Type 2 diabetes accounts for 90% of all diabetic cases in the world. As of 2021, over 4 million individuals in South Africans were diagnosed with diabetes. Meaning that at least 3.6 million people had type 2 diabetes that year.
The condition affects people of all ages and races. People with diabetes come from diverse backgrounds, educational level and social status. Genetics and family history play a role in the development of the disease and its complications.
Given this diversity, one may conclude that a single uniform approach to managing this condition may not be effective. Society for Endocrinology, Metabolism, and Diabetes of South Africa (SEMDSA), in line with international guidelines support an individualised approach to treatment.
When using the individualised treatment approach, it is important to consider each person’s needs, fears and coexisting conditions. These factors influence adherence , treatment success, and choice of glucose -lowering medication.
When selecting the appropriate glucose-lowering agent, several factors need to be considered: These include the extent to which the medication lowers HbA1c, its effect on weight, benefits to heart and kidney health, risk of hypoglycaemia , side effects, and cost.
Glycaemic control
Glycated haemoglobin (HbA1c) is the gold standard in the treatment and management of diabetes. Individual HbA1c goals or targets are decided based on age, health status and coexisting conditions. All medications used to treat diabetes lower HbA1c. The percentage lowering effect of the various medications differ, they range from 1% -2%.
Effect on weight
Medications used in the treatment of type 2 diabetes can affect weight in different ways. Some types of medications have no impact on weight, while others may result in either weight loss or weight gain.
Benefits to heart and kidneys
Individuals with Type 2 diabetes are at higher risk of developing heart and kidney disease. Certain medications used in the treatment of type 2 diabetes provide protective benefits to these organs, thereby lowering risk of developing heart and kidney related complications.
Risk of Hypoglycaemia
Treatment -related hypoglycaemia is common in those living with diabetes. Majority of the medicines used in diabetes present a low risk for hypoglycaemia, except those belonging to a group called sulphonylurea (moderate risk) and insulin (high risk). The use of two or more oral glucose lowering medications increase the risk of hypoglycaemia.
Hypoglycaemia can have disastrous results for heavy machinery operators, construction workers and drivers of public and heavy-duty transport vehicles to name just a few.
Side Effects
Side effects associated with diabetes medications vary depending on the class of medication. It is important that individuals on treatment be informed about expected side effects as this may affect adherence. Common side effects associated with diabetes medication include nausea, stomach disturbance, yeast infections, and urinary tract infections.
Cost
Affordability is another important factor to consider when choosing medication. Several studies have shown that medication affordability plays a major role in diabetes treatment non- adherence. Some individuals living with diabetes have been known to ration their medication to make them last longer.
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