11 January 2012

World Diabetes Day is observed on November 14, and calls upon those managing diabetes to understand the condition, know the risks, and take control.

MANAGING type 2 diabetes (T2D) is an everyday challenge for anyone who has the condition. Most T2D patients have to consider not only the diabetes, but also other associated medical conditions, such as high cholesterol or high blood pressure. Home monitoring and tests just add to the daily challenge of managing T2D.

The good news is that in most cases, type 2 diabetes can be effectively managed through a combination of lifestyle changes and medication. However, because T2D is a chronic disease, these lifestyle changes and medication regimes must become lifelong daily practices.

If not managed well, serious complications will arise, including possible kidney failure.

These adjustments have to become second nature. People with T2D can live very productive and active lives, with the right personal lifestyle practices, medication and social support.

Most T2D patients know only too well what they need to do to manage their condition effectively. The key to effective T2D management is comprehensive glycaemic control of “the glucose triad”. This refers to blood glucose levels before and after meals. Then there is the long-term measure, known as HbA1c to the medical profession, which evaluates overall control of diabetes and risk of complications. There is a volume of evidence to demonstrate that comprehensive and tight glycaemic control can significantly reduce the risk of other associated diseases.

Clearly, this is the aim of most T2D patients and doctors who treat them.

The reality is that not everyone will be disciplined enough in monitoring blood glucose levels, keeping to doctor visits, and lifestyle changes.

There is always extra help

Managing glycaemic control can change one’s lifestyle totally as it involves diet and exercise, handling medication and monitoring one’s own blood glucose. It can be quite overwhelming for a newly diagnosed T2D patient. They may also be susceptible to side effects of some T2D medication, which may result in low blood sugar (hypoglycaemia), weight gain and gastrointestinal disturbances.

T2D patients must be extra vigilant about low blood sugar levels. This can occur if meals are missed, or they are more physically active than normal. It can also occur if the prescribed medication lowers the production of glucose in the body, or increases the secretion of insulin.

It’s important to monitor for symptoms of hypoglycaemia when taking medication to manage T2D. Symptoms include sweating, dizziness, headache, blurred vision, heart palpitations, confusion, and in some cases, seizures.

All T2D patients could benefit from extra help, and most will need diabetes medication and insulin. The decision about which medication, or combination of medications, depends on many factors.

T2D patients are strongly encouraged to consult their physicians so they can receive individualised therapy.

There are several types of medication that can help control blood sugar levels. AG inhibitors slow down digestion and absorption of carbohydrates in the gut; sulphonylureas stimulate the production of insulin; and thiazolidinedianes reduce resistance to insulin. Biguandies, of which the widely known metformin is the only drug in this class, reduces glucose production during a fasting state.

The newest diabetes medication, known as DPP-4 inhibitors, work in two ways: they help the body make more insulin; and slow down the liver’s production of glucose.

The latest DPP-4 inhibitor launched recently in Malaysia, known as saxagliptin, can help to control blood sugar levels before and after meals. It is a once-a-day tablet that is convenient and easy to remember, thereby improving compliance. Clinical trials have shown superior tolerability and efficacy in its mode of action, without the common complaints of weight gain, gastrointestinal reaction and importantly, the risk of hypoglycaemia. Depending on physicians’ advice, saxagliptin can be taken with other commonly used oral anti-diabetic drugs, or on its own.

Take back control on World Diabetes Day

The World Health Organization (WHO) has identified four key non-communicable diseases (NCDs) as top global priorities – cardiovascular disease, cancer, chronic lung diseases and diabetes. According to global WHO data, these key NCDs collectively kill three in five people worldwide.

World Diabetes Day is observed every Nov 14, and calls upon those responsible for health in general, and managing diabetes in particular, to understand the condition, know the risks and take control.

T2D is a condition where the person with the condition is in the driving seat. Effective T2D management starts with a visit to the doctor, compliance to medical therapy, and lifestyle changes. T2D patients and their physicians are empowered with a wealth of evidence-based information, treatment options, and a wide variety of physical activities to stay in good health, maintain well-being, and continue to be productive and active.

There’s no need to struggle daily – T2D patients have extra help at their fingertips.

This article was published in www.thestar.com.my on 13 November 2011