In an interview with EFEsaludhe Head of Section of the Endocrinology and Nutrition Service of the University Clinical Hospital of Valenciareviews the current situation of diabetes, the revolutionary treatments and insists on the importance of preventing the disease so that it does not penalize our lives.
The new president of the SED, for the next two years, emphasizes that new drugs for people with diabetes who are obese, such as ozempic -funded for patients with type 2 diabetes and obesity-, have an “impressive” impact on weight reduction and help prevent cardiovascular disease and slow the progress of kidney disease.
But he warns that Drugs cannot be administered if a healthy life plan is not followed, something that, he assures, is not being given enough emphasis in “many clinics.” Consider, also, that no doctor should prescribe ozempic to lose weight to a person who does not have diabetes, since there are other alternatives available that do have that indication without the requirement of having that disease.
What challenges do you have ahead of you as president of the SED?
I would like to put diabetes in Spain at the international level it deserves. We have good connections, especially with related societies in Latin America, but not so much with European ones and the United States and Canada. Also promote the exchange of young researchers.
And make the SED’s activities much more dynamic and strengthen the relationships we have with patients, who are the reason for our activity. They have a series of needs that are not covered and it is necessary, in collaboration with them, to address them with the responsible authorities.
Finally we have a group in the SED, which are diabetes educators. They are nursing professionals who, at an official level, are not sufficiently recognized.
Where is the focus being placed to address type 1 diabetes?
There are several important things. On the one hand there are automatic insulin administration systems, which help a lot but are expensive. An important focus is how a health system can address it.
We are missing an important decision from the health authorities, because, at this moment, it is not very regulated and there is a lot of inequity in access.
Another important issue is the advances in new insulins. Soon we will have them for weekly administration, which will be a great advantage for type 1 and type 2 patients.
And for type 2 diabetes?
In type 2 diabetes, the outlook and the way we treat it has changed considerably in the last ten years with the appearance of new drugs, which show that they help prevent cardiovascular disease and slow the progression of kidney disease.
New products are coming out for the treatment, especially of obese patients with type 2 diabetes, and I think this is the field we are playing in now. These drugs and their impressive impact on weight reduction and how by reducing this we improve or delay the progression of the disease and improve patient expectations.
Has the progression of type 2 diabetes increased in recent years?
The estimated prevalence in Spain is 13.8% of people over 18 years of age. I always say the same thing, that the best treatment is to prevent it from appearing, to prevent it. Our society, our system, the media have to consider communicating this in another way.
We must act from Primary Care, with important measures to prevent diabetes, especially in terms of diet and physical exercise; and be aware that if one does not do that, one can really have diseases that can penalize one’s entire life.
How can the population be made aware of the importance of preventing diabetes?
We are in a world where things are almost given to us and we don’t realize it, for example, with fast food. And then television, applications… advertising, in general, often does not favor the practice of exercise.
I think we have to be very aware that these types of actions to prevent diabetes must be a priority for our authorities at all levels.
We talk a lot about the Mediterranean diet, which is famous and great, but many people don’t do it. The prevalence of obesity in adolescents has grown considerably and we are somewhat on par with what is happening in the United States, and that is a big problem.
Is the prevalence in childhood of concern?
A lot. I think we have to do more things. We have to do more things with related societies, such as the Spanish Obesity Society or the Spanish Society of Pediatric Endocrinology and the Society of Endocrinology and Nutrition.
And, above all, work with health managers, who also want to do things well, but often do not focus resources as they should.
The pandemic has put our health system to the limit and Primary Care has been completely overwhelmed. We must support them more and I think that, at the population level, there are not enough campaigns in this regard.
Diabetes and obesity have an inevitable relationship…
It is the key point. We have always known it, but we have not had the tools we have now. By reducing obesity, we improve the health of beta cells – those that secrete insulin, which maintains blood glucose levels – and therefore preserve their functionality, so that patients do not need more complex treatments, including , insulin.
On the other hand, we also have a direct impact on cardiovascular complications and other cardiovascular risk factors. If you lose weight, blood pressure improves; It decreases renal hyperfiltration and, therefore, prevents the progression of kidney disease.
It is a key and very important issue.
How does the fact that 13.8% of the adult population has type 2 diabetes affect the health system?
It is one of the diseases with the greatest health impact, since it accompanies many of the classic complications. For example, if a patient with diabetes reaches end-stage kidney disease, she needs dialysis. Or if you need non-traumatic amputation as a result of diabetes, it generates an expense that is multiplied by ten.
I honestly believe that the Administration is not paying the attention that it should be given to prevent diabetes.
Now focusing on the drugs that have revolutionized the treatment of diabetes and obesity, the GLP-1 antagonists, whose discoverers have been recognized with the Princess of Asturias Award for Scientific Research. Are they miracle drugs?
You don’t have to approach it like that. What we are discovering is that gastrointestinal hormones and especially GLP 1, but also glucagon, among others, have a very important role in regulating appetite. It is not that they are miracle drugs, but that we are beginning to understand how appetite is regulated and how this logically influences, let’s say, weight loss and its maintenance.
If before we thought that the only solution for an obese patient who had reached a point of extreme obesity was bariatric surgery, which reduced weight by 30%, with these drugs the loss is up to 25%.
This boom in drugs for people who do not have diabetes but want to lose weight has caused a shortage that affects patients. What is the magnitude of the problem?
We have had serious problems but no one thought that these drugs would have such a significant impact, to the point that people are even willing to pay for them out of pocket, and they are not cheap at all.
Novo Nordisk (pharmaceutical responsible for Ozempic) I think realized this issue. We have had serious problems because many patients who were prescribed it have not achieved it and have had to resort to other formulations.
The pharmaceutical company has worked on another indicated for obesity, without the patient having to have diabetes, called Wegovy and already authorized in Spain (without financing). Therefore, as of today, No professional should prescribe Ozempic to any patient who does not have diabetes. associated with obesity.
I think it is an obligation for all of us and it is a commitment that we must make. That’s what Wegovy is for and we will have more products in the future.
Are obese patients clear that the drug is not enough but that they must continue a healthy life?
What I am observing is that, unfortunately, in many clinics there is not enough emphasis or, at least, the patients do not have prior training with diet and exercise to demonstrate how important it is to structure the diet and eat properly.
If you do not do this beforehand and you really let yourself be carried away by the fact that a patient wants the drug per se to lose weight, but without having previously treated the other, I think it is a failure, because the moment they stop the medication , he’s going to gain weight.
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