Fit & Proper: If you are diabetic, take care of your heart

Jaynish (name changed), a 38-year-old investment banker, was diagnosed with diabetes four years ago. Due to his failure to respond to three oral antidiabetic drugs, he was prescribed four shots of insulin a day and was on these for over a year. In the past year, he complained of shortness of breath on exertion and swelling around the ankles. He was diagnosed with heart disease and was immediately started on medications for high blood pressure and cholesterol. Though he made major changes in his lifestyle, which improved his glucose control, the insulin shots continued to interfere with his professional and personal life.

Heart disease is the No 1 cause of death among people with Type 2 diabetes. There is also striking evidence that diabetes is related to obesity. Among Indians, particularly, the problem of central obesity, or fat deposition around the stomach area, is high. This central obesity is largely responsible for poor glucose control and also has a direct link to heart disease.

Initially, diabetes treatment was only about controlling elevated glucose levels, but now the treatment options look beyond glucose control. The most recent class of drugs approved and now available in India affect multiple factors associated with diabetes.

Jaynish's doctor, for example, prescribed him a new antidiabetic drug called empagliflozin. This drug belongs to a new class of antidiabetic drugs that have a unique mechanism of action. They throw out glucose (sugar) in the urine, bringing about a rapid reduction in blood glucose. At the same time, they bring about a small but significant reduction in weight and help control the blood pressure better. Jaynish's physician has now been able to reduce his insulin dose, helping him maintain good glucose control by relying on only oral antidiabetic tablets.

There was no solution for this until the recent advanced diabetes treatment solution substantiated by the EMPA study that is acknowledged by leading diabetologists and cardiologists.

Manoj Chadha
Consultant endocrinologist, PD Hinduja Hospital & Medical Research Centre, Mahim, Mumbai