Ralph DeFronzo, MD, discusses treating type 2 diabetes early and using drugs to correct the pathophysiologic disturbances associated with it. EndoTwitter
Why do we have much better drugs? These drugs not only lower the A1c, but they keep the A1c down for a long period of time. Above and beyond that, they have other advantages. They are cardioprotective and they also are renoprotective.
What's the big problem in our diabetic patients? What kills them? Cardiovascular disease. Now we have strong data with GLP-1 receptor agonists, SGLT2 inhibitors, and pioglitazone that they are cardioprotective. We really don't have any data that tell us that metformin is cardioprotective. From the standpoint of renal disease, we also now have very strong data with the SGLT2 inhibitors, emerging data from the GLP-1 receptor agonists, and a new class of drugs that don't lower glucose, but finerenone, which is effective in providing protection against cardiovascular disease and renal disease.
Early treatment of type 2 diabetes is essential because we have an impairment in beta-cell function when you first see the diabetic patient, and what's causing that progressive rise in A1c is progressive beta-cell failure. The other problem is with time we start to lose beta-cell mass. It is essential that we start early not only to improve beta-cell function but also to make sure that we prevent apoptosis, or death, of beta-cells.
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