Think DifferentlyMarch 14, 2013
This was the title of a one day conference held to publicise the new anti-diabetic drug, dapagliflozin. Quite a good title really seeing the novel approach of the drug to inhibit the reabsorption of glucose in the kidney leading to falling blood glucose levels.
Whether simply reducing blood sugar levels will have an effect on the complications of diabetes is open to question but the consequent weight loss may very well.
We have written about dapagliflozin before so let’s concentrate on another aspect of the conference. Naturally, with Bristol-Myers-Squibb and AstraZeneca sponsoring the conference, top class speakers were present. One of the attractions of these speakers is not so much the main thrust of the message but the little asides that are cast out. One hesitates to use the phrase, “casting pearls among swine” but . . . So let’s concentrate on these.
- In setting the scene, Professor Tony Barnett, who, he said, had come to Leeds mainly to see his parents, said that currently 2.9 million people in the UK have diabetes. That’s equivalent to 1:20 of the population. This figure was estimated to rise to £5 million in 2025. He worried about the 850,000 people with undiagnosed diabetes pointing out that early diagnosis meant better outcomes. Indeed, he went on to say that 80% of the annual NHS spend on diabetes is spent on managing avoidable complications. Incidentally, the annual spend of £10 billion equates to 10% of the total NHS budget.
- Half of all diabetes admissions are for active foot disease.
- People with Type 2 diabetes are at 2-4 times the risk of Coronary Heart Disease, and 75-80% of people with Type 2 diabetes die due to cardiovascular events.
- Hypoglycæmic attacks are much more common than we think. 50 serious road traffic accidents a month are caused by hypos. Severe hypos = increased cardiovascular risk. So, managing diabetes is a balance between good control against weight gain and hypos.
- Screening for diabetes in South Asians should begin at 25 years of age.
- Professor John Wilding concentrated on the kidney and tried (successfully) to explain the difference between eGFR and Albumen:creatinine ratio. Whereas eGFR is a measure of kidney function, ACR demonstrates the degree of renal damage.
- In patients with renal disease (or kidney disease, whichever term you prefer), the dose of metformin should be reduced when the eGFR drops below 45 and stopped when it drops below 30. Medication in severe kidney disease is difficult and normally is under specialist help.
- The amount of glucose reabsorbed is up-regulated if the patient has diabetes; that is, more is reabsorbed (leading to higher blood glucose levels).
- There is a predecessor of dapagliflozin called phlorizin or florizin which occurs naturally in apple pear and cherry trees. Remember you read that first here.
- Dapagliflozin is contraindicated with loop diuretics and pioglitazone, the latter because of bladder cancer risk.
- Non-steroidal anti-inflammatory drugs should be avoided if there is any degree of renal failure.
- Finally, there are certain things which cause the eyes to glaze over and thoughts turn to the coffee break. One of these is QIPP. The letters, if you didn’t know stand for Quality, Innovation, Productivity and Prevention. The aim is to save George Osborne £20 billion a year. It consists of . . . Oh, you look it up on the internet.