.
