The most common cause of death in a diabetic patient is heart disease. The irony is that till date, there is little data that supports that good control of sugar leads to prevention of heart related diseases. Patients are dying of heart disease and on the contrary, we do not know the effect of sugar control on heart disease. The outcome and banning of some drugs like rosiglitazone led to more confusion . Rosiglitazone was shown to have increased the chances of heart attack. The controversy shrouding around rosiglitazone has gone, but led to radical changes in American licensing authority FDA to make it mandatory for all antidiabetic drug have a clearance for cardiovascular safety. All new antidiabetic medicines now mandatorily need clearance for safety relating to heart disease. Presently approved drugs are safe for heart.
Do these medicines prevent heart disease?
Diabetic patients have an underlying resistance to the hormone insulin. Diabetic patients have high levels of cholesterol. Blood pressure is high in some cases and to the top of it, they are overweight or obese. This creates a favorable environment for heart disease to grow.
Are there some diabetic medicines which make you fat?
Yes, there are some diabetic medicines which make you fat and though we get good results with sugar control, we end up getting fat.
Are there any diabetic medicines which increase heart problems?
The issue of treatment for diabetes causing heart problem has been debated since 1960. Presently the approved drugs in the anti-diabetic drugs armamentarium are not known to increase heart disease. There some drugs which are to be avoided in cases of heart failure cases.
What has changed in new medicines?
There is a sea change in the benefits in the form of new drugs for diabetes. They are safe for controlling sugars and cause less of lowering of sugars to life threatening levels i.e. less hypoglycaemia. Weight loss is a beneficial and a new feature which has been added recently. Modern medicines for treatment of diabetes are not causing weight gain and some of them are causing weight loss also.
Are they safe for the kidneys?
This is a common concern amongst attendants of patients. Doctor are these drugs safe with the kidneys? There is a notion that oral medicines in diabetics cause or increase kidney problem. Diabetic medication does not lead to a kidney problem, but when you develop a kidney disease in a diabetic there are some oral medicines whose treatment needs rescheduling. Drugs are safe in kidney disease with diabetes under a qualified physicians advice. Now we know that drugs are safe for not causing hypoglycaemia, they are safe for weight, some of them are causing weight loss, they give a good control of sugars, and are safe for kidneys.
What is the breakthrough?
We as a lay person are always enchanted by something miraculous. Has something miraculous happened in near past? There are are many. Better medicines, good control, good monitoring devices, less of complications. Something which is creating ripples is diabetic medicines preventing heart disease. Medicines are not just safe they are preventing newer episodes of heart attacks .patients are dying of heart ailments and drug for it is preventing it. This is a win -win situation for the diabetics. Newer medicines are causing drop in deaths because of heart problems by 40%.We never had such data in past. These newer drugs like GLP1 analogues, SGLT2 inhibitors are the part of new treatment redefining heart outcome. They have shown tremendous results in breakthrough trials .They are a ray of hope for diabetics who already have heart disease. The drop in deaths in such group of patients has never been reported in the past.
Do we need all diabetics to have new drugs ?
The advantages of new medicines and usage needs acumen of your treating Endocrinologist. Every medicine has got some side effects which need to be balanced by your specialist. We cannot have fixed formulations for all of our patients.
What should be done?
Follow a qualified good doctor, preferably an Endocrinologist.
Message– Diabetes medicines are not justsafe for heart disease but some of them are preventing the second episode ofheart attack.this is what I say Em teer do nishaane beating diabetes and heart disease