Up-to-date Prevention and Treatment of Type 2 Diabetes

Abstract

 According to the "2019 National Health and Nutrition Survey" released by the Ministry of Health, Labour and Welfare, it is estimated that, as of 2019, there are 22.51 million people aged 20 and older in Japan at risk of developing diabetes. On the other hand, the "Goals of Diabetes Treatment" set forth by the Japan Diabetes Society emphasize achieving a lifespan and quality of life (QOL) comparable to those without diabetes. This includes not only preventing the onset and progression of complications but also addressing the prevention and management of comorbidities that are increasing due to aging, as well as the removal of stigma, social disadvantages, and discrimination.

 It has been reported that the risk of cardiovascular events begins to increase from the stage of impaired glucose tolerance, even before the onset of diabetes. Moreover, good glycemic control from the early stages of diabetes not only contributes to preventing the onset and progression of complications but also reduces the risk of developing comorbidities, such as dementia. It is also reported that at the time of diagnosis of type 2 diabetes, pancreatic beta-cell function has decreased by approximately 50%. Therefore, early therapeutic intervention, while pancreatic beta-cell function remains, is believed to alleviate the decline in insulin secretion capacity and help maintain good glycemic management in the future.

 Since fiscal 2008, specific health checkups and specific health guidance have been mandatory for insured persons and dependents aged 40 to 75, aiming to prevent and detect lifestyle-related diseases early. Through early diabetes treatment, including lifestyle improvement, efforts have been made to prevent the progression of the disease. However, it is reported that only about 35% of those recommended for medical consultation due to abnormal glucose metabolism actually visit a medical institution, and the treatment discontinuation rate is approximately 8% per year. The underlying reasons are presumed to include the fact that diabetes often has no symptoms, insufficient awareness of the significance of preventing complications and comorbidities, and the negative image (stigma) associated with being diagnosed with diabetes.

 Recently, evidence has been accumulating on the effectiveness of early introduction of diabetes medications, such as SGLT2 inhibitors and GLP-1 receptor agonists, in suppressing the onset and progression of complications and comorbidities. Additionally, it has become possible to achieve high-quality glycemic control using advanced devices, such as Continuous Glucose Monitoring (CGM). If the consultation rate after health checkups improves, the potential to prevent complications and comorbidities increases, ultimately contributing to the extension of healthy life expectancy.

 This article provides an overview, from the perspective of a diabetes metabolism specialist, on the importance of early therapeutic intervention and the continuation of treatment for diabetes, with a focus on recent advancements in diabetes treatment.