Personalised therapy for diabetes is the way forward, says William T.Cefalu, editor-in-chief, Diabetes Care, an international peer-reviewed journal of the American Diabetes Association.
“We have, at our disposal, many new drugs. The thing now, is how do we personalise therapy? ” Dr. Cefalu asks. “There is no one set way to treat every patient, instead we must be treating every patient individually. Based on the duration of the disease, ability to detect hypoglycaemia [low sugar], adherence to treatment protocols, and compliance, we can work out treatment strategies for each patient, depending on his co-morbid conditions,” he tells The Hindu in an interview, during his recent brief visit to Chennai.
Dr. Cefalu, who is also Chief, Endocrinolgy, Diabetes and Metabolism, Louisiana State University Health Sciences Center, New Orleans, stresses the urgency in diagnosing the condition early. “Diabetes is a progressive disease, and pre diabetes is associated with obesity, and it is important to recognise it early. It is the complications we are concerned about: blindness, cardio vascular disease, kidney disease,” he says. It is important first and foremost because of the huge burden on society, and as far as the costs of treating diabetes goes, takes a toll on the finances and emotions of the patient and his/her family.
Dr. Cefalu was in Chennai to deliver the 21st Dr. Mohan’s Diabetes Specialties Gold Medal Oration. His advice is to professionals to go at diabetes with all guns blazing. “The evidence is pretty clear: tackling glucose control and risk factors aggressively definitely have a good effect,” he says, countering critics who accuse diabetologists of ‘over-treating’ the condition. While, at the pre-diabetes stage, it is possible to prevent progression into diabetes, it is also possible to prevent complications that can oftentimes be fatal.
Focussing on the key question of the play of environment and genes in causing diabetes, Dr. Cefalu is very clear that lifestyle does play a major role. Of late, diabetologists have noticed an increase in childhood obesity and, Type 2 diabetes among this group, he adds. “Diabetes in children may be in a little more aggressive form. What is appropriate for them? As children grow and mature, it becomes difficult assessing the right balance.” However, advocating for a healthy lifestyle – diet and packing greater activity into a day is important.
In addition to new drugs, a lot of exciting new possibilities await the future of treatment of diabetes, Dr. Cefalu says. “A lot of work is happening in the area of islet cells transplants; some procedures have been done. The other exciting area is in artificial pancreas, where there has been significant progress. Also, the questions of what we do with bariatric surgery and at what point we intervene will be decided over the next few years.”
