The Difference 20 Years Makes in Diabetes Treatment

There have been many innovations in diabetes treatment since the days when glass insulin syringes had to be sterilized after every use, and needles were sharpened with emery stones.

During the past 20 years alone, treatment improvements have raised the quality of life for many with diabetes and decreased the incidence of people suffering the extreme consequences of diabetes complications.

Five changes particularly - some medicinal and others attitudinal - have radically altered the diabetes landscape in the last two decades.

1. Approval of Metformin

Some individuals will remember a drug called phenformin—a rather toxic diabetes treatment compound eventually pulled from pharmacy shelves. In 1995, a game-changer for many individuals was the FDA approval of metformin, an oral type 2 diabetes drug that did not cause hypoglycemia.

Though physicians today have several medication options, metformin remains a viable choice. Its overall safety record, efficacy, and generic affordability sustain metformin’s popularity.

2. Continuous Glucose Monitoring

In 1999, physician’s could download the first home-use CGM (continuous glucose monitoring) system. This allowed doctors to determine a patient’s baseline glucose profile and more effectively prescribe insulin. Five years later, the first patient-use CGM gave diabetic individuals the opportunity to track their blood sugar levels in real time, at home.

CGMs, plus the use of insulin pumps, have given people with type 1 diabetes - and some with type 2 - increased accuracy and confidence in blood glucose management, and more lifestyle flexibility.

3. Saving Sight

Anti-Vascular Endothelial Growth Factor (VEGF) therapy is a sight-restoring treatment used with macular edema, a thickening or swelling of the eye’s retina associated with diabetic retinopathy. Anti-VEGF injections treat both types of macular edema: focal (leakage from areas of micro-vascular abnormality) and diffuse (swelling caused by dilated retinal capillaries).

4. Not Just About Blood Sugar Anymore

“First treat the blood pressure, then lipids, then blood sugar,” says Dr. Charles Clark, Indiana University School of Medicine.

Dr Clark’s statement refers to the recognition that diabetes is a Cardio-metabolic Syndrome—a disease that includes cardiovascular risk.

Treating type 2 diabetes only as a blood-sugar control issue that can damage tiny blood vessels, leaves individuals at increased risk for larger blood vessel harm. Now that blood pressure, lipids (fats), and stress control is integral to diabetes care, the likelihood or severity of cardiovascular disease is reduced.

5. Patient Centered Teamwork

While multi-specialist medical teams provided patient care prior to 1995, making patients the central player on these teams is a more recent treatment innovation. This change in patient care reflects a growing acceptance that positive diabetes outcomes require collaboration between patients and treatment professionals.

Collaboration necessitates that patients understand their illness, and any cultural barriers to care must be addressed. Treatment decisions need to be timely, and rest on evidence-based options tailored to the patient’s illness severity, coexisting conditions, and patient preferences.

In short, a proactive professional treatment team works closely with a motivated, informed patient to achieve the best possible result. Quite a shift from the days when patients were simply told what to do.

Sources: Medscape; Medicine Net
Photo credit: Seattle Municipal Archives