Some New Advances that could make life Easier

Introduction

Diabetes is a chronic condition. In many cases, it seems to progress with time, requiring more than diet and exercise as time goes by. This means that in addition to diet and exercise, medications and monitoring are also required in the long term. In some cases, insulin is also advised.

Taking pills on time, needing to inject insulin many times a day - all these lead to anxiety, frustration and people with Diabetes are often overwhelmed, frustrated and depressed.

However, there is hope. Advances in research are coming in like never before. In this article, I will try to summarize a few selected ideas on the horizon, which could improve lives.

Eating right becomes easier

There has never been a better time for nutrition in the treatment of Type 2 Diabetes than now, which is the most common form of Diabetes and associated with obesity. New research from Dr Roy Taylor's laboratory had earlier shown that with a low-calorie diet, Type 2 Diabetes can go into remission. Recently, a two-year data of the study was presented, where this improvement could persist in half the people at the end of two years. Remission is different from true reversal and does not indicate a cure. Nevertheless, the concept of Type 2 Diabetes as an inevitably progressive disease changed forever with this publication. A part of this concept has been demonstrated in India too, with our research proving that high blood sugar levels in Diabetes could be controlled by a balanced low-calorie diet.

Talk to your doctor/nutritionist and make a plan for a healthy diet. There are several options like intermittent fasting, a low carbohydrate option and for those preferring vegetarian diet, vegetarian and even vegan (pure-plant based) options for improving Diabetes control. In my opinion, it is safe to follow a balanced diet, with 3-4 meals per day, with about 50 per cent of fewer calories coming from carbohydrates and with enough fats, proteins, minerals and vitamins. But there are no hard and fast rules and no one-size­ fits-all solution, so talk to a specialist about what works for you. Variety and taste are important, and combining the best ofdifferent approaches may also be an option, provided it is done professionally. While I do not recommend any app for measuring food intake, there are several, and the free version of an app called "my fitness pal" works for many people. Such apps, if provided with nutritional information can tell your calorie and carb intake too.

In addition, there is a profusion of healthy foods available - main courses, snacks and even beverages. Seek help from a professional and choose a meal plan that

works for you long term, which is healthy, has taste and variety. Seeking a professional's help is important because reading a food label involves going beyond the fine print and reading between the lines. There are many aspects of food labels that may be missed by an untrained eye. For example, did you know that dark chocolate could contain alkalinized dark chocolate with cocoa butter? Or that dry fruits contain sugar, fruits have ascorbic acid and that the raisins in dry fruit may contain added sulfur? Once you have learned the principles of diet from an expert, boredom or frustration of eating food can be overcome by choosing tastefully, yet in a healthy manner.

Fitness

One common reason for frustration and people getting fed up is their focus on weight."Doctor, I walk 10,000 steps per day yet I am not able to lose weight"- this is a common statement. Friends, exercise is a magic pill, it reduces blood glucose, blood pressure, lipids and protects against heart disease. However, exercise is not always associated with weight loss. Exercise can indeed cause weight loss in many people - but at least for some, the amount of exercise needed to facilitate weight loss is very huge.

However, once you have lost weight via diet, then exercise help in maintaining that weight loss.

Hence, if you are fed up with exercising without weight loss, here are four suggestions from me:

• Change the goal post and look at exercise as a means to holistic health, not weight loss.

• Exercise for 150 minutes a week if you have Diabetes. In addition, do resistance exercises and Yoga for 100 minutes a week.

• Remember, even if exercise doesn't directly help you with weight loss, it can maintain the weight loss.

• Get hold of a fitness tracker so that you can complete your exercise routine and slowly increase your exercise efficiency.

Monitoring blood glucose at home

Many people feel anxious as well as fed up by the need to check blood sugar frequently, enter them into a logbook or even enter a glucometer memory to access blood sugar records.

First of all - it is not necessary for all people with diabetes to check their blood sugar levels at home. People on insulin injections (insulin is a hormone that lowers blood glucose), or on a group of drugs called sulfonylureas, may develop dangerously low blood sugar levels and need monitoring at home. Pregnant women with Diabetes also require self-monitoring. People who have specific illnesses co-existing with Diabetes may need home monitoring - check with your doctor. But if you do not fall in the categories above - there is no need for monitoring at home.

Secondly, two new technologies promise to take the tediousness out of home glucose testing -

A. The advent of newer glucose meters that sync to the mobile phone immediately, storing data that can be accessed not just by the user, but even their relative or health care provider. The availability of blood glucose reading on mobile also means that interested people can analyse their blood glucose over months, even years - see trends, notice the percentage of values that are within the normal range etc. Recently a research study demonstrated that connected glucose meters could have a role in the remote management of blood glucose during Diabetes in pregnancy.

B. Pain-free testing throughout the day is today possible with continuous glucose monitoring technologies. Today, for people with Diabetes, there is no need to fish out a needle, take a drop of blood and put it onto a glucose meter several times to know how long the blood glucose has remained high after a large meal. Instead, they can simply take out their reader and look at the screen and see for themselves. Do bananas, dates and scoops of honey increase blood sugar levels? Your doctor or dietician may have said so, but with continuous glucose measurements, you can see for yourself. This is a tremendously empowering tool for people with Diabetes as they can choose tasty diets, but those which are personalised for them and those which do not cause a rise in sugar levels.

Taking medications and iniections

Newer Diabetes medications and injections have indeed improved blood glucose while reducing weight and protecting the heart and kidneys. But an increasing number of reports suggest that these medications are often forgotten and that it is a chore to remember taking medications.

There is no easy way out, but nowadays, several medications are available as combination pills - what is called in medical parlance as fixed drug combinations. These pills, which combine many pills into one can reduce the number of pills and make life easier.

Finally, nowadays certain medications for Diabetes, especially insulin, need to be injected every day. In future, this is going to change. Once a week injections are being researched for Diabetes as well as obesity. One such product is already available and many more are in the pipeline. Some of these injections may even need to be given at less frequent intervals if future research shows the way. Interestingly some newer injections, called inclisirans, are being researched, which can control cholesterol levels for over 6 months with a single injection!

It is also possible that the oral form of these glucose-control injections could become available. For instance, a once-weekly injection called semaglutide which controls blood glucose and reduces obesity was studied to cause weight loss of 15 kg, as well as 15 per cent even in people without Diabetes in a recent trial, published a few weeks ago. What is more, semaglutide has been combined with an absorption

enhancer that prevents digestion of the medicine - and an oral form has been developed and found to be effective. If these efforts continue to bear fruit, then we could see research blossoming for the

development of oral insulin too! Remember, insulin cannot be taken orally as it can be digested- that is why it needs to be injected.

But who knows, in the future scientists could discover ways to overcome this barrier.

Friends,the future is bright

Friends, remaining happy and healthy is important. Eat wisely, exercise well, sleep good and spend quality time with family, friends and colleagues at work. The role of science is to assist you in getting to lead a healthy and happy life. Believe and trust in the words of science.

These are my concluding thoughts, as the world battles the pandemic. Remember, our world has successfully battled pandemics before. Do not lose hope. Diseases can be overcome. Diabetes can be defeated and made into a friend - if you follow simple measures and put your faith in the processes of scientific thought.

Dr Unnikrishnan AG is the Editor in Chief of Diabetes Health magazine and CEO and Chief Endocrinologist at Chellaram Hospital - Diabetes Care and Multispecialty.