Ray of hope with once-weekly treatment of diabetes
Approximately 8.4 million Bangladeshi and an estimated 425 million adults worldwide have diabetes. Type 2 diabetes (T2D) is the most common around the world and also in Bangladesh, accounting for an estimated 90-95% of T2D cases in Bangladesh alone.
Diabetes mellitus is a chronic disease which further leads to life threatening diabetes related complications, e.g. cardiovascular disease, chronic kidney disease, blindness, amputation etc. Estimation reveals, about 50% of patients in Bangladesh are still undiagnosed and about 50% of patients are dying due to diabetes related complications.
Despite the availability of ample diabetes care facilities, Bangladeshi patients have poor blood glucose control. A sedentary lifestyle, poor medication adherence, fear of daily injectable medicines are the key barriers to optimal blood glucose control.
Currently, patients are being treated with oral anti-diabetic drugs and injectables (insulins and Glucagon-like peptide-1 receptor agonist or GLP1-RA). Though oral medicines have very good compliance, there are few clinical concerns like pancreas ß-cell failure, hypoglycaemia, weight gain etc., but insulin remains the gold standard for blood glucose control.
Despite proven advantages of insulin for diabetes management, patients are reluctant to use this because of daily injection phobia, hypoglycaemia, weight gain etc. Whereas GLP1-RA, which is available in injectable devices has proven benefits in blood glucose control, cardiovascular and renal complications reduction and the least chance of hypoglycaemia. Because of injectable delivery systems, patient's adherence is also not good with such medication.
In the last two decades, scientists are working more closely to minimise all these challenges. And they are successful to some extent. Besides daily injectables and oral medication, once weekly GLP-1RA (dulaglutide) medications are now available and being used to control blood glucose. Even in Bangladesh now patients have easy accessibility to this once weekly medication.
Patients can use this medication once a week, which can minimise the blood glucose by releasing the body's own insulin, reduction of co-morbidities (heart attack, stroke etc.) and deaths due to diabetes related complications. Study also confirms that dulaglutide can restore ß-cell function, which helps further to produce the body's own insulin.
Once weekly dulaglutide has proven its cardiovascular benefits ensuring both primary and secondary cardiovascular risk preventions. Several possibilities account benefits of dulaglutide on cardiovascular outcomes. These include the reduction of low density lipoproteins (LDL) cholesterol, blood pressure, weight and glycaemic control.
Evidence also suggests, once weekly dulaglutide independently improves blood vessel function, attenuates progression of atherosclerosis, thus dulaglutide has a direct effect on neuroprotection and it can reduce the risk of stroke significantly.
Furthermore, most importantly dulaglutide's injectable device has been developed keeping patients in mind, thus simple injection delivery system introduced to improve patient adherence with medications. The dulaglutide device has a hidden needle, which will relieve patients from needle phobia. Additional key benefits of once weekly dulaglutide is weight reduction. Usually, diabetes patients' Body Mass Index (BMI) remains high and dulaglutide can reduce that.
As diabetes patients are suffering from poor control, they need to adhere to their medications which can ensure their healthy wellbeing. Once weekly medication could be the ultimate solution for uncontrolled diabetes patients.
Once weekly dulaglutide can control blood glucose, reduce comorbidities and ensure weight reduction. Most importantly, such once weekly medicines can improve patient's adherence to treatment, which ensures a sustainable positive effect on diabetes management.
The writer is the Chief Consultant of the Department of Diabetes and Endocrinology at the Bangladesh Institute of Health Sciences Hospital (BIHS), Dhaka.