Changing medication: why it’s necessary to keep up-to-date

Diabetologist, Dr Paula Diab, explains the four scenarios in which changing medication is needed when treating diabetes.

Very often we get stuck in a place where we’re comfortable. We tend to stick with the same toothpaste or washing powder and go to the same restaurant for dinner. It’s good to feel comfortable but sometimes change is also good. This doesn’t mean a new set of wheels every year or trying out every restaurant in town, but it’s good to re-evaluate things from time to time.

So, why should you change your medication?

  1. Firstly, diabetes changes

It’s a little-known fact that the underlying pathogenic metabolism of Type 2 diabetes is present prior to the actual diagnosis of diabetes. What this means is that the cells in your body that produce insulin are significantly damaged even at the very start of your journey with diabetes. It’s important to remain ahead of these changes and ensure that the medication that you’re taking is constantly providing maximum benefit both in terms of managing your day-to-day health and preventing further damage and complications.

Over time, further pathological changes occur in the body which often necessitates a change in medication. Kidneys or vessels may become damaged and may require additional support or protection. These changes may occur not only because of lifestyle or dietary choices but purely due to the development of diabetes through the years. In addition, it also doesn’t make sense to continue targeting your therapy at a damaged organ. For example, as the cells in your pancreas become damaged, stimulating those cells to produce more insulin is like flogging a dead horse. Rather target a different pathway or mechanism of action.

  1. Your lifestyle may change

The most obvious example here is to compare a busy thirty-year-old working mother to a retired old lady living in an old age home where meals are provided at set times and activity is limited, not only by choice but also by physical ability. The same medication isn’t going to work for both of these people.

Some people eat erratic meals; they may eat out often, have business lunches whilst others have little to no control over their choice of food. Activities change on a daily basis and over time. The day you run a half marathon will require a different strategy from the rainy weekend you spend watching movies at home.

Sometimes our financial position and priorities in life also change. Rather than struggling with the same status quo, we may need to consider a different perspective. As we get older, our metabolism changes, our lifestyles change, and our goals change. Medication may also need to change.

  1. New medications are developed all the time

In just over two decades of managing people with diabetes, the scope of medication has almost completely changed. Some of the original medications used, no longer exist and others have been completely replaced. In fact, there is probably not one single tablet or insulin that was popular then, that is still used frequently today.

In the last two years that we have all been staying home and avoiding public events, there have been about eight new drugs developed and launched on the South African market specifically targeted for diabetes. This includes one completely new combination of medication as well as new delivery devices. Continuous glucose monitoring systems and pump therapy has changed, and closed-loop pumps are now also on the market.

These new drugs often provide an easier dosing regime, upgraded technology or an improved side effect profile. Recently, pharmaceutical companies have also been working at combining different classes of drugs so that multiple pathways can be targeted at the same time. Drugs that work synergistically not only benefit your body in that they often have a complementary side effect profile and enhance the action of the other but are also much easier to administer and reduce the burden of a box full of medication every day.

Researchers are also working on looking at additional mechanisms of treating diabetes and managing high glucose levels. Is it possible to prevent complications or even enhance the functioning of certain organs at the same time as managing your daily glucose fluctuations? There are very few other chronic diseases where the medication aims to treat daily symptoms and prevent further damage. This is exactly what we are striving for in diabetes.

  1. Protocols also change

The new South African guidelines are due to be released towards the end of this year. These will cover a range of topics that are associated with diabetes and provide expert guidance in terms of best available evidence. Although these guidelines are updated every five years, financial implications often mean that they don’t make their way into routine care. However, evidence-based, cost-effective medicine is still the ultimate goal of every healthcare provider no matter where they work or who the patient is.

Your responsibility

It’s your responsibility as a person living with diabetes, to identify key lifestyle factors that may influence your diabetes management and discuss these with your doctor.

Your doctor’s responsibility is to keep up to date with latest guidelines, evidence and protocols and to understand how the medications work.

The art of medicine is then beautifully demonstrated in the conversation that follows where doctor and patient work together to negotiate and decide on the best possible plan for that individual. A plan that is cost-effective, simple, evidence-based and will ultimately reduce the burden of diabetes.

Regular follow-up and changes to your medication shouldn’t be seen as a failure or medical authorities trying to benefit financially from the situation, but rather an opportunity to achieve a healthier and more manageable outcome. Ask your healthcare provider to assess your individual risk and situation and discuss the various alternatives with you: how the medications work, why they’re preferable and what benefit they have, and then you can make an informed decision about your health and disease management.

References available on request  

Dr Paula Diab


Dr Paula Diab is a diabetologist at Atrium Lifestyle Centre and is an extra-ordinary lecturer, Dept of Family Medicine, University of Pretoria.

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