Thursday, March 23, 2023

Diabetes: “We have to give the best treatment to our patients”, Dr. Ramirez

Treatment aims to reduce the risks to the heart, brain and kidneys. They want to improve the quality of life of the people.

“We have to give our patients the best treatment possible. It’s important to use these other drugs,” says Dr. Ramirez. Photo: Journal of Medicine and Public Health.

From Puerto Rico Forum: Alliance in Control diabetesWe spoke with Dr. Margarita Ramirez, endocrinologist and director of the Endocrinology Section of the Medical Sciences Campus, who gave us a dynamic overview of the development of diabetes. the treatment for diabetes,

A study by the Aberthis Health Laboratory in collaboration with the Puerto Rican Association of diabetes, which showed a very high incidence of 16%; revealing that 20% of the island’s population suffers from the disease and that 28%, at most, may be afflicted by it.

This issue has prompted various sectors to take measures and one of the fundamental is education, so that Puerto Ricans are aware of the options and prevention to reduce the rates in the future which are very high at the moment. It is also important to clarify that some of the drugs used in the treatmentbring with it a range of side effects and are still applicable in the management of diabetes,

Advances in medicine and drugs have resulted from the treatment Be more personalized as well as maintain sugar levels and be stable in both without altering weight gain. In addition, they help the patient and reduce the risk of cardiovascular, cerebral and renal effects associated with diabetes,

“We have to give our patients the best treatment possible. It’s important to use these other drugs,” says Dr. Ramirez.

GLP-1 Analogs

They are also known as glucagon-like peptide 1 receptor agonists (GLP-1 receptor agonists). These drugs are mostly injectable, and there is only one that is meant for oral administration. “There are injections that are usually given every week, one that is daily”

These drugs are similar to a natural hormone called incretin. They are characterized by growth of B cells and an increase in the amount of insulin used by the body, but it is not insulin. They reduce your appetite and the amount of glucagon your body uses, as well as the rate of stomach emptying.

For some people, atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease may take priority over their diabetes, In such cases the Society of diabetes The United States of America (ADA) recommends certain GLP-1 receptor agonists as part of an antihyperglycemic treatment regimen.

SGLT2 inhibitors

Sodium-glucose transporter (SGLT2) inhibitors work by preventing the kidneys from retaining glucose. Instead, the body eliminates glucose through urine. In cases where atherosclerotic cardiovascular disease, heart failure, or chronic kidney disease predominate, the ADA recommends SGLT2 inhibitors as a potential treatment option.

“Both drugs (GLP-1 analogs and SGLT2 inhibitors) cause significant weight loss, in addition to glucose control, and there is some indication right now in terms of their reducing cardiovascular and kidney risk,” he says.

New Diabetes Guidelines

“If the initial patient has kidney failure or some kidney problem, or is at high cardiovascular risk, these are the drugs to use, and the associated sugar control … It’s a very different way of controlling the disease than what we do.” used to in the past,” says Ramirez.

Now there’s availability, he says, and the problem is cost: “These drugs are expensive, but it’s not that we can’t prescribe them,” he clarifies. This represents a major challenge as specialists must consider and justify the health system in order to authorize treatment.

“For this reason, many primary care physicians end up prescribing them insulin and sulfonylureas, which would not be the best choice for the patient… Unfortunately, cost greatly affects the quality of care we can give our diabetic patients. are,” he explains. Ramirez.


The peculiarity of this drug is that it supports the body in resistance to insulin, it does not produce hypoglycemia, and as a side effect it can make the patient lose weight, unlike other drugs. “It was an important tool in managing diabetesRamirez says.

dipeptidyl peptidase-4 (DPP-4) inhibitors

“These are drugs that at one point also had their place… when combined with metformin you saw a significant drop in sugar and it also helped with insulin resistance. They were very good in that sense and they didn’t cause weight gain either “, Doctor. Ramirez explains.

These drugs are still prescribed by specialists in the management diabetesBut Dr. Ramirez clarifies that: “They’re not the best option with everything else we have, because it hasn’t been proven that they have the added benefit of lowering sugar,” she says.

First treatment: insulin, silfuriduria, glucotrol, glipizide

Doctor. According to Ramirez, when he started his training, the treatment “They were based on administering drugs like insulin, sulfonylurea, glucotrol, glipizide, and that was the only thing we had available,” he says. He says that currently there are more than six classes of drugs that have emerged for the management diabetes: “We have a weapon we didn’t have before,” he says.

Management of the disease has become more efficient and managed to differentiate cases, explains Ramirez: “Before we didn’t have many treatments and we basically prescribed everyone the same thing.”


Doctor. Ramirez comments that in the past, patients with diabetes Type 1 died from lack of insulin and with this drug they managed to provide an alternative: “When insulin treatment started in 1922 it was a huge advance,” he explains.


Then came the sulfonylureas, a drug characterized by lowering sugar levels: “Its mechanism of action is to increase the secretion of insulin in your body so that you can lower glucose levels. The problem with these is that they affect the pancreas. without resolving insulin resistance making it work more (diabetes Type 2),” he says.

In Dr. Ramirez’s words: “Sulfonylureas cause the patient to gain weight, and also have problems that cause many hypoglycemia, like insulin, because they work whether you eat or not,” she explains. Huh.

As a conclusion to this intervention in the Forum, we highlight the importance of the expert and his decision in the administration of treatment. In addition, the natural curiosity that aims to awaken in the population so that they question and learn about their situation.

View the full forum here.

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