Diabetes Remission: The real renaissance in diabetes care | The Financial Express

Diabetes Remission: The real renaissance in diabetes care

New classes of drugs for example, SGLT2 Inhibitors and GLP agonists are more than just diabetes drugs.

Diabetes Remission: The real renaissance in diabetes care
In India, presently a total of 107 million adults have been diagnosed with Type 2 diabetes. (File)

By Dr. Hema Venkataraman

The last decade has heralded many path-breaking and course-changing inventions in diabetes care. From connected technologies to new drug treatments, these are exciting times both for the providers and the people with diabetes.

Let’s take a peek at what’s new in diabetes care.

With over 60 new drugs approved by the FDA and 100 more in the making, pharma research in diabetes has had its busiest periods in the history of diabetes. New classes of drugs for example, SGLT2 Inhibitors and GLP agonists are more than just diabetes drugs. They cause unparalleled weight loss, reduce appetite, protect the heart and kidneys and lower blood glucose in ways never seen before with reduced reliance on insulin (apologies to Banting and Best, whose discovery of insulin still stands unbeaten even after 100 years).

The technology race in diabetes has never been more dramatic. Finger prick blood glucose (BG) testing will soon be a thing of the past, with many players (e.g. Abbott, Dexcom, Medtronic) competing for the sleekest state-of-the-art glucose sensing technology with Continuous Glucose Monitoring (CGM). The CGM patch painlessly checks your BG every few minutes and continuously displays BG readings on your phone, with low and high sugar alarms. Insulin Pumps will gradually replace the clumsy insulin injections, giving you trickles of insulin through the day from a little pod connected to you. More advanced CGM devices can instruct the insulin pumps to deliver insulin based on your BG levels with varying degrees of autonomy, not to forget the DIY Loopers (Hackers) who beat the larger tech giants to this many years ago. Finally, hot from the press is the Bionic Pancreas – today’s most advanced AI algorithm driven PUMP-CGM pair with near complete autonomy almost like the human pancreas. We are now moving from watching your child’s glucose on your phone while they’re playing at school to a more advanced technology that can ‘machine learn’ their habits and mimic their pancreas to give them exactly the insulin they need.

While the world was reeling under the rapid advances in health care, there also began a quiet revolution, a real renaissance in diabetes care with the discovery of ‘Diabetes Remission’ (DR). Just like art, architecture and philosophy of the renaissance, preventive medicine, unlike reactionary curative medicine, was the sign of a more evolved, self-sufficient, mature society that could afford a wider, deeper, more holistic thought-process. And maybe, much like our evolved and progressive approach to climate change, we have now learnt to look at the bigger picture of diabetes too.

The Discovery of Diabetes Remission

In 2017 a small group of researchers from the University of Newcastle, in the Northeast of England, made an exciting discovery that was going to change the face of diabetes care forever.

The DiRECT trial showed for the first time that with a 12-month calorie restricted diet program and weight loss, nearly half of the people with type 2 diabetes managed to achieve and maintain DR i.e., keep sugars in the normal range without the aid of medications.

Rebooting the Pancreas – a reality

A year later, they reported yet another fascinating discovery. The diabetic pancreas that was initially shrunken, fatty and irregular gradually increased in size to normal, lost fat, became smoother and produced normal levels of insulin, driving diabetes into remission.

This was truly the beginning of a paradigm shift in diabetes care (for type 2 diabetes) from a previously glucocentric drug treatment-based approach, to a more holistic, preventive strategy targeting the root cause of diabetes, i.e., fat in the pancreas. These enormous discoveries gave hope and promise to millions of people with diabetes, who until now were thought to be fighting a losing battle with escalating drug prescriptions. Everyone with newly diagnosed type 2 diabetes could now be offered an opportunity to put their diabetes into remission before embarking on their journey with medications.

India’s response to the discovery of DR

Way before the world was rethinking health policy design following this enormous breakthrough and much before the UK launched the nationwide roll-out of the DR program, Indian health technology start-ups were already rolling out DR programs across the country.

With a little lag and initial hesitancy, the organised healthcare sector also took to rolling out small-scale DR services, along with the thousands of standalone physicians and diabetologists who also joined the ‘Kill pill’ campaign at various levels. The shift from the pharma-centric approach to lifestyle medicine has been slow and uncomfortable for the organised healthcare industry.

The Indian consumer society, however, took to DR like second nature. The usual Indian scepticism for ‘western’ medical interventions was conspicuously absent with people only too eager to give-up western medicine. The concept of DR was a perfect cultural and philosophical fit for the ancient traditions of holistic medicine such as Ayurveda that heavily focuses on ‘root-cause treatment’.

The widespread implementation of the remission program is a welcome vaccine program to cull the diabesity pandemic in India, which is home to more than 50% of the world’s people with diabetes. However, what India also badly needs for large-scale DR, is a cultural shift in our perception and relationship with food, a strong public health campaign and policy on advertising and healthy eating.

(The author is a Medical advisor, New Initiatives, Practo, Consultant Endocrinologist and Senior Lecturer, University Hospitals Birmingham, NHS, UK. The article is for informational purposes only. Please consult medical experts and health professionals before starting any therapy, medication and/or remedy. Views expressed are personal and do not reflect the official position or policy of the FinancialExpress.com.)

Get live Share Market updates and latest India News and business news on Financial Express. Download Financial Express App for latest business news.

First published on: 08-12-2022 at 08:00 IST