Diabetes Mellitus, Case Study Example

Treatment And Management Of Diabetes Mellitus Type 2

Diabetes is a chronic disease, which associated with high glucose levels within the blood stream. Within the body, the beta cells present in the islets of langerhans, and are located within the pancreas produces insulin. Insulin is responsible for lowering blood glucose. A condition where there is inadequate production of insulin in the body that causes diabetes. There are two types of diabetes. One is insulin dependent and the other does not depend on insulin. In this research paper, our key focus is on diabetes mellitus Type 2. We will outline the commonly used medications and present the advantages and disadvantages of each class of drug. Additionally, we will present the dipeptidyl peptidase-4 inhibitors and their place in the treatment of patients with Type 2 diabetes mellitus.

Diabetes Mellitus is a condition caused by the deficiency of insulin, an anabolic hormone. The absence or presence of destroyed beta cells in the pancreas results in diabetes mellitus type 1. Children are the main patients of Diabetes mellitus type1. Diabetes mellitus type 2 is a heterogeneous disorder. In this case, the patient develops some insulin resistance and their beta cells do not have the ability to conquer this resistance.

Medications for type 2 diabetes are different. They come in a variety of classes. These are alpha-glucosidase inhibitors, the novel approach of amylin agonists, the orally active dipeptidyl-peptidase4 (DPP-4) inhibitors, meglitinides, thiazolidinediones (glitazones) and sulfonylureas. Each of these classes contains one or more drugs. The form of taking Diabetes drugs either is orally or injected into the body. These drugs perform different functions once they are in the body. It may inhibit production of and release of glucose from the liver or block the action of stomach enzymes that break down carbohydrates’ or make tissues more sensitive to insulin.

Each drug has its advantage and disadvantage.  We shall start by looking at Dipeptidyl-peptidase 4 (DPP-4) inhibitors also known as Saxagliptin (Onglyza) Sitagliptin (Januvia). Administration of this drug is through the mouth. Its advantage is that it does not cause weight gain. Its disadvantage is that, it may cause upper respiratory tract infection, sore throat and headache; Sitagliptin has been linked with severe irritation of the pancreas.

The second drug is Glucagon-like peptide 1 (GLP-1) agonists Exenatide (Byetta). When taking this drug, the patient receives an injection. Its merit is that it may promote weight loss its disadvantage is that it may cause sickness, headache and faintness; hardly ever, may cause kidney problems, for instance kidney failure; it is taken twice a day. Meglitinides   Repaglinide (Prandin) is taken by mouth. This drug works quickly. The problem with it is that it causes low blood sugar and weight gain; it is taken three times a day.

Sulfonylureas Glipizide (Glucotrol), Glimepiride (Amaryl), and Glyburide (DiaBeta, Glynase) are used alone or with other diabetes medications; it works quickly. Its disadvantage is that it causes low blood sugar, nausea and weight gain. Metformin (Fortamet, Glucophage, others) improves the effectiveness of insulin in the body. A patient takes it through the mouth. The advantage with this medication is it does not cause weight gain. However, it may decrease LDL (“bad”) cholesterol and triglycerides. In rare cases, it may cause a harmful build-up of lactic acid (lactic acidosis). In addition, Thiazolidinediones Rosiglitazone (Avandia), Pioglitazone (Actos) may slightly increase HDL (“good”) cholesterol. The only problem with it is that it may cause swelling and weight gain that results in or aggravates heart failure. In rare cases, it causes liver problems. Alpha-glucosidase inhibitors, Acarbose (Precose), and Miglitol (Glyset) do not cause weight gain. However, they may cause nausea and diarrhoea. A patient takes this drugs three times a day.

Insulin resistance and ?-cell dysfunction lead to hyperglycemia and sometimes macrovascular complications. These characters determine the presence of diabetes mellitus type 2. Dipeptidyl peptidase-4 (DPP-4) inhibitors are a new class of drugs mainly used for the management of type 2 diabetes.  We conducted a search on evaluation and comparison of pharmacology, pharmacokinetics, efficacy, and safety of the DPP-4 inhibitors in the treatment of type 2 diabetes. These drugs have become widely accepted in clinical practice because of their low risk of hypoglycaemia, favourable adverse-effect profile, and once-daily dosing. They do not affect a patients’ weight and decrease ?-cell apoptosis and increase ?-cell survival.

While looking at studies conducted from preclinical, clinical, and post marketing data, there is no distinct advantage of one DPP-4 inhibitor over another considering its efficacy, safety, or ease of clinical use. Though theoretically, looking at the toxic level, it is beneficial to use agents with a higher specificity for DPP-4 inhibition (Grossman, 2009).

Patient education is important. Giving a patient with diabetes brief instructions and medications does not assist the patient to manage the disease. The patient requires proper education concerning the disease from the physician, nutritionist diabetes educator and health professionals. Studies show that individual education is more advantageous to patients with type 2 diabetes who have a baseline haemoglobin A1c (HbA1c) of greater than 8%. Through education, these patients may realize better glycaemia control. Some treatments affect A1c concentration without effect of the blood glucose concentration.  Having full dependence on A1c measurement in patients with diabetes might be risky.  Research shows that lowering of A1c of a type 2 patient to less than or equal to 6% posses an increased risk of cardiovascular events. This implies that aggressive A1c lowering may not be the best strategy in all patients.

Clinical practitioners state that poor glycaemia control links to an increased risk for cardiovascular disease (Stratton, 2000). Glycaemia control is essential especially when we treat patients during the early stages of diabetes. Further studies on diabetes in the UK show that intensive therapy aimed at lowering glucose levels reduces micro vascular complications steadily as compared to conventionary dietary therapy alone.

In conclusion, the most important elements to note in caring for patients with diabetes mellitus are to eliminate symptoms and prevent, or at least slow, the advancement of complications. We can reduce Macrovascular risks through control of glycaemia and blood pressure (BP). Therefore, diabetes care requires proper goal setting, dietary as well as exercise modifications, medications; suitable self-monitoring of blood glucose, regular monitoring for complications, and laboratory assessment.

References

Stratton I. M, Adler A.I, Neil H.A, Matthews D.R, Manley S.E, Cull C.A, et al. (2000).

Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. 405-412.  Web  27 May 2011 <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC27454/?tool=pubmed >.

Grossman S. (2009) Differentiating Incretin Therapies Based on Structure, Activity, and

Metabolism: Focus on Liraglutide. Pharmacotherapy. Web 27 May 2011 <http://pharmacotherapyjournal.org/doi/abs/10.1592/phco.27.8.1163?journalCode=phco>