Advancements In The Treatment for Type II Diabetes
Many people have Type II diabetes but there are several new advances in their treatment. Dr. Yan Russell discusses these new advancements, the possible benefits, and more.
Featured Speaker:
Yan Russell, MD
Dr. Russell is a board-certified endocrinologist. She received her medical degree from Capital University of Medical Sciences. She completed her internal medicine residency training at NYU Brooklyn and endocrinology fellowship at SUNY Downstate Medical Center. Dr. Russell specialized in diabetes and thyroid disorders. Transcription:
Advancements In The Treatment for Type II Diabetes
Joey Wahler (Host): Many people have type 2 diabetes, but there is several new advances in its treatment. So, we're discussing what those are. Our guest, Dr. Yan Russell. She's an endocrinologist with Jamaica Hospital.
This is Jamaica Hospital Med Talk, a podcast from Jamaica Hospital. Thanks for listening. I'm Joey Wahler. Hi, Dr. Russell. Thanks for joining us.
Dr. Yan Russell: Hi, Joey. Thanks for having.
Host: Absolutely. So first, what's the basic difference between type 1 and 2 diabetes? And then, we'll talk about how common it is for people to have type 2 diabetes.
Dr. Yan Russell: Okay. Traditionally, diabetes is divided it into two types, type 1 and type 2 diabetes. And classically, type 1 diabetes is what we see most commonly in children and younger adults with lean body mass. The etiology of the type 1 diabetes is really absolute insufficiency of insulin. Type 2 diabetes, we're seeing more common in the older adults where they're more obese and they have more what we call the insulin resistance. So, their body is trying hard to make more insulin to compensate the body mass index and creating a relative deficiency of insulin.
Host: Gotcha. And so that being said, how common is type 2 diabetes in the country?
Dr. Yan Russell: So, per the most recent CDC report in the year 2022, more than 130 million adults in America have diabetes or pre-diabetes. And there were about 1.4 million new adult diabetes cases in the year 2019. And these are really big numbers. It's about one-third of the population of the US.
Host: Wow. Big to say the least. From your experience, how much of that is due to what's controllable by us, like diet, of course?
Dr. Yan Russell: I would like to discuss the risk factors to developing diabetes and the number one risk factor is overweight or obesity. And following that is physical inactivity. Most of us these days are not as physically active as we were before. Older age, age of 45 years or older and history of gestational diabetes for women, or history of pre-diabetes and family history of diabetes, these are all contributors to developing diabetes.
Host: So, certainly genetics is part of it, right?
Dr. Yan Russell: That's correct.
Host: But diet is a huge factor. And so, it sounds like many people that have type 2 diabetes, they really don't necessarily have to have been in that situation had they been able to alter certain things about their lifestyle, yes?
Dr. Yan Russell: That's correct. Eating smarter and getting involved more physically with exercise, keeping yourself in shape will really help prevent the development of diabetes.
Host: So, you mentioned one difference between diabetes 1 and 2 is age. One affecting younger people and the other as we get older, type 2. So, around what age range typically will type 2 diabetes become a factor?
Dr. Yan Russell: It's becoming more and more of a trend now that we're seeing more and more younger people with type 2 diabetes. But I will say over the age of 45 is definitely a set point where people will start seeing diabetes coming out. And this is all because of the obesity pandemic of the country right now.
Host: And so when you say the trend is that younger people are getting it, is that, again, as we've been mentioning, because people's eating habits are not just getting worse but getting worse at a younger age?
Dr. Yan Russell: That's correct. I would say it is all about lifestyle choices.
Host: So, we mentioned we're talking advances in treatment for type 2 diabetes, and let's start with something called continuous glucose monitoring, known as CGM. How do these devices work and what are the benefits compared to other monitoring?
Dr. Yan Russell: So, CGM stands for continuous glucose monitoring. This is a very small sensor underneath the skin. It takes glucose measurement day and night. The glucose readings then get transmitted to a compatible device, such as a smartphone or a reader, where the patient can read their glucose numbers in real time. Comparing with the traditional glucometer method, CGM requires no fingersticks.
Host: And how often is the information it's providing updated?
Dr. Yan Russell: CGM checks sugars basically on a continuous basis at very frequent intervals as frequently as every five minutes. So therefore, it provides a very dynamic change of your glucose profile over the entire day.
Host: Wow. And you mentioned that it's compatible with a smartphone as is just about everything else in our lives these days, right?
Dr. Yan Russell: That's correct. A lot of my patients use their personal cell phone to view their CGM data, and then you can actually invite up to five people to follow your CGM or your sugar readings throughout the day. So, these people can remind you about taking medications, making better choices of your lifestyle as well.
Host: So, that's better, for instance, for older people who maybe are having memory issues, stuff like that, yes?
