Diabetes Type 2 Support Group
Type 2 Diabetes is a condition in which the body either does not produce enough insulin or does not make efficient use of it. Insulin is a hormone needed to convert food into glucose, a sugar that the body uses for energy. Without enough insulin, glucose can accumulate in the blood, and can cause serious health problems such as heart disease and strokes and organ damage...
The future of treating Type 2 diabetes
We now know that the problem in type 2 diabetes relates to high fat levels in the pancreas and the liver. When calorie intake is sharply decreased - either by a diet, or by weight loss surgery - the fat levels in these organs decreases and it has been shown that the function of the pancreas and liver returns to normal.
The diagnosis of type 2 diabetes may in future be regarded as a medical emergency. The body's metabolism is being "gummed up" by excess fat in important organs. The concept of emergency surgery is familiar to all. We should become accustomed to the concept of emergency medical therapy - a very low calorie diet to achieve a drop in body weight of 15% within weeks.
Insulin was first used in the 1920s
Given that such emergency action can restore normal metabolism, further research on the best way to keep weight steady after the short period of weight loss is urgently required.
This definitive treatment for type 2 diabetes will only be possible for those who recognise the importance of escaping from the shadow of diabetes, with its risks to eyesight, limb and life. However, there will always be a need for better medical treatment which can improve high blood glucose levels, and indeed be used in people with very long duration diabetes who may be more resistant to the beneficial effects of major weight loss.
Developing new drugs
There are interesting possibilities amongst the new, and not so new, drugs on offer.
Some drugs increase the amount of glucose which is lost in the urine.
How about a single injection each week which could help the body respond more appropriately to food, and at the same time would help with weight control? This is what the so-called GLP-1 agonists do - drugs which mimic a naturally occurring gut hormone, that tell the body to produce more insulin and the brain to stop eating. These are already available, and a long-acting injection is well on its way.
Curb your blood sugar
You can also improve blood sugar levels after meals without using drugs. There are two important approaches.
Firstly, if a small, protein rich snack is taken first thing in the morning, and breakfast is delayed for two hours, the rise in blood glucose after breakfast is reduced by about one half. This is called the second meal effect and although it has been recognised in non-diabetic individuals for almost a century, it has only recently been shown to work in people with type 2 diabetes.
Secondly, if you go out for a half hour walk after a meal (or do any physical activity) then the rise in blood glucose will be very much less compared to just sitting in a chair. This is because muscle tissue takes up glucose more rapidly during exercise, and the meal time rise in glucose is blunted.
Professor Roy Taylor was Professor of Medicine and Metabolism at Newcastle University, and is now Director of the Newcastle Magnetic Resonance Centre.
More on This Story
Related Stories
What is diabetes? 19 APRIL 2013, BBC SCIENCE
We now know that the problem in type 2 diabetes relates to high fat levels in the pancreas and the liver. When calorie intake is sharply decreased - either by a diet, or by weight loss surgery - the fat levels in these organs decreases and it has been shown that the function of the pancreas and liver returns to normal.
The diagnosis of type 2 diabetes may in future be regarded as a medical emergency. The body's metabolism is being "gummed up" by excess fat in important organs. The concept of emergency surgery is familiar to all. We should become accustomed to the concept of emergency medical therapy - a very low calorie diet to achieve a drop in body weight of 15% within weeks.
Insulin was first used in the 1920s
Given that such emergency action can restore normal metabolism, further research on the best way to keep weight steady after the short period of weight loss is urgently required.
This definitive treatment for type 2 diabetes will only be possible for those who recognise the importance of escaping from the shadow of diabetes, with its risks to eyesight, limb and life. However, there will always be a need for better medical treatment which can improve high blood glucose levels, and indeed be used in people with very long duration diabetes who may be more resistant to the beneficial effects of major weight loss.
Developing new drugs
There are interesting possibilities amongst the new, and not so new, drugs on offer.
Some drugs increase the amount of glucose which is lost in the urine.
How about a single injection each week which could help the body respond more appropriately to food, and at the same time would help with weight control? This is what the so-called GLP-1 agonists do - drugs which mimic a naturally occurring gut hormone, that tell the body to produce more insulin and the brain to stop eating. These are already available, and a long-acting injection is well on its way.
Curb your blood sugar
You can also improve blood sugar levels after meals without using drugs. There are two important approaches.
Firstly, if a small, protein rich snack is taken first thing in the morning, and breakfast is delayed for two hours, the rise in blood glucose after breakfast is reduced by about one half. This is called the second meal effect and although it has been recognised in non-diabetic individuals for almost a century, it has only recently been shown to work in people with type 2 diabetes.
Secondly, if you go out for a half hour walk after a meal (or do any physical activity) then the rise in blood glucose will be very much less compared to just sitting in a chair. This is because muscle tissue takes up glucose more rapidly during exercise, and the meal time rise in glucose is blunted.
Professor Roy Taylor was Professor of Medicine and Metabolism at Newcastle University, and is now Director of the Newcastle Magnetic Resonance Centre.
