What role do newer agents have in diabetes in the community?
Dr Munro followed on from his first talk about glycaemic and blood pressure targets in diabetes by highlighting the risks associated with obesity and diabetes beyond cardiovascular disease. ‘Cancer is a major cause of death in patients with type II diabetes’, he said. Thirty one per cent of deaths in patients with diabetes are due to cardiovascular disease but 29% are due to cancer. Increased body mass index (BMI) is associated with an increased risk of cancer. Type II diabetes is associated with hyperinsulinaemia in the initial phases of the disease. Insulin has a mitogenic action and insulin growth factor – 1 is associated with increased cancer cell expression. Hyperglycaemia also promotes abnormal cell growth. Metformin has been shown to have a protective effect against cancer.
New agents such as the gliptins (dipeptidylpeptidase-4 inhibitors) and glucagon-like peptide–1 (GLP-1) agonists are improving the range of options available to clinicians treating patients with diabetes. New delivery systems which allow nasal, sublingual and buccal administration of insulin also look promising. In addition, once weekly insulin regimes such as Degludec are currently undergoing evaluation and may in the future reduce the burden of daily injections and monitoring in patients with diabetes requiring insulin.
The link between the gut and obesity needs to be better understood in order to provide therapeutic options. Mice experiments have shown that transplanting the bowel contents of a thin mouse into an obese (ob/ob) mouse results in the obese mouse becoming thin. ‘Theories around gut microbiota have been used to explain these findings’, said Dr Munro.
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