Exploring the World of Endocrinology

Dr. Kamonkiat Wirunsawanya has traveled the world to study and work in the field of medicine, but his passion to help others started in his youthful days after a sincere plea from his father who was facing illness.

Wirunsawanya earned his medical degree at Rangsit University College of Medicine in Thailand. He worked at Ban-Phaeo Hospital in Thailand, then came to Hawaii for his residency in internal medicine at University of Hawaii John A. Burns School of Medicine. Wirunsawanya then completed a fellowship in endocrinology at Boston University Medical Center.

In this article he explores the latest in treatment options for the chronic disease of diabetes.

Why did you decide to pursue medicine and specialize in endocrinology?

In high school, I developed a deep fascination for science, particularly biology. When my father fell ill due to diabetes, he approached me with a heartfelt request; asking if I would consider a career in medicine to be help care for him. Despite his unfortunate passing, his wish left a lasting impact on me.

In medical school, I discovered the way the endocrine system influences the body captivates me. I’m also able to establish meaningful relationships with patients, as many endocrine conditions are chronic in nature.

What types of problems do you see in patients?

I encounter a diverse range of endocrine conditions, including but not limited to diabetes, obesity, thyroid disorders, low testosterone, pituitary issues and osteoporosis. The rare endocrine conditions truly pique my interest. These cases serve as invaluable learning opportunities, prompting me to delve deeper into the intricacies of the endocrine system and expanding my knowledge.

What are the more traditional treatments for diabetes?

Conventional treatments include lifestyle changes, blood-sugar managing medications and insulin. Lifestyle modification is considered the most important aspect of diabetes treatment, involving increasing physical activity and restricting calories. Typically, the initial approach also involves oral medications. The next step would be insulin therapy.  

How do new treatments work and differ from previous options?

We find ourselves in an exciting era for diabetes management. Well-controlled studies show that newer medications SGLT-2 inhibitors, GLP-1 receptor agonists and GLP-1/GIP receptor agonists not only lower blood sugar, these also prevent complications from diabetes like kidney disease and cardiovascular issues.

SGLT-2 inhibitors are oral medications that help the kidneys remove sugar from the blood. More sugar is excreted with urine. Studies have shown that SGLT-2 inhibitors not only lower blood sugar but also contribute to delaying the progression of chronic kidney disease and preventing hospitalizations for individuals with heart failure.

GLP-1 receptor agonists are injectable and oral drugs you may know as Ozempic, Trulicity, Victoza and Rybelsus. These mimic a hormone called GLP-1, which helps to lower blood sugar levels by stimulating the release of insulin, inhibiting glucagon production, and slowing the digestion of food. GLP-1 receptor agonists have been shown to be effective in lowering blood sugar and A1C levels, and they may also help to promote weight loss secondary to appetite-suppressive effect of the medications.

Mounjaro is the brand name for GLP-1/GIP receptor agonist. This medication combines the effects of GLP-1 with the addition of GIP, resulting in enhanced insulin sensitivity and a more effective reduction of blood sugar. Mounjaro proves to be more effective in lowering blood sugar and promoting weight loss.

What are some common misconceptions about these new medications?

Some believe that new diabetic medications eliminate the need for dietary or lifestyle changes. However, it's important to emphasize that these medications are most effective in conjunction with a healthy diet and regular physical activity.

Another assumption is that all new diabetes medications are covered by insurance. Coverage varies so patients should contact their insurance provider. There is also a misconception that these medications work for all types of diabetes. While there is data that indicates some efficacy for Type 1 diabetes patients, none of these medications have yet received approval for use in Type 1 diabetes.

This article was first featured in the Jan. 24, 2024, issue of MidWeek as a part of the "Dr. in the House" series. See the full publication here.

Published on: January 24, 2024