Related Stories
What is diabetes? 19 APRIL 2013, BBC SCIENCE
the part about diabetes coming from too much fat in the liver and pancreas and if you go on a low calorie diet will bring these two organs back to normal functions also doesn't seem right. I personally have normal liver functions, always have, and never had a fatty liver but I still have diabetes and yes I am on meds after the first 10 years of just proper and healthy diet and exercise. then it progressed and I needed meds.
So please take articles like this with a grain of salt and always check with your doctor about trying "emergency low calorie" diets, you could end up doing more damage to your in the long run.
This is the article mentioned at the bottom - http://www.bbc.co.uk/science/0/21704103 I can't see anything in it about these 'agonists', the 'second meal effect', 'emergency medical therapy' or the other things mentioned in the article. Can you give your sources for all the facts in this post please Lostonrye?
Marsharebel - so someone online suggested something - a stranger, probably not medically qualified and certainly having no experience or knowledge of your medical history. Fair enough though, it is worth checking out. You then ask your doctor - the right thing to do, as s/he is medically qualified and has access to your medical history. They advise against it. But you still decide to take the advice of the randomer above that of your doctor? I mean, of course it is your decision. But I would be cautious myself.
About the drug research here below is some info
seems fairly independent but given most research is done by the pharmaceutical industry if you believe it is up to yourself
I only use Metfromin but as its been around for years I guess if there were any bad stuff it would be well known by now
i would advice anyone visiting these sites never to take something as gospel
Sign In|RegisterHomeNewsGet involvedAbout NICE
Find guidanceNICE PathwaysQuality standardsInto practiceQOF
Home>News>Press releases>NICE says yes to dapagliflozin for some people with type 2 diabetes in final draft guidance
News
News
Media centre
Features
NICE newsletters and alerts
Events
NICE annual conference
Guidance in Focus
Podcasts
Videocasts
Meetings held in public
NICE says yes to dapagliflozin for some people with type 2 diabetes in final draft guidance
In final draft guidance published today, NICE has recommended dapagliflozin (Forxiga, Bristol-Myers Squibb and Astra Zeneca) for some people with type 2 diabetes.
Type 2 diabetes is a long-term condition that causes a person's blood sugar level to become too high. It occurs when the body does not produce enough insulin for it to function properly, or when the body's cells do not use insulin properly. Insulin is a hormone made by the pancreas, and is central to regulating blood sugar and fat metabolism in the body.
Dapagliflozin is recommended in combination therapy with blood-sugar-lowering drug metformin as an option for treating type 2 diabetes, if it is used as described for DPP4-inhibitorsi in Type 2 diabetes: the management of type 2 diabetes (NICE clinical guideline 87). The draft guidance also recommends dapagliflozin in combination with insulin as an option for treating type 2 diabetes.
Dapagliflozin in a triple therapy regimen in combination with metformin and sulfonylurea, another blood-sugar-lowering drug, is not recommended for treating type 2 diabetes, except in the context of research as part of a clinical trial.
Professor Carole Longson, Health Technology Evaluation Centre Director at NICE said: We are pleased to recommend dapagliflozin for some people with type 2 diabetes. It is a serious problem in the UK and dapagliflozin provides another treatment option for some people with this condition.
Dapagliflozin is a sodium-glucose cotransporter-2 (SGLT-2) inhibitor that blocks the reabsorption of glucose in the kidneys and promotes excretion of excess glucose in the urine.
Following the consultation on the draft recommendations in February, NICE requested further clarification and information from the manufacturers. NICE also asked the decision support unitii to further review the economic analysis provided by the manufacturer and to perform exploratory analyses for dapagliflozin in dual therapy and as an add-on to insulin therapy.
The final draft guidance (final appraisal determination / FAD) can be found from 00:01hrs on Thursday 30 May on the NICE website
NICE has not yet issued final guidance to the NHS; these decisions may change in the event of an appeal.
Until NICE issues final guidance, NHS bodies should make decisions locally on the funding of specific treatments. Once NICE issues its guidance on a technology it replaces local recommendations across the country.
Final guidance is expected to be published in June 2013.
Ends
Notes to Editors
References
i. DPP-4 inhibitors lower blood sugar levels by blocking an enzyme known as dipeptidyl peptidase IV (DPP-4), which is responsible for breaking down the proteins that stimulate the insulin-producing cells, and slows gastric emptying time after a meal.
ii. The Decision Support Unit is commissioned by the NICE to provide a research and training resource to support the Institute's Technology Appraisal Programme. Further information on the NICE Decision Support Unit.
About the guidance
1. The final draft guidance (final appraisal determination / FAD) can be found from 00:01hrs Thursday 30 May
Embargoed copies are available on request; please contact the press office.
2. Final guidance is expected in June 2013.
3. In preliminary draft recommendations (appraisal consultation document / ACD) published in February 2013, NICE were minded not to recommend dapagliflozin in combination therapy for treating type 2 diabetes, and asked for further clarification and information from the manufacturer.
4. Dapagliflozin in a triple therapy regimen is currently being studied as an add-on to 2 other oral agents. The Committee considered that the cost-effectiveness analyses should be considered as exploratory in nature.
