Type 2 Diabetes and Cardiovascular Disease

May 06, 2015 | Health Tips

• People with diabetes have 2 to 3 times higher risk of having a heart attack compared with people without diabetes.
• People with diabetes should have a very strict control of factors that increase the risk of a heart attack such as high cholesterol and high blood pressure as well as good blood glucose control.
• The way type 2 diabetes is treated may increase the risk of a heart attack and recently much attention is being paid to glucose-lowering drugs and their cardiovascular safety.
• People with diabetes should know how to recognize the symptoms of coronary insufficiency because they should immediately start to do tests to see whether there is a need for an intervention.

Diabetic Kidney Disease

May 12, 2015 | Health Tips

• Diabetic nephropathy (DN) is a microvascular complication of diabetes mellitus characterized by persistent proteinuria, decline in GFR and increased morbidity and mortality in diabetics.
• This is one of the most important causes of premature death among patients with diabetes and a major health concern.
• Development of progressive renal disease is observed in only a proportion (20-30%) of individuals with type 2 diabetes and familial clustering provide clear evidence for genetic contribution.
• Multiple mechanisms contribute to the development and outcomes of DN, such as an interaction between hyperglycemia-induced metabolic and hemodynamic changes and genetic predisposition, which sets the stage for kidney injury.
• Initiators of DKD: Hyperglycemia, predisposing genes.
• Promoters of DKD: Hyperglycemia, hypertension, dyslipidemia, insulin resistance, smoking, procoagulant state, long duration of diabetes, anemia, ethinicity/ westernization, sex, age, albuminuria.
• Early detection of DN, the multifactorial approach targeting the main risk factors (hyperglycemia, hypertension, dyslipidemia and smoking), and the use of renoprotective agents such as the drugs that act on the rennin-angiotensin-aldosterone system, may delay progression of kidney disease in diabetes mellitus, besides reducing cardiovascular mortality.

Diabetic retinopathy: Some people claim to see into the future…. But will our patients see in the future

May 15, 2015 | Health Tips

• Diabetic retinopathy is a leading cause of preventable blindness in working age population.
• It is one of the most complex, multifactorial heterogenous disorder.
• Several factors influence development of an effective screening program such as screening method, population cover, cost and cost-effectiveness, guidelines, compliance, quality assurance. We need to make early screening more accessible.
• Future in screening: computer aided DR detection, automated identification of DR from color fundus image.
• Laser photocoagulation is effective treatment for PDR. The strongest evidence comes from two RCTs: Diabetic retinopathy study and early treatment study.
• Anti-VEGF treatment was approved by the FDA in 2012.
• Factors involved in angiogenesis and downstream signaling (PKC, angiopoietins, platelet-derived growth factor, Wnt signaling axis) and inflammatory cytokines are other target molecules.

The main challenge is the complex nature of the DR. Several new screening and treatment modalities are in the horizon.

Glycemic Goals in Clinical Practice: Targeting Postprandial Hyperglycemia

May 20, 2015 | Health Tips

• Postprandial hyperglycemia is common in diabetics and it precedes fasting hyperglycemia.
• Indian diet is rich in carbohydrates unlike Western diet. High dietary carbohydrate load is associated with increased risk of T2DM.
• PPG is important because T2DM patients may be in the postprandial state for more than 12 hours in a day.
• Increased PPG is associated with endothelial dysfunction and oxidative and nitrosative stress making it a strong predictor of CV events in diabetic patients (DECODE, Honolulu Heart study, DECODA).
• Postmeal plasma glucose should be measured 1-2 hours after a meal.
• For good glycemic control, both FPG and PPG should be normal or at least near normal levels.
• If A1c <7.5%, initial therapy should address PPG, preferentially.
• Reducing postprandial hyperglycemia → decreased CVD related morbidity and mortality.
• α-glucosidase inhibitors like voglibose and voglibose-based combination therapy can effectively control postprandial hyperglycemia as they delay absorption of carbohydrates and also offer added advantages of being weight neutral & least risk of hypoglycemia.

Insulin is Sole Therapy for Type 1 Diabetes

May 22, 2015 | Health Tips

• Type 1 diabetes has no beta cell reserve.
• Exogenous insulin is the only therapy in this situation.
• They are insulin dependent and its deficiency precipitates ketoacidosis.
• OAD of different mech. of action other than secretagogues are not fully efficient in controlling plasma glucose.

Clinical Significance of CGM: Adopting and adjusting therapies

May 27, 2015 | Health Tips

• Continuous glucose monitoring (CGM) evolved in 1999.
• The most professional CGM device in India is iPro2 using Enlite sensor.
• The sensor will record the interstitial glucose value once in every 5 minutes and may be used continuously for 1 week.
• We have earlier reported clinical use of CGM in prediabetes, in type 2 diabetes on various therapies, to identify undetected nocturnal hypoglycemia, duration of hypoglycemic excursions, undetectable glycemic variability, etc. helping the diabetes team to adjust existing therapies or to adopt suitable therapies and lifestyles to address specific abnormalities in CGM.
• The technology of CGM is fast advancing and is integrated with insulin pump and mathematical algorithms (PID, MPC, Fuzzy Logic) in artificial pancreas clinical trials.