Diabetes, what it means for patients the new scientific advancements?

Author: Dr Zanariah Hussein (consultant endocrinologist)

(THESTAR.COM) – Overweight and obesity are defined as abnormal or excessive fat accumulation that presents a risk to health. They are major risk factors for a number of chronic diseases, including diabetes and cardiovascular diseases, among others.

About 65% of the world’s population live in countries where overweight and obesity kill more people than underweight issues.

According to the Malaysian Health and Morbidity Survey 2011, 33.3% of the total population in the country are pre-obese while 27.2% are obese.

The recently released Oxfam international report titled Good Enough To Eat Index revealed that Malaysia has been ranked the fattest country in South-East Asia and sixth in the Asia Pacific region.

Overweight and obesity are mainly caused by an energy imbalance between calories consumed and calories expended.

Other causes of excess body weight include an increase in physical inactivity due to the increasingly sedentary nature of many forms of work, changing modes of transportation and increasing urbanisation.

Weight, type 2 diabetes and SGLT2

Type 2 diabetes makes up 90% of the total diabetes population around the world, and is largely the result of excess body weight and physical inactivity.

Weight can influence diabetes and vice versa. It is harder for diabetic patients to control blood sugar levels if they gain more weight.

In prehistoric times, it is believed, the human body developed a system for maximising energy conservation and storage due to a lack of consistent food supplies. This system included reducing the activity of our neurological endocrine system to slow metabolism, conserving the stored energy in our bodies, as well as a method to increase reabsorption of excess glucose that was removed by the kidneys.

Today, most of us have an adequate or most likely over-abundant supply of glucose from food consumed. Consequently, the system that was once necessary for survival now contributes to increased weight and diabetes risk.

Long term blood sugar control is very important to delay the onset and reduce the severity of type 2 diabetes complications and macrovascular risk.


A protein called sodium-glucose cotransporter 2 (SGLT2) regulates the reabsorption of 90% of glucose in the kidneys. It prevents the loss of glucose by transporting glucose from the kidneys back into the body’s circulation.

Advancements in diabetes treatment have given rise to a SGLT2 inhibitor that acts to prevent the reabsorption of glucose in the kidneys, resulting in glucose passing through the urine.

As it increases the renal glucose excretion, type 2 diabetes patients may experience a decline in blood glucose levels.

The amount of glucose that is excreted in the urine daily may also result in weight loss of up to a few kilograms a month. For diabetes patients, losing a moderate amount of weight can dramatically slow the progression of the disease.

Studies have shown that approximately 50 to 100 grams of glucose is excreted in the urine daily. Therefore, going on the principle of roughly four calories to one gram of glucose, between 200 and 400 calories are excreted on a daily basis.

Hence, some patients may experience weight loss, and this can be advantageous for those who are overweight or obese.

In the long run, the amount of calories being excreted in the urine is equivalent to about two to three kilograms of weight loss over six months. Diabetes cannot presently be cured, but it can be controlled and patients can lead a full and active life.

Weight management still remains an important component of type 2 diabetes management, but reaching and maintaining a healthy weight can be a challenge. However, a new class of diabetes treatment with a novel mechanism of action that works independently of insulin has many benefits for type 2 diabetics, especially in facilitating weight loss. Speak to your doctor to find out more about how to manage diabetes effectively.

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