DIABETES MANAGEMENT, MEDCARE HOSPITAL AL SAFA
Dr Yasmeen Ajaz, Consultant Endocrinologist at Medcare Hospital Al Safa
Can you describe your approach to developing personalised diabetes management plans for patients?
Our approach for implementation of diabetes care involves motivational discussion between us and the patients. We set personalised goals and an action plan utilising primary care resources.
We do frequent monitoring for clinical outcomes, medication intake and planned diabetes consultations when compared to usual care. As we know The UAE has a multicultural and diverse patient population with diabetes, effective diabetes patient education is challenging, it is essential to understand the unique needs and preferences of different populations.
To ensure that the patient education materials are accessible and effective for diverse populations, it is important to consider factors such as language, literacy level, cultural values and health benefits.In our hospital at Medcare Al Safa ,we have educational material like brochures, which are printed in many languages, multilingual health educators and other digital resources
GESTATIONAL DIABETES, MEDCARE WOMEN & CHILDREN HOSPITAL
Dr Alshimaa Rezk, Specialist Endocrinologist at Medcare Women & Children Hospital
What are the key challenges you’ve encountered in managing gestational diabetes in pregnant women?
Managing gestational diabetes in pregnant women comes with challenges, such as getting patients to accept the diagnosis and make necessary lifestyle changes. Limited approved medications during pregnancy, mainly relying on insulin injections, add to the complexity. Due to safety concerns in pregnancy, there’s a strong emphasis on lifestyle adjustments as medication options are restricted. Monitoring blood glucose levels regularly, especially during fasting and after meals, becomes crucial.
How do you adapt your treatment and counselling strategies to ensure the best outcomes for both the mother and the baby?
We advocate for timely screening, conduct thorough evaluations of the mother’s medical history, including any pre-existing diabetes or metabolic conditions and accordingly, tailor treatment plans. Other key components of our approach are initiating safe insulin therapy when it is necessary. We also evaluate oral medication usage, and implemente a stringent blood glucose monitoring protocol including frequent measurements of fasting and postprandial levels, to effectively manage glucose levels and reduce risks.
We also recommend and monitor appropriate physical activity, work closely with obstetricians to optimise foetal well-being, and schedule routine follow-up appointments for ongoing assessment and adjustments. For women with a history of gestational diabetes, we offer preconception counseling to optimise health before subsequent pregnancies.
Postpartum care plans, including guidance on blood glucose monitoring and addressing the heightened risk of type 2 diabetes for the mother, are integral to our comprehensive approach.
DIABETES EFFECT ON FOOT AND ANKLE, MEDCARE ORTHOPAEDICS & SPINE HOSPITAL
Dr Maan Taba, Consultant Orthopaedic Surgeon at Medcare Orthopaedics & Spine Hospital
Can you discuss your experience in managing diabetic foot and ankle complications, and how do you collaborate with multidisciplinary teams to provide comprehensive care for diabetic patients with foot and ankle issues?
Understanding the relationship between uncontrolled diabetes, vascular compromise, foot deformity, diabetic foot infection, and other comorbidities advocates a holistic approach to treating the patient as a whole, rather than simply the focused areas of the patient.
I had a case of a patient with severe diabetic neuropathy who arrived at the hospital with Diabetic Neuropathy where his nerves in his feet had been damaged, making it impossible for him to feel the sensation of the pain from the infection on his toe. He had Diabetic foot osteomyelitis (DFO) on his big toe, which is caused by a soft tissue infection/ulcer that progresses into the bone, affecting the cortex first and later the marrow.
We investigated the origin of the patient’s ulcer, and we discovered that the patient was suffering from a number of health issues caused by his uncontrolled diabetes. We also discovered that the patient’s arteries were calcified and that his proximal tibial helix was completely damaged. His HbA1c levels were also high and his glycemia was also fluctuating, which meant that unless the patient boosted his immunity and controlled his diabetes, the infection on his foot would not heal.
Because of the diabetic foot’s inadequate blood flow due to artery stenosis, the vascular surgeon had to examine his arteries by dilating them with balloons. This was done to investigate the likelihood of grafting needed to enhance the blood flow of the foot, which would aid in the healing of the skin ulcer and infection. Because the patient had multiple health issues, we had to ensure that the patient’s big toe remained functional while maintaining the same anatomical shape so that the doctors could use devices such as an external fixator or even grafting of beads with antibiotic to keep the anatomy of the big foot in its correct position.
Once the cellular level of the arteries was rectified at the vascular level and the bone level had been corrected by myself, the podiatrist had to be involved in controlling the skin ulcers with proper granular stimulation or granulation of the skin.
DIABETES EFFECT ON RETINA, MEDCARE EYE CENTRE
Dr. Sashwanthi Mohan, Specialist Ophthalmologist at Medcare Eye Centre
Can you explain your approach to diagnosing and treating diabetic retinopathy, and how do you stay updated on the latest advancements in retinal care?
In the diagnosis and treatment of diabetic retinopathy, my approach focuses on proactive and comprehensive care. Regular eye exams including dilated retinal examination for all diabetic patients with incorporation of advanced imaging techniques like fundus photography and optical coherence tomography, are integral to early detection and monitoring. Treatment strategies are tailored to individual patient needs, including lifestyle management for optimal control of blood sugar, the use of intravitreal injections to manage diabetic macular edema, targeted laser therapy for treating abnormal vessel growth in proliferative diabetic retinopathy, and, in advanced cases, vitrectomy surgery.
To provide the best possible outcomes for my patients at Medcare Eye Centre, I place a strong emphasis on staying updated with the latest advancements in retinal care. This involves a commitment to ongoing professional development, such as reviewing medical literature and research, attending relevant conferences, engaging in collaborative discussions with colleagues, and ensuring that the most recent, effective and safe treatments are integrated into my clinical practice.