Starting this week, Colombian doctors must follow new instructions on how to treat and manage patients diagnosed with type 2 diabetes. For the first time in ten years, the country renewed its guidelines for the care of this disease, which is one of the most common chronic conditions nationwide today.
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This is relevant, since medical guides contain recommendations based on scientific evidence that health personnel must follow when treating a certain disease in order to standardize treatments and offer the best alternatives to patients.
In the case of the new guidelines for type 2 diabetes, these were promoted by the Colombian Association of Endocrinology, Diabetes and Metabolism, and representatives from more than six scientific entities in the country participated.
What is the news?
The last time this guide was modified was in 2016. Katherine Restrepo Erazo, one of the endocrinologists who participated in the process, explained to EL COLOMBIANO that in this decade “there has been a very important change in the knowledge and therapeutic tools that we currently have available for the management of diabetes.”
In that sense, the new recommendations are focused on preventing the main cause of death of diabetics, which is cardiovascular diseases. As Restrepo says, until a few years ago, the medications that existed helped control blood sugar levels, but these had no impact on cardiovascular or kidney risk, or on weight, in the case of overweight or obese patients. Now, the drugs that have been proven to have effects on these factors are part of the Colombian guide, which means that they are the most scientifically recommended treatments to treat chronic disease. These are SGLT2 inhibitors and GLP-1 agonists, the latter also known for being used to treat obesity and one of their best-known names on the market is Ozempic.
The origin of SGLT2 inhibitors and GLP-1 agonists
The bases of GLP-1 agonists (a substance that binds to a cellular receptor and produces a response) began in the 1970s with the aim of treating type 2 diabetes, which is the most common among diabetics and occurs when the body cannot use insulin effectively or does not produce enough.
Ozempic is part of that “family” of medications. Its active ingredient is semaglutide, which stimulates insulin secretion and decreases glucagon, which is a hormone produced by the intestine that increases blood glucose levels.
When we eat there are several hormones involved in the digestion process. One of them is glucagon, which is part of the incretin family. The moment food reaches the stomach, a nutrient absorption process begins. In the case of carbohydrates, they give a signal to the pancreas, the insulin factory. What medications like Ozempic do is reduce the production of glucagon which, contrary to what many think, is already a hormone that is part of our body and not something new that the drug introduces into the body.
The first GLP-1 agonist approved for marketing was Byetta, which began to be distributed in 2005 in the United States to treat type 2 diabetes. However, in medical research on the effects of the drug, it was found that these agonists were related to weight loss in diabetic patients who used them.
The development of these drugs has marked a before and after in the treatment of diabetes, and also in the way in which the functioning of the pancreas and, more specifically, the production of glucose was understood.
For their part, SGLT2 inhibitors are a type of medication that, when ingested, acts on the kidneys, helping to eliminate excess sugar through urine. Until the 1980s, it was unknown what relationship kidney cells, that is, those produced in the kidneys, had with glucose. It was in the eighties that a group of American researchers discovered how glucose is reabsorbed in this organ and, later, scientists identified a protein responsible for this process and the gene that produces it. That protein turned out to be part of a new family called sodium-glucose cotransporters, or SGLTs. The first was called SGLT1, and shortly after another very similar one, SGLT2, was discovered. Both fulfill the function of transporting glucose within the kidney.
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By observing how important these proteins were in the glucose absorption process, these inhibitors were created that help eliminate sugar in urine instead of reabsorbing it. These began to be used in type 2 diabetics, but later research found that the medications are also useful for improving kidney and cardiovascular health.
However, research into the effects of these inhibitors and agonists, and how to enhance them, continues. “Research is advancing in the development of new molecules, such as GLP-1 agonists combined with other compounds, to achieve a greater impact on the patient’s weight and metabolic control. That is, by controlling weight, glycemic control is improved and complications are reduced.
An improvement has also been seen in conditions such as sleep apnea, fatty liver and vascular outcomes in the lower extremities,” says the endocrinologist, who also says that long-acting insulins are being created that, for example, can be applied weekly, instead of daily. This is one of the current lines of research.
Here it is worth making a clarification. In Colombia these medications were already prescribed to treat diabetes – these are only sold with a doctor’s prescription. What changes when they are included in the guide is that these are now one of the first options in the care route that doctors follow when a patient with this disease is in their office.
“The guide seeks to establish a care path that indicates which combinations of treatments offer better results and reduce complications. The medications already existed and were used in clinical practice for about ten years, but since they were not formally included in the guidelines, they were considered secondary options. The objective now is to prioritize the best treatment for the patient,” says the specialist.
Another important change in this new document is that to treat diabetes it is no longer enough to control blood sugar: it is necessary to monitor other aspects, especially preventable risk factors such as a sedentary lifestyle and cigarette smoking.
Diabetes figures in Colombia and in the world
As in Colombia, type 2 diabetes is also among the most prevalent chronic diseases worldwide. According to the WHO, in its most recent report published in 2022, nearly 830 million people have been diagnosed with this condition.
In the country, the High Cost Account estimates that three out of every 100 Colombians live with diabetes. However, the medical union has raised alarms due to the high percentage of underdiagnosis of the disease, which can be fatal. It is estimated that 50% of patients are undiagnosed and that only half of those who receive treatment manage to control their diabetes.
