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Don’t delay: Protect your heart and kidneys today

By LAI S. REYES, The Philippine STAR Published Oct 26, 2020 5:00 pm

Diabetes can be greedy. Not only does it take a big bite out of your budget, it also zaps the joy out of life as eating issues and sexual problems may eventually arise. Add to the lethal mix the increasing risk of type 2 diabetic patients to develop ischemic heart disease and kidney failure as they get older.

“Up to 50 percent of patients with type 2 diabetes developed heart failure within five years after diagnosis,” warns Dr. Cyril Tolosa, head of medical affairs, AstraZeneca. “And one or two of these patients will die.”

He adds that up to 40 percent of these patients will also develop chronic kidney disease that leads to dialysis and transplant.

And, more often than not, their journey leads to a destination no patient wants to go to: premature death.

(From left) Dr. Elizabeth Roasa, Dr. Erlyn Demerre, AstraZeneca media affairs director Dr. Cyril Tolosa, Prof. Subodh Verma, Dr. Nemencio Nicodemus and AstraZeneca medical affairs manager Dr. Albert Pamplona make a fight sign to signify their commitment to fight the complications of type 2 diabetes.

The burden of diabetes

Diabetes is a growing global epidemic. Records show that 11 adults globally have diabetes, and 80 percent of the burden is in low- and middle-income countries. The Philippines ranks fifth in the region with the most cases.

“Diabetes is a pandemic that happened even before COVID-19 was known to all of us,” shares Dr. Nemencio Nicodemus Jr., an endocrinologist from the Philippine General Hospital. “Around the globe, there was a 51-percent increase in the number of people with diabetes in 2019. And that one in 11 adults globally has diabetes.”

The Food and Nutrition Research Institute, which regularly conducts a nationwide survey on the prevalence of diabetes in the country, reported that 10.9 percent of Filipino adults have diabetes, and 8.2 percent have pre-diabetes.

“More than half of the people with pre-diabetes will eventually become diabetics within the next five years,” adds Dr. Nicodemus. “The percentage will increase during the next survey if we don’t do anything about it.”

In relation to diabetes and diabetes-related complications, ischemic heart disease and chronic kidney disease have significantly increased as causes of premature deaths in the Philippines in a span of 10 years — from 2007 to 2017.

“And death here comes earlier than expected,” notes Dr. Nicodemus.

Heart failure results in significant morbidity and mortality, especially in the aging population, and is an important contributor to the burden, cause and loss of productivity in our society.

“Outcomes of heart failure can be worse than the common cancers we know like breast, prostate and bowel cancer,” says Dr. Eryln Demerre, a cardiologist from St. Luke’s Medical Center. “That’s why it’s important to recognize the causes and manage them appropriately and adequately.”

There are many risk factors for heart failure and heart disease. Some can be modified, like smoking, obesity, alcohol intake and an inactive lifestyle. But others can’t be modified at all, like family history and aging.

“Now, when these factors come into play, especially diabetes and hypertension, this leads to heart disease and, if left unattended, heart failure,” warns Dr. Demerre.

Data from the Philippine Renal Registry showed that over a period of 10 years, four out of 10 patients suffered from kidney failure due to diabetes.

“It’s called diabetic nephropathy,” explains Dr. Nicodemus.

Another complication caused by diabetes is heart failure. Based on the data from PGH, the two most common risk factors for developing heart failure among Filipinos are hypertension and diabetes.

“I was diagnosed with diabetes in 2009,” shared graphic artist Edwin Garcia, 47. “I learned that I had problems with my kidneys in 2016 when I was hospitalized due to a mild ischemic attack. I was devastated and got depressed for six months.”

Diabetes runs in their blood. Edwin’s brother died of the disease.

“I was aware that diabetes is hereditary. So prior to my diagnosis, I was very active. But sh*t happens,” shares Edwin. “What I fear the most is having to undergo dialysis treatment, because for me, dialysis is one step to my grave. So I try to protect my kidneys by eating the right kind of food items and daily exercise.”

The diabetes, heart and kidney connection is real. 

“Diabetes and hypertension, which are chronic conditions, have been implicated as the leading culprits of end-stage renal disease (ESRD),” notes Dr. Elizabeth Roasa, a nephrologist from University of Santo Tomas (UST). “When left uncontrolled, there is an inexorable decline in renal function over time.” 

A new day for Type 2 diabetic patients

“As medical professionals, we are at war against this lethal triad: diabetes, heart failure and chronic kidney disease,” declares Dr. Subodh Verma, an internationally renowned cardiac surgeon-scientist at St. Michael’s Hospital in Toronto, Canada. “Because the triad is growing exponentially worldwide.”

Not only do these chronic diseases shorten life, they’re very costly. And so an ounce of prevention is worth a pound of cure.

Committed to ensure that no one would suffer from heart failure and chronic kidney disease complications from diabetes, AstraZeneca has launched the new indication of Forxiga approved by Philippine Food and Drug Administration (FDA) that protects the heart and kidneys of type 2 diabetic patients. 

Forxiga has been approved by the Philippine Food and Drug Administration for the prevention of new or worsening heart failure or cardiovascular death in adult patients with type 2 diabetes.

Forxiga is a first-in-class, oral medication that belongs to a class of drugs called SGLT2 inhibitors. Aside from its new indication, Forxiga is indicated as both mono therapy and as part of combination therapy to improve blood glucose control, with the additional benefits of weight loss and blood pressure reduction, as an adjunct to diet and exercise. The FDA approval of Forxiga’s new indication is based on the results of DECLARE-TIMI 58, the largest, broadest and longest SGLT2 inhibitor cardiovascular outcomes trial to date. The trial involved 17,160 type 2 diabetes patients, 60 percent of who have cardiovascular risk factors and 40 percent have established cardiovascular disease. 

“The DECLARE–TIMI 58 trial showed that in a broad population of patients with type 2 diabetes, the use of Forxiga resulted in a significantly lower rate of cardiovascular death or hospitalization for heart failure compared to placebo, with additional findings supporting a possible lower rate of adverse renal outcomes,” said Verma.
Most of us know someone who has diabetes. And it’s such a relief to know that they can now break free from the lethal triad.

Forxiga is a prescription medicine. Patients should consult their physicians regarding their diabetes condition and treatment.