I’ve been a practicing family physician in Wilson for more than 28 ½ years. For some time now, I have wanted to write about something some may say is controversial, but the experience and science are clear, and today, I can no longer remain silent.
When I came to town, I had no special knowledge of Type 2 diabetes, or T2D, and we only had insulin and drugs called sulfonylureas to treat it. I was finding more and more patients with T2D and soon we had a new drug called Glucophage (metformin). I was urged by experts to advise on diet, exercise and weight loss, give sulfonylureas and metformin, and every three months, perform an A1C — a test that checks to see what percentage of your blood sugar has stuck to it.
So, all these efforts by both me and my patients, and every three months, their A1C increased!
A graph from a very important medical study called the United Kingdom Prospective Diabetes Study demonstrates the body’s declining ability to make insulin. There is no evidence on the graph that a person will be able at any time to make more insulin tomorrow than they are today while on metformin. If possible, we need not prescribe sulfonylureas and metformin, as these drugs were unable to stop the decline of the body’s ability to make insulin.
Another more complex graph from this same study demonstrates a parallel decline with declining insulin production. This parallel decline with B-cell function (which produces insulin) and incretin function (which is related to hunger/satiety) is very important to our metabolism and overall health. If you do not address this problem, obesity, prediabetes, diabetes, high blood pressure and your heart’s health will remain a consequence.
Glucagon-like peptide 1 was discovered to exist in our bodies in the 1950s. GLP-1 has a half-life (meaning it lasts for) 1-2 minutes, and if the body can still make GLP-1, that can be extended by a drug called a DPP-4 inhibitor. One such drug is Januvia, and it may have been packaged right here in Wilson at the Merck plant.
Another drug called a GLP-1 agonist (sometimes very close in structure to what our body should make) goes directly to the source of the problem by replacing what is missing. The first GLP-1 agonist became available around 2005. These products started as injections and were needed twice a day, then once a day, and then once a week.
Recently, these became available in a pill form, called Rybelsus, also made right here in North Carolina. In hundreds of patients over the years since GLP-1 agonist became available, I have been able to stop or delay the declining of insulin in the body and have seen declining A1Cs for almost all of my patients, often returning to nondiabetic levels.
Who should want a GLP-1 agonist? In the UKPDS, we saw an imbalance in these important hormones begin to occur more than 10 years before a person receives a diagnosis of diabetes. So, unless there is a contraindication, anyone finding themselves with “prediabetes” should want the product.
How do I find out if I have “prediabetes”? If your body mass index is 30 or greater (you can calculate your BMI by visiting www.nhlbi.nih.gov or by asking your health care provider), or you have high blood pressure, or your lipid labs show increased triglycerides, decreased HDL and the presence of VLDL. You can also get a lipid panel from LabCorp called the NMR lipoprofile. This lab is much more specific. Also, an A1C of 5.7 to 6.4 probably is greater than 90% predictive. Finally, if fasting blood sugars are greater than 100, this can be indicative of prediabetes.
I hear patients say, “I don’t want to take drugs, I’ll just follow a ketogenic diet.” But I assure you that studies, including the UKPDS, had individuals choosing a diet similar to this, and I have never heard of even one of them not progressing in diabetes based on A1Cs, which continue to climb.
If you don’t make enough thyroid hormone, you would take a drug to replace the hormone called levothyroxine. If you don’t make enough GLP-1, you should take it.
Wake up, America. Type 2 diabetes can be prevented!
Gregg Sigmon, M.D., is a family medicine physician at the Wilson Family Practice Center.
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