SA JOURNAL OF DIABETES & VASCULAR DISEASE
DRUG TRENDS
VOLUME 10 NUMBER 1 • MARCH 2013
39
S
anofi hosted their annual specialist
diabetes meeting in Cape Town in
November 2012. Pieter Taljaard of Sanofi
opened the meeting with a brief address,
raising the concern that the number
of diabetes patients in South Africa is
increasing annually by 18 000. Sanofi are
committed to treatment and innovation in
the management of types 1 and 2 diabetes
in both the public and private sectors.
It is increasingly accepted that the
long-term outcomes of chronic illness are
significantly improved when healthcare is
managed with a team approach. The patient
is integral to the team, with healthcare
workers providing the support system that
caters to the patient’s specific circumstances.
Guidelines should serve to assist the clinician
in tailoring a suitable response that considers
the unique combination of circumstances
any patient may have. Individualisation
of patient care is paramount, not only in
terms of pharmaceutical therapies but also
in the allied field of psychosocial support,
which encourages lifestyle alterations and
therapeutic adherence.
Examining the players implicated in the
pathogenesis of type 2 diabetes (T2DM),
De Fronzo’s ‘ominous octet’ was often
referred to during the Sanofi meeting.
1
The
implications of De Fronzo’s review for T2DM
therapy are that treatment will require
multiple combinations of agents to correct
multiple pathophysiological defects, based
on known pathogenic abnormalities in the
individual rather than simple reduction in
HbA
1c
levels. Treatment must also be started
early in the natural history of T2DM if
β
-cell
failure is to be prevented (Fig. 1).
1.
De Fronzo RA. From the triumvirate to the ominous
octet: a new paradigm for the treatment of type 2
diabetes mellitus.
Diabetes
2009;
589
: 774–795.
Treating type 2 diabetes in 2012:
choices based on facts
Prof Larry Distiller, endocrinologist, CDE,
Houghton
Previous estimates and projections on
the global prevalence of T2DM have had
to be revisited due to the obesity-driven
exponential increase in diabetes. The latest
figures indicatemore than 880million people
will have diabetes by 2025, approximately
one in every 10 people on the planet.
Meeting the challenges of diabetes
treatment is confounded by many factors.
South Africa currently represents the third
most obese population in the world, with an
increase in body mass index (BMI) of 5 to 8
kg/m
2
over the last two decades. Healthcare
workers are weighed down by the evidence,
the treatment guidelines of various authorities
rarely reach consensus, and protocols are
becoming increasingly more complex in
light of the multiple new therapeutic agents
available for diabetes management.
Moreover, patient-centred care that is
respectful of and responsive to the needs and
values of the patient shows improved clinical
outcomes. The doctor no longer dictates the
therapeutic options but negotiates the route
with the patient. When profiling the patient
with diabetes, the doctor needs to ascertain
the attitudes of the individual and what
motivates him/her, the risks of hypoglycaemia
Figure 1
SANOFI diabetes specialist weekend 2012, Cape Town
Drug trends