Dr. Yan Russell: And also, for younger kids as well.
Host: Gotcha. Sure. Absolutely. And you mentioned the no fingersticking with this approach, and so I would imagine a lot of patients are definitely in favor of that, right?
Dr. Yan Russell: Absolutely. So you heard it right, no more fingersticks to me. I think that's got to be the worst part of glucose control. Before CGM, the patient really literally had to prick themselves in the finger to test blood sugar levels at least four times a day. And this is really, really not easy.
Host: So switching gears, a new type 2 diabetes medication is GLP-1. So, what are its advantages? And that's an injection, right?
Dr. Yan Russell: That's correct. So, GLP-1 stands for glucagon-like peptide-1 receptor agonist. So, GLP-1 s is not insulin, though some of these medications are injectables. This is a common misunderstanding between the patients and the provider. These medications are not insulin because a lot of people have fear to getting onto the insulin. It is a class of medication that improves sugar level by the following three mechanisms: so it helps the pancreas secrete more insulin after a meal, that's number one; number two, it delays the emptying of the food from the stomach to the gut; number three, it decreases the release of glucose from the liver to the bloodstream. Many of the GLP-1s require only one injection per week.
Host: One injection per week as opposed to what otherwise?
Dr. Yan Russell: Well, insulin for instance, require either one injection a day or up to four injections a day.
Host: So, clearly a drastic difference between those two.
Dr. Yan Russell: That's correct because it's taken only once a week. It reduces the medication burden for our patient. And this results in greatly improved compliance, as compliance is a very big issue with a largely self-managed chronic disease like diabetes. But it also provides a very powerful reduction of A1c.
Host: Now, what about the connection between the GLP-1 usage and weight loss, and why is that so important for type 2 diabetics?
Dr. Yan Russell: Weight loss is very, very important for us treating diabetes and not only improves the physical fitness. Patients will feel better about themselves, but it also decreases the overall insulin resistance. Therefore, the dosage of the insulin can be reduced. The number of pills, ones we need to take for diabetes, can also come down as well. Therefore, I think it's better quality for the life of our patients.
Host: Gotcha. How about something known as an SGLT-2 inhibitor? How does that work and what would you say the benefits there are compared to, say, the GLP-1 we just discussed? Boy, you've got to be familiar with a lot of acronyms to get through endocrinology, don't you, doc?
Dr. Yan Russell: You're right. So, SGLT-2 inhibitors are a class of oral medications. So, it's not injectable. It stands for sodium glucose co-transporter 2 inhibitor. This class of medication improves sugar by working on the kidneys, promoting the excretion or removal of excess glucose through the urine. There are several of these medications, and they're all oral medications to be taken one a day.
Host: And are there any patients in particular based on condition that this is most recommended for?
Dr. Yan Russell: Yes. So in addition to lowering the blood sugar, these medication have proven benefit to lower the risk of future heart attack, stroke or cardiovascular death in patients with type 2 diabetes and established cardiovascular disease, and they're also used to treat chronic kidney disease in patients with type 2 diabetes. As we know, chronic kidney disease is one of the complications of diabetes. So, the SGLT-2 inhibitors slow down the progression of kidney disease and help preserve kidney function over time. They provide some weight loss benefit and help lower blood pressure as well.
Host: A couple of other things, what about potential side effects that are noteworthy for any of the treatments we just covered?
Dr. Yan Russell: I'm glad you bring that up. To be sure, every medication has its own adverse side effects and the contraindications. Discussion with the providers is required prior to the initiation of this medication. Our endocrine team is happy to discuss the indications and potential side effects of these medication with our patients. Just give us a call.
Host: And so in summary, you led me perfectly into my final question, which is since there are various options as we've talked about, what's your best advice about those seeking a new treatment for type 2 diabetes? Obviously, reaching out to a physician such as yourself and your department, that would be job one, right?
Dr. Yan Russell: Yeah, I think diabetes management is largely self-care. But I think getting an expert opinion and having a discussion with an endocrinologist specialized in diabetes treatment will be a very important step. We will like to discuss this medication and the side effect with you, so that both party, both you and the providers understand the medication and we know what to expect in the long run.
Host: So basically, details on what side effects to be aware of are best discussed with an individual patient because it varies depending upon their condition.
Dr. Yan Russell: That's correct.
Host: Well, folks, we trust you're now more familiar with treatment advances for type 2 diabetes. Dr. Yan Russell, thanks so much again.
Dr. Yan Russell: Thank you for having me.
Host: And to schedule an appointment as we discussed at Jamaica Hospital, please call 718-206-7001. Again, that's 718-206-7001. For more information about the services Jamaica Hospital offers, please visit jamaicahospital.org/podcasts. Again, jamaicahospital.org/podcasts. Now, if you found this podcast helpful, please share it on your social media.
