‘Personalized medicine’ in DM care

Can improve morbidity, mortality, QOL in diabetics

Individualizing treatment and administering “personalized medicine that can improve long-term outcomes, are key factors to improve medical care of patients with type 2 diabetes mellitus (DM).

This was the key message in a plenary lecture delivered by Dr. Pavel Hamet of the Universite de Montreal, during the 30th annual convention of Diabetes Philippines recently at Shangri-La Edsa Hotel. Dr. Hamet was the keynote lecturer invited for the Dr. Augusto Litonjua Endowed Lecture.

Chronic kidney disease (CKD) has been extensively discussed during the convention as one of the complications of type 2 DM that can adversely affect morbidity, mortality and the patients’ quality of life (QOL).

“The impact of high sugar and high blood pressure can damage the kidneys. If one has high blood sugar, it can result to thick blood which also puts pressure on the arteries and makes the heart work harder,” said Dr. Hamet.

Dr. Hamet pointed out that to prevent CKD and other complications, there is a need to produce medicines that are personalized and can cure the disease. “We propose that the development of personalized medicine tool, using genomic determinates in addition to clinical ones will provide an additional needed improvement of morbidity/mortality and quality of life to our patients,” said Dr. Hamet, who gave a lecture on discussed “Fighting Renal Impairment in Diabetes: Tools of Today and Tomorrow.”

Dr. Hamet explained that complications of type 2 DM can be prevented by the appropriate control of both blood pressure and blood glucose as seen in the Action in Diabetes and Vascular disease: PreterAx and DiamicroN-MR Controlled Evaluation (ADVANCE) study wherein there was a risk reduction of 28 percent in renal events, 24 percent in cardiovascular death, and 18 percent in all-cause mortality after 4.3 years.

He also mentioned that two other studies – Action to Control Cardiovascular Risk in Diabetes (ACCORD) and the Veterans Affairs Diabetes (VADT) also showed reduction of renal complications caused by type 2 diabetes.

Blood glucose control in the ADVANCE study demonstrated a reduced risk of 65 percent in ESRD, 9 percent in microalbuminuria, and 30 percent in macroalbuminuria.

Meanwhile, the “Dr. Ricardo E. Fernando Endowed Lectureship” was presented by Dr. Agnes D. Mejia who discussed the “CVD-CKD: Stop the Vicious Cycle.”

“Metabolic syndrome is associated with a high prevalence of CKD that increases with more components of the syndrome. Even morbid obesity, known to result in obesity-related glomerulopathy, results in reduction in renal plasma flow (RPF) and glomerular filtration rate (GFR) both of which improve with weight reduction,” said Dr. Mejia.

To stop the vicious cycle, patients should look into the three factors: metabolic syndrome, family history, and national health programs.

The convention, with the theme: “Forging an Alliance to Stop Diabetes” brought together experts on the field who shared latest studies on diabetes and its effects on the body. Alexa Villano

VitalSigns Issue 59 Vol. 3, January 1-31, 2014