Javier Delgado and Javier Ena Muñoz.
The vascular and arrhythmia risk associated with hypoglycemia can be reduced in patients with diabetes thanks to advances in glucose monitoring, the new insulins and the safety provided by the latest drugs. This is how blunt Javier Ena Muñoz, attached to the Internal Medicine Service of the Marina Baixa Hospital (Villajoyosa, Alicante), has shown himself during his presentation at the XVI meeting of the Diabetes, Obesity and Nutrition working group of the Spanish Society of Internal Medicine (SEMI).
“We have tools to improve the prognosis of diabetic disease with greater security and this should try spread to the entire population. We have better tools for treatment, diagnosis and prevention, and they should be used in the majority of patients with diabetes”, claims Ena Muñoz.
A claim that arises from the “lag” between the advances produced and the prescription that many health professionals make in their clinical day-to-day. “We are still waiting for its use to become generalized because the penetration in the prescription is still improvable. There are many patients who would benefit from these drugs, but they are with the old ones, which control glucose, but do not reduce mortality”, details the internist.
A great “advancement” in hypoglycemia in the last 5 years
According to the diabetes expert, the panorama has changed radically in the last five years thanks to the possibility of monitoring, new insulins and drugs. “The new drugs are safer because reduce the risk of hypoglycemia and improve prognosis with fewer myocardial infarctions, cardiovascular accidents and sudden deaths”, explains Ena Muñoz.
The internist defines hypoglycemia as the “most feared” side effect of diabetes treatment because it “greatly affects” the patient’s quality of life and because it consumes a lot of healthcare resources. “There are many absences from work due to hypoglycemia and, above all, if they have to go to the hospital and it also affects adherence to the treatment that treats their diabetes. Therefore, they are an adverse effect that should be prevented”.
For this prevention, Ena Muñoz highlights the appearance of new drugs that are very active in lowering glucose levels and that have a much lower risk of hypoglycemia than those known until now, such as human insulins and sulfonylureas. “These have remained relegated to the background due to the risk of hypoglycemia”, claims the internist.
Hypoglycemia is common in type 1 and type 2 diabetic patients with multiple doses of insulin. However, these have decreased markedly thanks to advances in treatment. “The news third generation insulins they are still better than insulin analogs. It has been a very important advance to reduce the risk”, assures the specialist.
Prevent arrhythmias with telemonitoring
One of the effects of hypoglycemia is QT prolongation on the electrocardiogram. “These patients have risk of having a serious circular arrhythmia with tachycardia or joint fibrillation. This can trigger sudden death, which is why it is so important to prevent hypoglycemia”, explains Ena Muñoz.
As detailed by the internist, the risk of suffering from this is greater in patients who have hypoglycemia frequently, since they stop having a response from the body to it. So they are in risk of developing an arrhythmia without having had previous symptoms of hypoglycemia.
“Currently, for these type I diabetes patients who are at special risk, there is acontinuous monitoring system of glucose. This allows, through a device that is placed on the skin and with an associated app, to control hypoglycemia at all times. It has been a great advance”, details the specialist, who assures that patients who use this continuous monitoring tool very frequently (more than 30 times a day) have better glycemic control and a great reduction in the time of hypoglycemia and its frequency. .
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