Bold approach to diabetes care

For diabetic patients, comorbidities aren’t just a side note — they’re practically written into the script. Conditions like cardiovascular disease, kidney disease, and nerve damage are strikingly common in diabetic populations, and doctors across the UAE are pulling out all stops to catch these silent threats early.

Dr Arun C S Menon, Consultant Endocrinology at Aster Clinic, Bur Dubai, highlights that diabetic neuropathy tops the list, affecting nearly 30 per cent of his diabetic patients. “Many of these cases remain asymptomatic,” he says, adding that proactive screening is vital for early identification. Cardiovascular issues impact roughly 20 per cent of his diabetic patients, while 15 per cent face renal complications, all of which are often hidden until screened.

To stay ahead, Dr Menon and his team conduct comprehensive cardiovascular screenings, which include blood pressure monitoring, lipid profiles, and stress tests for high-risk individuals. For advanced screening, atherosclerosis is monitored through carotid intima-media thickness (CIMT) or the ankle-brachial index (ABI), he explains. Kidney function, on the other hand, is closely watched through the Urinary Albumin-to-Creatinine Ratio (ACR), Serum Creatinine, and eGFR tests. Regular foot exams, monofilament testing, and nerve conduction studies help catch neuropathy in its earliest stages.

Dr Salaheldin Ahmed Nasr Rezk, Specialist Internal Medicine at Burjeel Medical Center, Al Shamkha, notes that diabetes markedly increases the likelihood of cardiovascular disease — diabetic patients are up to four times more likely to develop these complications than their non-diabetic counterparts. “Approximately 40 per cent of diabetic patients face chronic kidney disease,” he says, emphasising that nerve damage affects around 30 per cent of them.

Dr Rezk believes in routine screening as a cornerstone of care. His clinic employs blood pressure checks, lipid profiles, and microalbuminuria tests to detect early signs of kidney damage, allowing timely intervention. “Early intervention is critical in preventing disease progression,” he asserts, underscoring the importance of catching these conditions before they worsen.

For Dr. Ludmila Vassilieva, Homeopath and Founder of the Holistic Healing Medical Center in Dubai, diabetes is often a result of “a chaotic lifestyle filled with stress and suffering.” She believes that almost 99% of chronic diseases are lifestyle-related, including type 2 diabetes. “Every cell needs the right amount of sugar to function optimally,” she says, explaining that a life out of balance can result in either excess sugar being stored as fat or low levels of sugar, which can prompt sugar cravings. The result? A cycle of cravings and imbalance that can exacerbate diabetes and its related conditions.

Instead of merely managing diabetes, Dr. Vassilieva’s approach focuses on “holistic healing to address the root cause” by transforming the patient’s lifestyle. Her program at the Holistic Healing Medical Center aims to monitor the body’s energy and sugar flow continuously, helping patients not just control but potentially eliminate their dependence on medication for diabetes. “Holistic healing can move you from a life filled with stress, suffering, depression, and illness to one of health and happiness,” she claims, positioning lifestyle modifications as the cornerstone of her strategy.

Main hurdles

For Dr Menon, the biggest challenge in managing diabetes among patients is motivating them to make lifestyle changes, especially in terms of diet and physical activity. “Patients with comorbidities like obesity, heart disease, or kidney disease face additional barriers,” he says. Adding to the complexity, mental health issues like stress, depression, and anxiety often hinder patients’ ability to manage their conditions effectively, making it harder to establish a stable routine. Polypharmacy – the use of multiple medications – is another hurdle, leading to side effects like hypoglycemia, weight gain, or postural hypotension. Dr Menon highlights that “ensuring patients understand the importance of managing multiple conditions is essential,” but notes that barriers like low health literacy and limited access to resources often complicate adherence to complex treatment plans.

Dr Rezk, echoes these challenges, particularly the tightrope walk of balancing glucose management with the needs of comorbid conditions like kidney and cardiovascular disease. “Some diabetes medications can adversely affect kidney health, so we have to carefully adjust medications based on each patient’s renal function,” he explains. To mitigate this, Dr Rezk often relies on SGLT-2 inhibitors, which studies have shown to reduce cardiovascular mortality and slow the progression of kidney disease in diabetic patients with renal concerns. Crafting comprehensive treatment plans that address both diabetes and its comorbidities, he believes, requires a strategy that uses “multi-functional medications” to maximise benefit across conditions.

Lifestyle changes

Taking control of diabetes isn’t just about the numbers – it’s a full-scale lifestyle shift, with diet and exercise at the forefront in combating related health risks.

Dr Menon believes that lifestyle modifications are “essential in managing diabetes and preventing complications.” His guidance on diet is straightforward but effective: patients should focus on nutrient-dense foods, especially complex carbohydrates from whole grains and vegetables, rather than sugary snacks.

For glycemic control, he recommends foods with a low glycemic index, like non-starchy vegetables and berries, and adds that fibre from oats, beans, and fruits is a must for lowering LDL cholesterol and managing weight. “For cardiovascular health, I advise patients to go for healthy fats like olive oil and nuts, and avoid sodium-heavy processed foods,” he says.

