World Diabetes Day 2021: What Is 360-Degree Approach for Diabetes Management?

About 537 million adults around the world are currently living with diabetes and this number is predicted to rise to 643 million by 2030 and 784 million by 2045.

Diabetes led to 6.7 million deaths in 2021, according to data from the 10th Edition of the IDF Diabetes Atlas. It revealed that 537 million adults (aged 20 to79 years) around the world are currently living with diabetes and this number is predicted to rise to 643 million by 2030 and 784 million by 2045. World Diabetes Day is the largest diabetes awareness campaign, and it is observed on 14 November every year. As the special day approaches, Dr. Dilip Gude, Senior Consultant Physician, Yashoda Hospitals Hyderabad, highlighted the importance of 360-degree approach for diabetes management.

He says, "Diabetes control involves a holistic approach with the right balance of diet, exercise, and medication."

Dr. Gude continues

Diabetes medicines may cause weight gain

Some diabetes medicines may cause weight gain, exhaust one's pancreatic beta cells and increase hypoglycemia (low sugars) risk, and there is a high chance that most patients may be taking these medicines.

Sulfonylureas are a class of medicines very widely used and while they are potent and cheap, they come with the baggage of excess weight gain, draining out pancreatic beta cells, sometimes to the point of failure, and causing hypoglycemia. Insulin, although very important in some cases like high HBA1C (very poor sugar control) with osmotic symptoms (increased urine frequency etc), is an anabolic hormone that causes weight gain. Hence both sulfonylureas and Insulin are preferred as 3rd line agents.

Diabetics should try to keep BMI under 23 to avoid complications

It is strongly recommended to maintain body mass index (BMI under 23 as lowering BMI to 23 or less is known to minimize many complications apart from diabetes such as obstructive sleep apnea, osteoarthritis, systemic and pulmonary hypertension, etc.

More than 70% Indian diabetic patients are already obese or overweight and most guidelines recommend a weight loss inducing or at least weight neutral diabetic medicine. Better classes such as SGLT2 inhibitors (empagliflozin, canagliflozin, dapagliflozin, etc), GLP1RAs (liraglutide, dulaglutide, etc) metformin, alpha-glucosidase inhibitors, etc are known to cause weight loss. The former two classes are further known to improve heart and kidney health.

Diabetes affects almost every part of the body and the risk of heart attack, heart failure, kidney disease is very high. These classes of medicines apart from weight loss properties are known to prevent most types of heart and kidney diseases. The newer regimens of anti-diabetic meds are known to protect the pancreatic beta cells, reduce the risk of hypoglycemia/low sugars, improve vascular (arteries, etc) health, improve fatty liver, reduce uric acid, etc.

With weight loss and other such great benefits, insulin sensitivity improves, and the patient's daily insulin requirement comes down drastically. In many instances, insulin may even be stopped. Better diabetes control with such protective effects on major organs may even translate to increased lifespan.

Most importantly structured diabetic diet and exercise recommendations form the pillar of any diabetes management along with such newer and safer anti-diabetic regimens.

Regular screening for cardiovascular complicationsessential

Almost all diabetic patients also suffer from a constellation of other disorders like deranged lipid profile, hypertension, increased waist circumference together known as metabolic syndrome. This syndrome in itself is known to increase cardiovascular risk manifold. It also becomes imperative that diabetic patients get themselves screened periodically for microvascular (damage in the retina, kidney, nerves, etc) and macrovascular (heart disease, brain stroke risk, blood supply defects in legs, etc) complications.

In diabetics bringing down LDL cholesterol to the newly recommended goals of less than 100 or 70 depending on risk factors is very important hence necessitating cholesterol-lowering medicines such as statins in almost every diabetic patient. Thus, if you are a diabetic, you must discuss these holistic treatment options with your doctor.