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Modern Medicine and Traditional Chinese
Medicine - Diabetes Mellitus
Conventional Medical Treatment
Insulin was the first, and remains the primary means of treatment for Type 1
diabetes and is administered by subcutaneous injection. This method is necessary
since insulin is destroyed by gastric stomach secretions when it is taken by
mouth. Insulin injections must be balanced with meals and daily activities, and
glucose levels must be closely monitored through frequent blood sugar testing.
Many diabetics need inject insulin only once a day; others require two or more
injections. The usual time for a dose of insulin is before breakfast. The dosage
is initially established according to the severity of the condition, but it
often has to be reassessed as one or another of the variables in the person's
condition changes.
During the past several years a large number of different classes of drug
therapies for patients with both Type 1 and Type 2 diabetes have been developed.
The concept of genetic re-engineering of insulins to produce insulin analogs
(synthetic insulin) with improved properties has enhanced the ability to affect
glycaemic control with fewer adverse reactions. For Type 2 patients, the number
of orally active antidiabetic agents has increased from one class of agents (the
sulfonylureas - sulfa drugs) to the current total of four classes of agents. The
three new classes include agents of potentially even greater glycaemic efficacy,
such as Biguanide 'Metformin'; agents directly improving the underlying insulin
resistance of Type 2 diabetes, specifically thiazolidinediones such as 'Troglitazone';
and finally agents that alter the rate of hydrolysis and absorption of
oligosaccharides, such as the alpha-glucosidase inhibitor 'Acarbose'.
The sulfonylureas as a group have proven to be not very effective. After three
months of continual treatment at an adequate dosage, only about sixty percent of
Type 2 diabetics are able to control blood sugar levels using these drugs.
Furthermore these agents generally lose their effectiveness over time. After an
initial period of success they fail to produce a positive effect in about
thirty- percent of the cases at best.
In addition to being of limited value, there is evidence that the sulfonylureas
actually produce harmful long-term effects. Tolbutamide has been reported to be
associated with increased cardiovascular mortality. Other major side effects of
the sulfonylureas are hypoglycaemia, allergic skin reactions, headache, fatigue,
nausea, vomiting and liver damage. Common examples of sulfonylureas include
Chlorpropamide (Diabinese), Glipizide (Glucotrol), Tolazamide (Tolinase) and
Tolbutamide (Orinase).
Metformin has been used in the management of Type 2 diabetes in more than 90
countries for over 30 years. It was approved for use in diabetes patients in the
United States in 1995. Metformin reduces the excessive hepatic glucose
production that characterizes Type 2 diabetes. With reduced hyperglycaemia,
glucose uptake by peripheral tissues is enhanced while insulin levels remain
stable or decline. Metformin also lowers elevated cholesterol and lipids,
particularly the serum levels of triglycerides. Frequency of adverse effects is
low at the doses needed to obtain the desired metabolic effect.
Troglitazone is a member of a new class of drugs that are 'insulin sensitizers'.
It was selected on the basis of its effect to lower glycaemia without increasing
insulin levels, its ability to improve lipid levels and absence of significant
side effects or adverse events in short-term human studies. The new generation
oral drugs do have a specific and beneficial place particularly for patients who
are on an appropriate diet and exercise program, have attained an optimal weight
and are still unable to adequately control blood sugar levels. However with the
increased number of oral antidiabetic agents soon to increase even further, the
medical emphasis upon management of hyperglycaemia in Type 2 diabetes with these
agents will likely increase. Realistically this is the easiest and least
time-consuming response that can be made by practitioners to the impact of
managed care plans. However to prescribe these agents alone and in combination
for even minimal degrees of hyperglycaemia without an adequate trial of diet and
exercise will only serve to accentuate the problem. For the noninsulin dependent
diabetic, dietary and life style changes can often provide adequate remediation.
Medical Cost Attributed To Diabetes
Medical cost for persons with diabetes are higher because they visit physician's
offices, hospital outpatient departments and emergency rooms more frequently
than their non-diabetic counterparts and are more likely to be admitted to
hospitals and nursing homes. One estimate of the total health-care expenditures
for diabetes in the USA is approximately $100 billion per year in both direct
and indirect costs, or about 12% of all health-care expenditures.
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