by Marshaneil Soumi D' Rozario | 14th Nov, 2018
Diabetes, as we know, is a multisystem disease affecting the heart, kidney, eye, nerve etc. The morbidity associated with the disease and the costs involved in treatment are humongous. A study in 2007 suggested that an estimated USD 2.2 billion would be needed to manage all cases of type 2 diabetes in India. This number might have increased at least by 1.5times now. The prevalence of diabetes in 2013 in India is 9.1% vs. 8.3% worldwide. In 2013, there were 65.1 million people between 20 and 79 years of age with diabetes and this number was predicted to rise to 109 million by 2035. There is a paradigm shift in diabetes management protocols.
Dr. Dilip Gude, M.B.B.S. (Osmania), MPH (USA), MD, DNB, MNAMS (Gen Med) Fellowship in Diabetology (Gold Medalist), Fellowship in Critical Care Sr. Consultant Physician & Diabetologist of Virinchi Hospitals gives an insight into the importance of weight loss in diabetes.
ADA American diabetic association suggests that if a possible 10 year-heart disease risk is present, and then the antidiabetic agent preferred should target weight loss as well apart from sugar control. 80% of diabetic medicines are either weight gain inducing or weight neutral agents. Insulin, sulfonylureas are known to cause weight gain and the latter is the most commonly prescribed antidiabetic agent in India. Weight gain is known to worsen insulin sensitivity, accelerate atherosclerosis, heart disease, cause sleep apnea, and a host of other musculoskeletal diseases. The need to include or add medication classes that may reduce weight along with good glycolic control is absolute and demands that clinicians pay heed to this. Two classes are well known for this. GLP1 receptor agonists (dulaglutide, liraglutide) and SGLT 2 inhibitors (empagliflozin and canagliflozin). Apart from diet and exercise which may have a modest weight loss, one of the above classes of medicine may actually be required to manage your weight loss and diabetes. And it's not just weight loss and sugar control but these classes have shown benefit in protecting the kidney and heart from the long-term effects of poorly controlled sugar like heart attacks and kidney failures. Most general practitioners either due to cost issue or lack of knowledge tend to skip these classes as it may practically be easy to control sugars with cheaper alternatives.
The occasion of 'World Diabetes Day' is aimed to raise awareness of diabetes, its prevention, and complications and the care that people with the condition need. Four-in-five adults across the globe failed to correctly identify the warning signs of diabetes in the IDF study. This is a major concern, due to the signs being milder in type 2 diabetes, the most prevalent form of the condition, responsible for around 90% of all diabetes cases. According to Dr. Dilip Gude, "Maybe its time for patients to ask for better alternatives that may actually protect their kidney and heart. It is also the need of the hour for clinicians to be Up-to-date about the latest advancements through continuing medical education platforms and share real-world experiences. So targeting BMI(to less than 23) as a part of treatment goals may actually be the equally important need of the hour as optimal FBS/PLBS and HBA1C".
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