5. Dapagliflozin has a UK marketing authorisation in adults aged 18 years and older with type 2 diabetes mellitus to improve glycaemic control as:
monotherapy when diet and exercise alone do not provide adequate glycaemic control in patients for whom use of metformin is considered inappropriate due to intolerance
add-on combination therapy with other glucose-lowering agents including insulin, when these, together with diet and exercise, do not provide adequate glycaemic control'.
The subject of this appraisal is the add-on therapy indication.
6. The manufacturers' submission states that the cost of dapagliflozin is 36.59 for 28 5-mg or 10-mg tablets (excluding VAT). Dapagliflozin is administered orally as a single dose of 10 mg per day. Costs may vary in different settings because of negotiated procurement discounts.
7. A patient access scheme has not been submitted by the manufacturer.
8. Diabetes currently affects almost 3 million people in the UK, of which about 90% will have type 2 diabetes. This is estimated to rise to 5 million - that is, nearly 10% of the population - by 2025. (Diabetes UK).
9. Diabetes is a major risk factor for cardiovascular disease and stroke among people of working age. An estimated 850,000 people in the UK may have diabetes but don't know it and may remain undiagnosed. Many more may have blood glucose levels above the normal range, (impaired glucose regulation) but not high enough for a diabetes diagnosis. (Diabetes UK).
10. For dapagliflozin as add-on to insulin, the Committee noted that in all the analyses conducted by the DSU the estimate of the ICER for dapagliflozin compared with DPP-4 inhibitors was below 20,000 per QALY.
11. Dapagliflozin is accepted for restricted use within NHS Scotland as a treatment option of type 2 diabetes in adults aged 18 and over.
12. NICE technology appraisals apply across the NHS in England and Wales.
13. Further details on NICE technology appraisals
Related NICE guidance
Published
Exenatide prolonged-release suspension for injection in combination with oral antidiabetic therapy for the treatment of type 2 diabetes. NICE technology appraisal guidance 248 (2012).
Liraglutide for the treatment of type 2 diabetes mellitus. NICE technology appraisal guidance 203 (2010).
Type 2 diabetes: the management of type 2 diabetes (partial update of CG66). NICE clinical guideline 87 (2009).
Type 2 diabetes: the management of type 2 diabetes (partially updated by CG87). NICE clinical guideline 66 (2008).
Diabetes in pregnancy: management of diabetes and its complications from pre-conception to the postnatal period. NICE clinical guideline 63 (2008).
Continuous subcutaneous insulin infusion for the treatment of diabetes mellitus (review). NICE technology appraisal guidance 151 (2008).
Type 2 diabetes: prevention and management of foot problems. NICE clinical guideline 10 (2004).
About NICE
The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.
Formerly the National Institute for Health and Clinical Excellence, our name changed on 1 April 2013 to reflect our new and additional responsibility to develop guidance and set quality standards for social care, as outlined in the Health and Social Care Act (2012).
Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.
Our products and resources are produced for the NHS, local authorities, care providers, charities, and anyone who has a responsibility for commissioning or providing healthcare, public health or social care services.
To find out more about what we do, visit our website: www.nice.org.uk and follow us on Twitter: @NICEcomms
This page was last updated: 29 May 2013
Explore NICEEvidence SearchNICE Community
About NICE
Who we are, What we do, How we work
Get involved
Current Consultations, Join a working group
Scientific Advice Consultancy
Advice to pharmaceutical companies
Quality Initiatives
Clinical commissioning group outcomes indicator set, Quality and Outcomes Framework, NICE fellows and scholars
NICE International
NICE International Advisory group, International projects
NICE accreditation
Whats new in accreditation, accreditation decisions
Cost saving support
NICE Guidance
Find Guidance, Clinical Guidelines, Diagnostics, Interventional Procedures, Medical Technologies, Public Health, Quality Standards, Social care, Technology Appraisals
NICE Quality Standards
Published quality standards, Quality standards in development, Social care quality standards
Research and development
Research recommendations
Search, Latest recommendations
Patients and the public
Search guidance, Treatment and care, Join a working group
Other publications
Special reports and HDA publications
Social care
Support for General Practice
Resources for GPs, NICE Commissiong resources
Commissioning guides
Commissioning guides for Cardiovascular, Central nervous system, Digestive system
Putting guidance into practice
Benefits, Implementation tools, How to guides, Assessment tools, Help implement NICE Guidance ...
Education and learning
Education, Strategy, Online tools
Shared learning
Shared learning implementation guidance
Notify NICE
New and reviewed Interventional procedures
Medicines and prescribing support
Evidence summaries: new medicines, Events, Alerts
News and press
NICE press office, News and features, Press releases, Latest News
NICE Events
Annual conference, Speaking engagements, Attend a meeting
Features and rich media
Latest NICE features, Guidance in focus, Podcasts
Subscribe for alerts
NICE guidance and newsletters
Local government
Public health briefings for local government
Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions
Copyright 2013 National Institute for Health and Care Excellence. All rights reserved.