And a reminder, all content of this podcast is intended for general information purposes only, not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions discussed on this podcast. Hoping your health is good health, I'm Joey Wahler.
Advancements In The Treatment for Type II Diabetes
Joey Wahler (Host): Many people have type 2 diabetes, but there is several new advances in its treatment. So, we're discussing what those are. Our guest, Dr. Yan Russell. She's an endocrinologist with Jamaica Hospital.
This is Jamaica Hospital Med Talk, a podcast from Jamaica Hospital. Thanks for listening. I'm Joey Wahler. Hi, Dr. Russell. Thanks for joining us.
Dr. Yan Russell: Hi, Joey. Thanks for having.
Host: Absolutely. So first, what's the basic difference between type 1 and 2 diabetes? And then, we'll talk about how common it is for people to have type 2 diabetes.
Dr. Yan Russell: Okay. Traditionally, diabetes is divided it into two types, type 1 and type 2 diabetes. And classically, type 1 diabetes is what we see most commonly in children and younger adults with lean body mass. The etiology of the type 1 diabetes is really absolute insufficiency of insulin. Type 2 diabetes, we're seeing more common in the older adults where they're more obese and they have more what we call the insulin resistance. So, their body is trying hard to make more insulin to compensate the body mass index and creating a relative deficiency of insulin.
Host: Gotcha. And so that being said, how common is type 2 diabetes in the country?
Dr. Yan Russell: So, per the most recent CDC report in the year 2022, more than 130 million adults in America have diabetes or pre-diabetes. And there were about 1.4 million new adult diabetes cases in the year 2019. And these are really big numbers. It's about one-third of the population of the US.
Host: Wow. Big to say the least. From your experience, how much of that is due to what's controllable by us, like diet, of course?
Dr. Yan Russell: I would like to discuss the risk factors to developing diabetes and the number one risk factor is overweight or obesity. And following that is physical inactivity. Most of us these days are not as physically active as we were before. Older age, age of 45 years or older and history of gestational diabetes for women, or history of pre-diabetes and family history of diabetes, these are all contributors to developing diabetes.
Host: So, certainly genetics is part of it, right?
Dr. Yan Russell: That's correct.
Host: But diet is a huge factor. And so, it sounds like many people that have type 2 diabetes, they really don't necessarily have to have been in that situation had they been able to alter certain things about their lifestyle, yes?
Dr. Yan Russell: That's correct. Eating smarter and getting involved more physically with exercise, keeping yourself in shape will really help prevent the development of diabetes.
Host: So, you mentioned one difference between diabetes 1 and 2 is age. One affecting younger people and the other as we get older, type 2. So, around what age range typically will type 2 diabetes become a factor?
Dr. Yan Russell: It's becoming more and more of a trend now that we're seeing more and more younger people with type 2 diabetes. But I will say over the age of 45 is definitely a set point where people will start seeing diabetes coming out. And this is all because of the obesity pandemic of the country right now.
Host: And so when you say the trend is that younger people are getting it, is that, again, as we've been mentioning, because people's eating habits are not just getting worse but getting worse at a younger age?
Dr. Yan Russell: That's correct. I would say it is all about lifestyle choices.
Host: So, we mentioned we're talking advances in treatment for type 2 diabetes, and let's start with something called continuous glucose monitoring, known as CGM. How do these devices work and what are the benefits compared to other monitoring?
Dr. Yan Russell: So, CGM stands for continuous glucose monitoring. This is a very small sensor underneath the skin. It takes glucose measurement day and night. The glucose readings then get transmitted to a compatible device, such as a smartphone or a reader, where the patient can read their glucose numbers in real time. Comparing with the traditional glucometer method, CGM requires no fingersticks.
Host: And how often is the information it's providing updated?
Dr. Yan Russell: CGM checks sugars basically on a continuous basis at very frequent intervals as frequently as every five minutes. So therefore, it provides a very dynamic change of your glucose profile over the entire day.
Host: Wow. And you mentioned that it's compatible with a smartphone as is just about everything else in our lives these days, right?
Dr. Yan Russell: That's correct. A lot of my patients use their personal cell phone to view their CGM data, and then you can actually invite up to five people to follow your CGM or your sugar readings throughout the day. So, these people can remind you about taking medications, making better choices of your lifestyle as well.
Host: So, that's better, for instance, for older people who maybe are having memory issues, stuff like that, yes?
Dr. Yan Russell: And also, for younger kids as well.
Host: Gotcha. Sure. Absolutely. And you mentioned the no fingersticking with this approach, and so I would imagine a lot of patients are definitely in favor of that, right?
