The other day, sitting in the shade and scratching my dog’s ears, I thought about some of the surprising developments over the past few in treating and managing type 2 diabetes.
By surprising, I mean unexpected, unanticipated, serendipitous things that came out of research labs and hospitals from studies that started focused on one outcome but later were found to have some happy side effects.
Here are five I can think of:
1. The unexpected weight loss benefit of the GLP-4s
(Byetta, Bydureon, Januvia)
The morphing of Gila Monster spit into a twofer diabetes drug—exenatide—that both stimulated insulin-producing beta cells. While quieting down the liver’s glucose production would have been a landmark event if those were the only two things it did. But researchers noticed an unanticipated benefit: exenatide helped users lose weight by tamping down their hunger pangs. Such a deal: the ability to manage blood sugar levels and weight simply by taking daily or weekly injections!
Exenatide-producing drug companies very smartly began marketing their products as a diabetes management drug that “could” or “may” lead to weight loss. They didn’t have to promise weight loss or make a big deal about it because word of mouth about exenatide’s marvelous extra benefit already paved much of the way for its acceptance in consumer’s minds.
2. The unexpected side benefit of bariatric surgery
Originally, gastric bypass surgery, which shrinks the stomach, redirects the path food takes through the digestive system and dampens hunger pangs, was applied to help morbidly obese people lose weight. But an unexpected side benefit soon emerged. A majority of obese type 2s who underwent the surgery began enjoying a substantial, even total, reduction of their diabetes symptoms: Their blood sugar levels plummeted to within normal range, and their insulin resistance faded. For many of them, those side effects amounted to a virtual cure, although medical people prefer to call them a remission.
Another good side effect is that bariatric surgeons are trying to make the case that the procedure should be available to type 2s who are overweight but not morbidly obese (a body mass index of 35+). The reasoning is that a fairly routine surgical procedure applied now will offset the future expense of medicating and treating diabetes over an adult lifespan, as well as preventing the very serious prospect of amputations.
3. The unexpected dampening of the hex on fats
From Baby Boomers on down, Americans have been bombarded for years with the mantra that fat is bad because it can lead to heart attacks or stroke. To avoid fat, people began consuming more carbohydrates, yet the nation’s incidences of cardiovascular disease kept rising.
The solution? Double down on banishing fat, not only from our individual diets but even from the animals we eat. Lean pork did away with the tasty fat that people had enjoyed through the centuries. A leaner beef was so stripped of its tenderness and flavor that consumers had to go to pricey restaurants to enjoy the kind of tender, well-marbled steaks. That in an earlier time they could have easily picked up just by walking over to the corner butcher.
These days, voices that have been crying in the wilderness for years saying that fat is not the culprit for cardiovascular problems are finally being heard. Like the unraveling of any deeply held belief, certainty about the badness of fat is going to take some time. But if you look at the nutritional information on the back of food products, more and more manufacturers are focusing on touting the low number of carbs.
This was uncannily predicted in Woody Allen’s 1973 comedy, “A a man who has been in hibernation wakes up in 2173, 200 years later than his own time. Two doctors who are looking after him discuss his dietary needs. What they say has become some of the most memorable lines in movie history.
4. The unexpected rise of the smartphone as a diabetics-friendly device
Apps have become cheap (or free) and plentiful. If anything, there’s an embarrassment of riches for people with diabetes. Among the better known free apps available for downloading are Diabetic Connect, Fooducate, Glooko, and more. Given the incredible popularity of mobile devices, diabetic users’ ability to record their disease on the go, or be reminded to take medicine, or send data to their healthcare providers, or communicate with fellow diabetics is simply a wonderful modern marvel.
5. An unexpected “third way” drug for blood sugar control
For years the most common medicines for type 2 focused either on making pancreatic beta cells produce more insulin or making the liver produce less glucose. (Insulin itself, a last resort for many type 2s, was in its own category.) Aside from tacking on good diet and exercise as accompaniments to drug therapy, there wasn’t much more that doctors or endocrinologists could prescribe.
That changed when the first results of research came out on the gliflozin category of drugs. This category of drugs (SGLT2) worked in an entirely different way to manage blood sugar levels. By introducing another set of organs, besides the pancreas and the liver, to the management of type2: the kidneys.
Researchers knew that the kidneys, in the process of “cleaning up” return glucose to the bloodstream even as they’re sending other matter to the urinary system. But what if you could find a way to coax the kidneys into diverting some (not all) of the glucose to the urinary system?
Once the FDA approved entries in the gliflozin drug category— (canagliflozin (Invokana) dapagliflozin , (Farxiga), and empagliflozin (Jardiance). The US market had a distinctly different new therapy to help type 2 manage their disease.