Medical experts from across multiple Aster Clinics share latest findings on diabetes treatment while responding to common queries about the condition
Dr Prakash S. Pania, Consultant, Endocrinology, Aster Clinic, Bur Dubai (AJMC) & Aster Clinic, Arabian Ranches
To tame diabetes, we need to read and tame the patient’s mind. I have to first gain the patient’s confidence and reassure him that I can get him well.
Most people who have lived with diabetes for many years/decades, have experienced periods of deep frustration and that feeling of… “I can’t do this anymore…” How do you help a patient overcome diabetes burnout?
Diabetes along with its associated comorbidities like hypertension, dyslipidemia, Ischemic heart disease and its complications involving the nerves, eyes and the kidneys can take a devastating toll on the patient. Due to its progressive and complex nature, diabetes requires a persistent multidisciplinary approach to keep the patients’ sugar under tight control and it’s complications, under surveillance.
To tame diabetes, we need to read and tame the patient’s mind. I have to first gain the patient’s confidence and reassure him that I can get him well. The battle is half won in the mind itself. The patient should want to get his sugars controlled. Only then can I help him reach his goal. Empathy is the first step towards diabetes management.
I need to take a detailed medical, past, personal, family and treatment history and understand where the patient is going wrong. Sometimes, without resorting to heroic measures, a slight tweak in the machinery could set the juggernaut rolling. A change in diet, increase in physical activity, modifying the timing or the dosage of certain medications, stopping drugs causing adverse effects or initiating drugs (including Insulin/non insulin injectables) could bring about miraculous results.
I have to not only achieve a good glycemic control, but also keep the comorbidities like hypertension, dyslipidemia and other metabolic parameters (most of which are silent killers) under check and periodically investigate for diabetic complications and get periodic eye checks.
It is my constant endeavour to keep motivating the patient to maintain good results. Once the patient’s sugars start improving, he starts feeling better and a sense of positivity prevails.
What could endocrinologists do better or differently at the clinician level to improve quality of care for patients with diabetes?
The theme for World Diabetes Day 2021-23 is access to diabetes care. This translates to access to the endocrinologist, the diabetes nurse, the dietician / diabetes educator, other sub specialities, lab facilities and to medicines. At Aster, we are well equipped to provide the holistic care that our diabetic patient requires.
I have to think from the patient’s perspective, which means considering chronic disorders, multiple comorbidities, complications and medication, frequent visits to different specialists and at the same time balance work and home, all of which take a toll. I also have to plan ahead to limit patient visits to clinics (especially during the ongoing pandemic).
How to deal with minor emergencies like hypoglycemias / spikes in blood sugars are taught to the patient and many take corrective measures by themselves. For major emergencies, they are asked to visit the hospital.
To ensure that the patient listens to what I say, I have to practice what I preach. If I ask patients to stick to a good nutritious diet, I do it myself first. If I ask patients to exercsise regularly (especially during this ongoing 30x30 fitness challenge), I have to keep fit myself first. In other words, I encourage patients to exercise strong will power and try to lead by example, which goes a long way in improving the quality of care provided.
Dr Patanjali, CP, Specialist, Endocrinology, Aster Clinic, Discovery Gardens and Aster Clinic, Al Muteena
Has the availability of newer drugs changed the way you treat diabetes?
Yes. Over the last few years diabetes care has become more patient centric. All the newer drugs have to be proven to be safe for the heart and kidney in clinical trials before getting approved. Drugs have to be chosen not only to improve glucose control but also to prevent cardiovascular and renal complications. Some newer drugs have additional benefits such as weight loss, improving fatty liver etc. The options for treatment of diabetes have increased tremendously over the last few years and we can tailor treatments based on individual patient profiles.
Prevention and reversal of diabetes is an important field of research, which has seen many advances. Bariatric surgery is an example which has been shown to reverse diabetes.
Are you optimistic about the future of diabetes care? What can we look forward to in the next 5 to 10 years?
