Diabetes

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Diabetes is a chronic disease characterised by high levels of sugar (glucose) in the blood. There are two main types, type 1 and type 2. 

Both types of diabetes require careful management to prevent complications like heart disease, kidney failure, blindness, and nerve damage.

Diabetes is a chronic disease characterised by high levels of sugar (glucose) in the blood. There are two main types:

• Type 1 Diabetes: The immune system destroys the cells in the pancreas that produce insulin, leading to an insulin deficiency.
• Type 2 Diabetes: The body becomes resistant to insulin or doesn't produce enough, leading to high blood sugar levels.

• Type 1 Diabetes: Genetic factors, autoimmune reactions, and possibly viral infections.
• Type 2 Diabetes: Genetics, obesity, poor diet, lack of physical activity, and age.

Common symptoms for both types include:

• Frequent urination
• Excessive thirst
• Extreme hunger
• Unexplained weight loss (Type 1)
• Fatigue
• Blurred vision
• Slow-healing wounds
• Tingling or numbness in hands or feet

Type 1 Diabetes

• Insulin

Type 2 Diabetes 

• Metformin 
• SGLT2 inhibitors eg dapagliflozin, empagliflozin 
• DPP-4 inhibitors eg linagliptin, sitagliptin 
• GLP-1 receptor agonists eg semaglutide, liraglutide
• Sulfonylureas eg gliclazide
• Insulin

• Metformin: nausea, diarrhoea, vitamin B12 deficiency
• SGLT2 inhibitors - urinary and genital infections, nausea, constipation
• DPP-4 inhibitors: upper respiratory infections, headache, pancreatitis
• GLP-1 receptor agonists: nausea, vomiting, pancreatitis risk
• Sulfonylureas: hypoglycaemia (low blood sugar), weight gain, skin rash
• Insulin: hypoglycemia, weight gain, injection site reactions

Approximately 422 million people worldwide have diabetes. 

In Australia, around 1.2 million people are diagnosed with diabetes, with the vast majority having Type 2.

• Dietary Changes: A balanced diet emphasizing high fibre, nutrient-dense whole foods can help manage blood sugar levels.
• Exercise: Regular physical activity can improve insulin sensitivity.
• Weight Management: Weight loss can significantly improve blood sugar control.
• Herbal Remedies: Certain herbs, such as gymnema, cinnamon and fenugreek, may have potential benefits but should be used with caution.

De-prescribing in Type 2 diabetes focuses on reducing or eliminating medications when appropriate, often in the context of lifestyle improvements or if risks outweigh benefits.

• Lifestyle Intervention Programs: Studies have shown that intensive lifestyle interventions can lead to medication reduction in Type 2 diabetes.
• Patient-Centered Care: Collaborative, individualised approaches can support de-prescribing efforts, especially in older patients with Type 2 diabetes.
  

Deprescribing in diabetes requires a nuanced, patient-centred approach, often involving a shift towards non-pharmacological management strategies like dietary changes, exercise, and weight loss. As with other chronic conditions, continuous monitoring and collaboration with healthcare providers experienced in holistic diabetes care are essential.