Dr Rezk also highlights the role of lifestyle modifications in managing diabetes-related conditions. He points to research that shows how 150 minutes of moderate physical activity per week can drastically reduce cardiovascular risks for diabetic patients. For diet, his advice is to focus on complex carbohydrates, lean proteins, and healthy fats, while keeping processed sugars and sodium intake low.

Dr Karthik Balachandran, Specialist Endocrinology at Zulekha Hospital Dubai, echoes the importance of a well-rounded approach. “Many people think blood sugar control is the be-all and end-all of diabetes management – it’s not,” he claims, stressing that proper diabetes care also includes blood pressure management, cholesterol control, physical activity, stress reduction, and, when possible, quitting smoking.

The role of diet and exercise is essential in her approach to comprehensive diabetes care. Dr. Vassilieva encourages her patients to make sustainable changes to their eating habits, focusing on balanced meals that support stable blood sugar levels and provide long-term energy. Physical activity, she believes, is equally important as it helps regulate insulin sensitivity, promotes cardiovascular health, and reduces stress – all factors that are crucial in managing diabetes-related comorbidities.

Ultimately, Dr. Vassilieva advocates for a holistic shift in diabetes care, emphasizing the importance of addressing lifestyle and emotional well-being to combat not just diabetes but the array of health challenges it brings along. As she sees it, “freedom from disease” is possible when patients embrace comprehensive, balanced changes that transform their lives from the inside out.

New developments

When it comes to diabetes, the latest advancements show we’re looking beyond blood sugar levels and embracing a holistic strategy for health.

Dr Menon explains that the focus in diabetes care has shifted significantly in recent years, prioritising what he calls “comprehensive health management.” He highlights personalised, integrated care as a critical advancement, with precision medicine and multidisciplinary teams enabling a more holistic approach for patients with complex needs. “This approach means we can address multiple health issues in tandem, enhancing overall outcomes,” he says.

Heart and kidney health are now central considerations in diabetes treatment, especially with the rise of SGLT2 inhibitors and GLP-1 receptor agonists. Dr Menon notes that these medications “don’t just control glucose; they actively protect cardiovascular and kidney health,” reducing risks of heart failure and diabetic nephropathy – a major breakthrough for patients with comorbidities.

On the lifestyle front, Dr. Magdy Allam, Consultant Endocrinology at Zulekha Hospital Dubai, underscores the crucial role of diet, exercise, and weight management. According to Dr. Allam, dietary adjustments – like focusing on high-fibre and low glycemic index foods – can significantly reduce HbA1c levels. He advocates for a Mediterranean-style diet, which studies show can lower cardiovascular risks by 30 per cent in diabetic patients. Exercise, particularly aerobic and resistance training, can reduce HbA1c by 0.7% on average, with regular activity compounding the effects when combined with dietary changes. “When patients embrace lifestyle adjustments, we see remarkable improvements in glycemic control, blood pressure, and lipid levels,” he says, emphasising that it’s the “combined effect” of these modifications that creates lasting health benefits.

Taking healthcare to people

Diabetes care in Abu Dhabi isn’t about waiting for patients to come in – it’s about bringing healthcare directly to them.

Fawaghi Alnaqbi, Chief Medical Officer at Ambulatory Health Services (AHS), explains how AHS, part of the Middle East’s largest healthcare group, PureHealth, supports diabetes care across Abu Dhabi with 31 multi-specialty centres and mobile clinics, reaching even the remotest areas. “Our approach is built on four pillars: prevention, early detection, management, and access to care,” says Alnaqbi. Through programs like Ifhas and Our Medical Home, AHS identifies at-risk individuals early, enabling timely intervention.

Technology is also central to AHS’s strategy. AI-enabled diabetic retinopathy screenings and the Sudoscan test allow for early detection of complications. “This technology is crucial for reaching underserved areas,” notes Alnaqbi. AHS combines screenings with 360-degree management, crafting tailored care plans so that every patient gets support no matter where they are.

Beyond screening, advances in anti-VEGF therapy are reshaping diabetic macular edema treatment. Dr Bertran highlights newer, long-acting agents like Faricimab, a bispecific antibody targeting both VEGF and Angiopoietin-2, which allows for extended dosing intervals, reducing the number of injections required. “These innovations are shifting treatment protocols towards personalized regimens with fewer injections, enhancing patient adherence and outcomes,” she explains. High-dose Aflibercept and experimental gene therapies like ixoberogene soroparvovec are also under development, offering sustained intraocular VEGF inhibition that could further reduce treatment frequency. As for the future, Dr Aboul-Hosn is optimistic about AI and personalised treatments but emphasises the importance of holistic approaches. “Innovative glycemic regulation treatments will impact the health of the eyes,” he says, pointing to the need for integrated care that addresses blood sugar control alongside eye health.