Take Charge and Manage Diabetes

Diabetes is a chronic health condition that affects how your body turns food into energy and characterized by elevated levels of blood sugar. When your blood sugar rises, it triggers your pancreas to release insulin which allow sugar to be used as energy in your cells.

If you are diabetic, your body either doesn’t make enough insulin or cells stop responding to insulin, causes too much blood sugar stays in your bloodstream. Over time, it may lead to serious damage to the heart, blood vessels, eyes, kidneys and nerves.

World Health Organisation (WHO) estimates there were 422 million adults with diabetes worldwide in 2014. The age-adjusted prevalence in adults rose from 4.7% in 1980 to 8.5% in 2014, with the greatest increase in low- and middle-income countries, and 1.6 million deaths are directly attributed to diabetes each year. Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades.

The most common type of diabetes mellitus is type 2 diabetes (T2DM), usually in adults, which occurs when the body becomes resistant to insulin. In the past three decades the prevalence of type 2 diabetes has risen drastically in countries of all income levels. Most people with T2DM are overweight or obese, which either causes or aggravates insulin resistance. Many of those who are not obese by BMI criteria have a higher proportion of body fat distributed predominantly in the abdominal region, indicating visceral adiposity, compared to people without diabetes. It is estimated that a significant percentage of cases of type 2 diabetes mellitus (49%) are undiagnosed. This may due to symptoms in type 2 diabetes mellitus are often not severe, or may be absent, owing to the slow pace at which the hyperglycaemia is worsening.

Whereas, type 1 diabetes mellitus, once known as juvenile diabetes or insulin-dependent diabetes, characterized by the body’s inability to produce insulin due to the autoimmune destruction of the beta cells in the pancreas. Type 1 diabetes mellitus is more likely to present with symptoms and its onset is typically in young age. Lifestyle modification is always the most important and cost-effective fundamental aspect of diabetes control and long-term care management. Diabetes control and management can be divided into 2 major aspect: the non-pharmacological management and the pharmacological management.

Non-pharmacological Management

• Medical nutrition therapy to promote and support healthful eating patterns, emphasizing a variety of nutrient-dense foods in appropriate portion sizes, in order to improve overall health and specifically to achieve and maintain body weight goals (BMI 18.5 to 24.9 kg/m2), attain individualized glycaemic, blood pressure, and lipid goals, as well as to delay or prevent the complications of diabetes.
• Overweight and obese patients should be advised to reduce weight by seven percent (7%), diabetes specific formulation meal replacement therapy by replacing one to two out of three meals a day has shown significant effects in terms of weight management in diabetes patients.
• All patients should be advised to practise regular daily physical activity appropriate for their physical capabilities (e.g walking). Most adults should engage in at least 150 minutes of moderate or vigorous-intensity aerobic activity, divide into three to five sessions per week.
• Self-Monitoring Blood Glucose (SMBG), closely monitoring of blood sugar level can help better take charge and control blood sugar level.
• Diabetes specific oral nutrition supplement as meal replacement to replace one to two out of three meals a day has shown to effectively reduce weight in overweight or obese diabetes patients as well as improving post-prandial blood sugar control.

Pharmacological Management

1. Line treatment:

• Metformin does not cause weight gain or hypoglycaemia and is the recommended as initial treatment for people who do not achieve the desired glycaemic control with diet and physical activity. Increase the dosage gradually according to the diabetes protocol.
• A second-generation sulfonylurea (preferably gliclazide) can be used as initial (first line) treatment when metformin is contraindicated or not tolerated. Sulfonylureas may cause weight gain or hypoglycaemia.

2. Line treatment when metformin alone fails to control glycaemia:

• Add a second-generation sulfonylurea (preferably gliclazide) or DPP-4 inhibitor to metformin in patients with inadequately controlled glycaemia on metformin, along with diet and physical activity.
• Third line therapy SGLT-2 inhibitor can add in if the hyperglycaemic still not under control.

3. Intensification of treatment when first line and/or second line therapy fail to control glycaemia:

• Refer for insulin treatment or add human insulin1 to oral medication.

There are no simple solutions for diabetes control and management but coordinated multicomponent interventions can make a significant improvement and delay of diabetes related complication. Everyone has a role to play in diabetes control and management – people with diabetes, family members, health-care providers, government as well as civil society, food producers, and manufacturers and suppliers of medicines and technology are all stakeholders. Collectively, they can all make a significant contribution to halt the rise in diabetes and improve the lives of those living with the disease.