Drugs alone are not the best treatment for type 2 diabetes

DEAR DR. ROACH: My husband is a truck driver and he is 68 years old. He’s been taking metformin for a long time and I’ve read that this drug doesn’t help lower blood sugar. He also uses human insulin twice a day.

What I want to know is is there a better medicine for him? I think he is gaining weight due to insulin resistance, as he has a bigger belly, and his GP doesn’t seem to care about the issue, even though I brought it to his attention. — Anon.

ANSWER: Metformin is considered the best initial treatment for most people with type 2 diabetes, due to its long history and excellent safety profile. There are also a large number of studies that have found that long-term results are better for people taking metformin than they were with other drugs that were available at the time the studies were done. It is true that metformin by itself is unlikely to cause an excessive drop in blood sugar, but it certainly reduces high blood sugar very well. Unfortunately, on its own, it is often not enough to control blood sugar.

Medication alone is not the best treatment for type 2 diabetes. Regular exercise and a healthy diet are essential parts of a diabetes treatment plan. When that’s not enough (and it’s very difficult for professional drivers to exercise regularly), many diabetes experts will now choose another type of medication, when previously insulin was the best option. .

I’m worried about insulin in a truck driver because it can lower blood sugar. Another problem with insulin (and drugs that cause the body to release more insulin, such as glyburide) is that they tend to worsen insulin resistance and promote weight gain (especially around the belly, where it is most associated with heart disease).

Although we have drugs that act directly on insulin resistance, drugs in the GLP-1 agonist class (such as liraglutide and semaglutide) have been shown to reduce the risk of heart disease in high risk people. These also promote weight loss, but the main thing is that they protect against serious complications.

I certainly don’t have enough information to recommend any particular drug to him, but getting a second opinion from a diabetes expert is a prudent step at this point, in my opinion.

DEAR DR. ROACH: I am a 76 year old female and have suffered from alopecia since I was 5 years old. I also take Synthroid. When I was getting one of my COVID shots, I was asked if I had an autoimmune disease. I said I had no idea. Later I heard that alopecia was an autoimmune disease, instead of the usual saying: “No hair, no reason, no cure”. My questions are: how do I know if this is the case? And why was it important to know then? –LJK

ANSWER: Alopecia is a general term for hair loss, and several types of alopecia are considered to be autoimmune in nature, with the body’s immune system attacking cells that grow hair. Most cases of thyroid disease are also autoimmune. People with an autoimmune disease are at a higher risk for others.

The COVID vaccine may be less effective in some people with autoimmune diseases when they take drugs to suppress the immune system. In addition, when vaccines were scarce, people with immune system diseases were given higher priority for vaccination. Now, however, there’s no reason for you to take the COVID vaccine any differently than others.

Dr Roach regrets that he cannot respond to individual letters, but will incorporate them into the column whenever possible. Readers can send questions to ToYourGoodHealth@med.cornell.edu or mail to 628 Virginia Dr., Orlando, FL

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