Prevention and reversal of diabetes is an important field of research, which has seen many advances. Bariatric surgery is an example which has been shown to reverse diabetes. Newer glucose monitoring devices and better sensors and more widespread usage of insulin delivery devices like pumps will improve management of Type 1 diabetes and reduce the burden on patients. Newer insulins which can be given less frequently like once a week insulin have shown promise and should be available shortly. Pancreas transplant may become more acceptable and we hope for a cure for Type 1 diabetes.
Dr Maneesha Pandey, Consultant, Endocrinology, Aster Clinic, Bur Dubai (AJMC)
How is Aster supporting Access to Diabetes Care, the theme for World Diabetes Day?
It is estimated that in the UAE one in five people are diabetic and another one in five are prediabetic. Keeping the annual theme of World Diabetes Day in mind, the focus is on improving access to diabetes care for all, and the need for action to prevent diabetes and its complications. In accordance with this theme at Aster we provide international levels of care with a dedicated team of endocrinologists, dieticians, retina specialists and lab, all under one roof.
Glycemic control is suboptimal in a large proportion of patients with type 2 diabetes who are subsequently at increased risk of developing severe complications.
Along with lifestyle interventions such as diet and exercise, pharmacotherapy is a basis of care for patients with diabetes. What are some of the barriers to meeting glycemic targets through the use of medication? Can adherence be a concern?
Glycemic control is suboptimal in a large proportion of patients with type 2 diabetes who are subsequently at increased risk of developing severe complications. Studies suggest that 45 per cent of diabetic patients do not achieve their glycemic targets. Some of the barriers include not following an appropriate treatment regime, psychosocial issues and last but not the least, the difficulties patients face in following the prescription and recommendations for diabetes self-care, or non-compliance from patients.
Dr Kingini Bhadran, Specialist, Endocrinology, Aster Clinic, Al Qusais (Damascus St)
What does Aster Clinic offer in terms of case management to patients? How much has it helped improve patient outcomes?
The journey of diabetes management starts with your doctor guiding you on the path towards a healthy and balanced lifestyle along with the treatment methodology required. We understand how hard it is to make lifestyle changes and then keep at it in our routines. This is where Aster Clinic’s comprehensive support and team helps. Our expert endocrinologist, dietician and diabetes nurse helps you in your journey towards management of the disease.
Along with this, we have other superspecialty services such as cardiology, nephrology, opthalmology and neurology to screen for various other complications that might arise due to diabetes mellitus. The clinic also uses technology to facilitate blood glucose measurements such as continuous blood glucose measurements, or the non-invasive blood glucose measurements; services and awareness about insulin pumps, and TENS for peripheral neuropathy. We conduct regular diabetes awareness campaigns and fitness campaigns, and our specialised preventive diabetes packages are a great support for people who want to monitor their health regularly and also for patients lacking insurance support, so as to facilitate blood tests and consultations at affordable rates. Alongside this, we also conduct awareness campaigns through social media platforms to enlighten the public regarding the need for prevention, regular testing, and options available for treatment. The best way to fight diabetes is by understanding it better.
Type 2 diabetes is an ever rising pandemic around the world. In the UAE, one in five people between the ages of 20 and 79 have Type 2 diabetes, which is the 15th highest rate globally. Within the Emirati population, diabetes mellitus prevalence is around 20 per cent.
What do you think needs to be done to reduce the prevalence of Type 2 diabetes in the UAE?
Type 2 diabetes is an ever rising pandemic around the world. In the UAE, one in five people between the ages of 20 and 79 have Type 2 diabetes, which is the 15th highest rate globally. Within the Emirati population, diabetes mellitus prevalence is around 20 per cent. The road to recovery involves several steps, first one being adapting good lifestyle measures such as regular exercise. Brisk walking for at least 30 minutes five days a week, following a healthy and balanced diet, reducing sugar, carbohydrates and junk food, and including a high-fibre, high-protein diet are the key lifestyle measures to be taken.
Good sleep is also an important measure of our overall health as it decreases stress. We cannot ignore the importance of regular preventive check-ups. Early diagnosis and treatment, as well as timely monitoring of coexisting conditions if present, such as high blood pressure, high cholesterol, being overweight or having polycystic ovary syndrome are important in your journey on the road to recovery from diabetes.