Type 2 diabetes mellitus (T2DM) is truly emerging to be a severe public healthiness problem in our country. The experts are alarmed at the increasing prevalence worldwide, particularly in Southeast Asia, and it looks enjoy the Philippines is among the hot spots that have actually to be carefully monitored. In fact, diabetes is a severe culprit why we additionally have actually an increasing fee of end-stage renal ailment requiring lifelong dialysis or kidney transplantation.
Several days ago, I had the privilege to facilitate a forum on the clinical pitfalls in the management of diabetes mellitus, organized by LRI-Therapharma. Dr. Augusto Litonjua, considered by several as the “Father of Philippine Endocrinology,” and the founding president of the Philippine Society of Endocrinology, Diabetes and Metabolism (PSEDM); Philippine Focus for Diabetes Education Foundation (PCDEF), and several others endocrinology associations in the country and in Asia, headed the panel.
Since T2DM is a multisystemic problem damaging every organ of the physique particularly the heart and kidneys, equally as renowned specialists in these organs were additionally present, namely, Dr. Nelson Abelardo, chief of the cardio section and assistant medical director of Manila Doctor’s Hospital; and Dr. Agnes Estrella, head of the dialysis units of the ACE Medical Center, Our Lady of Mercy General Hospital and Galvez Medical Focus in Bulacan.
The big problem
The whole panel stressed that the big problem in the management of T2DM is that patients usually have actually no symptoms for an excellent lot of years, and several stay undiagnosed; or if diagnosed, they do not take their prescribed medicines since anyway, they don’t have actually any sort of symptom. Little do they recognize that slowly, their heart, kidneys, brain, eyes, nerves and arteries are gradually being afflicted leading to irreversible damage and complications enjoy heart attack and heart failure, stroke, kidney failure, blindness and leg gangrene requiring amputation—merely to name a few.
Early treatment and regulate of T2DM is useful and leads to an excellent “legacy effect,” says Dr. Litonjua. He explains that a legacy effect means that early diagnosis and treatment can easily lead to lasting incentives in preventing the dreaded complications of T2DM caused by injury to the small blood vessels (microvascular) and big blood vessels (macrovascular). Examples of microvacular complications are kidney ailment (nephropathy) and eventual failure, nerve injury or neuropathy, and eye issues leading to blindness (retinopathy). Examples of macrovascular complications are narrowing of the heart and brain arteries leading to heart attack and stroke.
Screening guidelines
To diagnose T2DM early, the PSEDM, Diabetes Philippines, Institute for Studies on Diabetes Foundation (ISDF) and PCDEF came up along with screening guidelines for early detection, and they recommend this be done if one or much more of the adhering to are present:
- Sustained blood stress (BP) equal or much more compared to 140/90 mm Hg;
- Obesity; and
- Age much more compared to 40 years.
Elevated BP and obesity are common accompanying issues of T2DM. They usually cluster together; hence, as quickly as located together, they’re called “Metabolic Syndrome.” Why 40 years of age as a cut-off age? That’s the age older compared to which the incidence of T2DM shoots up remarkably, based on the findings of a neighborhood survey—the National Nourishment and healthiness Survey.
The panel additionally cited a recent update of treatment guidelines published by the American Association of Clinical Endocrinologists (AACE), which additionally has actually a neighborhood chapter (AACE-Philippines). The adhering to underlying principles are emphasized as the basis for management of T2DM:
- Blood sugar target, reflected by the blood test called HbA1c, need to be individualized based on age, life expectancy, comorbidities, diabetes duration, hypoglycemic risk, etc.
- Self-monitoring of blood sugar levels at house by the patient can easily serve as an necessary guide for adjusting medications.
- Patient-related and medication-related factors need to be considered in prescribing the most suitable antidiabetic therapy for a patient.
- To stay away from hypoglycemia and reduce the risk for weight get are accompanying priorities for any sort of antidiabetic therapy.
Since the main objective in the management of T2DM is to stay away from complications, the adhering to approaches are additionally considered important:
- Yearly dilated eye examinations (fundoscopy) to find out any sort of damage of the nerves (retinopathy);
- Annual microalbumin determination in the urine to find out the earliest authorize of kidney involvement;
- Foot examinations at each visit, checking the pulses and recognizing any sort of authorize of inadequate move in the legs and feet;
- HbA1c every three to 6 months to find out if target blood sugar levels are accomplished (which need to be individualized depending on age, life expectancy, others concomitant problems);
- Blood stress preferably much less compared to 130/80 mm Hg, and even lesser if there is kidney involvement already (diabetic nephropathy); and
• Statin therapy to reduce low-density lipoprotein cholesterol, even if the cholesterol levels levels are standard or even normal.
