Don’t take diabetes lightly

If we’rE scared to death about the possibility of the Ebola virus reaching our shores—which can potentially kill several hundreds of our countrymen as it has already done in some parts of Africa where it originated—we should be more scared about the diabetes epidemic which has been plaguing us for quite sometime now, killing thousands of Filipinos annually.

Yesterday, the Philippines joined the rest of the world in celebrating World Diabetes Day to draw awareness to the importance of a healthy lifestyle in preventing diabetes and its potentially-fatal complications like heart attack, stroke, blindness, kidney failure and leg gangrene requiring amputation.

I had the chance to listen to several diabetes experts this week when I was invited to give a talk during the 20th National Assembly of Diabetes Educators chaired by Dr. Joy Fontanilla. This was followed by the 31st annual convention of Diabetes Philippines.

Diabetes prevention

In a separate briefing on the ADVANCE-ON  (Action in Diabetes and Vascular disease: PreterAx and DiamicroN MR Controlled Evaluation posttrial ObservatioNal study), three experts shared valuable insights on how diabetes could be prevented, and how complications could be reduced.

“Diabetes has reached epidemic proportions throughout the world,” warned Prof. Stephen Colagiuri, who chaired the drafting of clinical treatment guidelines issued by the International Diabetes Federation.

Dr. Augusto Litonjua, who is recognized as the “Father of Endocrinology” in the Philippines, echoed the warning but emphasized how one’s resolve and discipline in maintaining a healthy lifestyle can prevent diabetes, particularly in those who have a strong family history, and help control the blood sugar in those who are  diabetics already.

Dr. Nemensio Nicodemus Jr., a local expert on diabetes and a consultant at the Philippine General Hospital and Manila Doctor’s Hospital, chaired the session and presented the results of the AVANCE-ON study which demonstrated that long-term intensive blood sugar control based on a regimen using gliclazide-modified release (a locally available antidiabetic agent) may confer long-term benefits on diabetic patients, particularly the reduction of the risk of kidney failure.

Kidney failure requiring lifelong dialysis is one of the dreaded complications of diabetes. A visit to any dialysis center will make one realize how prevalent diabetes-related kidney failure is. Almost a third of patients being dialyzed because of diabetes.

Both foreign and local experts believe that the diabetes burden, especially that imposed by its complications, can be reduced by improving diabetes management.

Unfortunately, worldwide, diabetic patients are not being treated optimally. And since diabetics may not feel any symptom in the first 10 to 15 years from the onset of the cause of diabetes which is insulin resistance, many of these patients are untreated or undertreated.  And slowly, the heart, kidneys, brain, eyes and arteries of the body suffer from the disease.

At the time of diagnosis, many diabetics already have established complications on the heart, brain and leg arteries. Chances are,  complications are already starting on the eyes and kidneys. So much time and opportunity to improve the patient’s long-term outlook have been lost already.

But still, it’s never too late to treat diabetics optimally. Studies like the ADVANCE-ON provide some reassurance that with sustained optimal treatment, one can protect the vital organs like the kidneys. Complications in the kidneys, just like in the eyes are called microvascular (small arteries), while complications in the heart and brain are called macrovascular (bigger arteries).

Studies evaluating long-term efficacy of antidiabetic drugs show favorable effects on microvascular complications, but show no convincing effects on macrovascular complications. Since the macrovascular complications start much earlier than microvascular complications, they are already well established and difficult to reverse when diabetes is finally diagnosed.

Early diagnosis is therefore important, and one should not only rely on the result of a fasting blood sugar (FBS), a blood test taken after an overnight fast. Many so-called prediabetics may have normal or even low FBS levels. Dr. Litonjua recommends a postprandial blood sugar (PPBS) determination, which is taken around two hours after a heavy meal.

If the PPBS is abnormal, even if the FBS is still normal, many diabetes experts will  already recommend that the patient start antidiabetic treatment, usually with metformin, considered the first-line drug for diabetes. Fortunately, it is also the cheapest.

Aside from the FBS and PPBS, another test to diagnose diabetes is by determining the glycated hemoglobin level (HbA1c). It is also requested usually every three months to check if the patient’s blood sugar is adequately controlled for the last two to three months.

Intensive therapy

Another favorable finding of the ADVANCE ON study was that intensive therapy with gliclazide reduced the risk of kidney failure without weight gain and with low rates of hypoglycemia, or an excessive lowering of the blood sugar. Frequent hypoglycemia is even worse than elevated blood sugar or hyperglycemia. It can make the heart very irritable; if undetected and untreated, the heart can just fibrillate and stop beating. Hypoglycemic individuals can also lapse into coma if the hypoglycemia is sustained.

It’s definitely bad news to have diabetes; but the good news is that with early diagnosis and optimal treatment, one can still live a long, happy, complication-free life with it.