Dr. Yan Russell: Absolutely. So you heard it right, no more fingersticks to me. I think that's got to be the worst part of glucose control. Before CGM, the patient really literally had to prick themselves in the finger to test blood sugar levels at least four times a day. And this is really, really not easy.
Host: So switching gears, a new type 2 diabetes medication is GLP-1. So, what are its advantages? And that's an injection, right?
Dr. Yan Russell: That's correct. So, GLP-1 stands for glucagon-like peptide-1 receptor agonist. So, GLP-1 s is not insulin, though some of these medications are injectables. This is a common misunderstanding between the patients and the provider. These medications are not insulin because a lot of people have fear to getting onto the insulin. It is a class of medication that improves sugar level by the following three mechanisms: so it helps the pancreas secrete more insulin after a meal, that's number one; number two, it delays the emptying of the food from the stomach to the gut; number three, it decreases the release of glucose from the liver to the bloodstream. Many of the GLP-1s require only one injection per week.
Host: One injection per week as opposed to what otherwise?
Dr. Yan Russell: Well, insulin for instance, require either one injection a day or up to four injections a day.
Host: So, clearly a drastic difference between those two.
Dr. Yan Russell: That's correct because it's taken only once a week. It reduces the medication burden for our patient. And this results in greatly improved compliance, as compliance is a very big issue with a largely self-managed chronic disease like diabetes. But it also provides a very powerful reduction of A1c.
Host: Now, what about the connection between the GLP-1 usage and weight loss, and why is that so important for type 2 diabetics?
Dr. Yan Russell: Weight loss is very, very important for us treating diabetes and not only improves the physical fitness. Patients will feel better about themselves, but it also decreases the overall insulin resistance. Therefore, the dosage of the insulin can be reduced. The number of pills, ones we need to take for diabetes, can also come down as well. Therefore, I think it's better quality for the life of our patients.
Host: Gotcha. How about something known as an SGLT-2 inhibitor? How does that work and what would you say the benefits there are compared to, say, the GLP-1 we just discussed? Boy, you've got to be familiar with a lot of acronyms to get through endocrinology, don't you, doc?
Dr. Yan Russell: You're right. So, SGLT-2 inhibitors are a class of oral medications. So, it's not injectable. It stands for sodium glucose co-transporter 2 inhibitor. This class of medication improves sugar by working on the kidneys, promoting the excretion or removal of excess glucose through the urine. There are several of these medications, and they're all oral medications to be taken one a day.
Host: And are there any patients in particular based on condition that this is most recommended for?
Dr. Yan Russell: Yes. So in addition to lowering the blood sugar, these medication have proven benefit to lower the risk of future heart attack, stroke or cardiovascular death in patients with type 2 diabetes and established cardiovascular disease, and they're also used to treat chronic kidney disease in patients with type 2 diabetes. As we know, chronic kidney disease is one of the complications of diabetes. So, the SGLT-2 inhibitors slow down the progression of kidney disease and help preserve kidney function over time. They provide some weight loss benefit and help lower blood pressure as well.
Host: A couple of other things, what about potential side effects that are noteworthy for any of the treatments we just covered?
Dr. Yan Russell: I'm glad you bring that up. To be sure, every medication has its own adverse side effects and the contraindications. Discussion with the providers is required prior to the initiation of this medication. Our endocrine team is happy to discuss the indications and potential side effects of these medication with our patients. Just give us a call.
Host: And so in summary, you led me perfectly into my final question, which is since there are various options as we've talked about, what's your best advice about those seeking a new treatment for type 2 diabetes? Obviously, reaching out to a physician such as yourself and your department, that would be job one, right?
Dr. Yan Russell: Yeah, I think diabetes management is largely self-care. But I think getting an expert opinion and having a discussion with an endocrinologist specialized in diabetes treatment will be a very important step. We will like to discuss this medication and the side effect with you, so that both party, both you and the providers understand the medication and we know what to expect in the long run.
Host: So basically, details on what side effects to be aware of are best discussed with an individual patient because it varies depending upon their condition.
Dr. Yan Russell: That's correct.
Host: Well, folks, we trust you're now more familiar with treatment advances for type 2 diabetes. Dr. Yan Russell, thanks so much again.
Dr. Yan Russell: Thank you for having me.
Host: And to schedule an appointment as we discussed at Jamaica Hospital, please call 718-206-7001. Again, that's 718-206-7001. For more information about the services Jamaica Hospital offers, please visit jamaicahospital.org/podcasts. Again, jamaicahospital.org/podcasts. Now, if you found this podcast helpful, please share it on your social media.
And a reminder, all content of this podcast is intended for general information purposes only, not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions discussed on this podcast. Hoping your health is good health, I'm Joey Wahler.