Changing the Trajectory of Diabetes

In conjunction with World Diabetes Day on November 14, 2022, Subang Jaya Medical Centre’s Dr Chan Siew Pheng, Consultant Endocrinologist, and Ms Yong Lai Mee, Senior Nurse Diabetes Educator, share their expert views on how people with diabetes can change the course of the disease.

Dr Chan Siew Pheng, Consultant Endocrinologist, Subang Jaya Medical Centre

According to Dr Chan Siew Pheng, advances in the management of Type 2 diabetes have dramatically changed with new medications that can reduce heart and kidney complications beyond improving blood glucose control. Despite this, the harsh reality is that the disease prevalence continues to rise. Type 2 affects approximately 95% of people with diabetes in Malaysia, a nation which also has the highest rate of diabetes in the Western Pacific region. According to the same study, seven million Malaysian adults aged 18 and older are predicted to be affected by the disease by 2025.  [Source]

An almost invisible disease, diabetes can have a devastating impact when left unchecked or uncontrolled and it can affect each person differently. As blood glucose levels can be high and low, both extremes are life-threatening if left unattended for long. Among developments that are changing how people with diabetes manage the disease are diabetes technologies like glucose sensor monitors and insulin pumps which are radically transforming lives.

Glucose sensor monitors, and particularly continuous glucose monitoring or CGM devices of today are portable and provide accurate and real-time readings of blood glucose levels, with some supported by artificial intelligence, and all without the often-dreaded finger prick.

Insulin pumps are mini-computer devices that deliver a basal rate of insulin through a tube or cannula, functioning much like the pancreas. Taking the guesswork out of the amount of insulin one needs, the pump enables insulin to be slowly released into the body. In addition to the basal insulin rate, additional bolus doses can be given at mealtimes, with the dosage based on one’s blood glucose readings, as well as the amount of food intake.

Staying "Diabetes-free"

While these technologies make life easier, people with Type 2 diabetes, particularly those who have been recently diagnosed, can also potentially change the path of the disease by going into remission with non-diabetic glucose levels and without requiring medication for control.

For many, the term “remission” is more often associated with cancer; thus, it would be surprising to hear it being used for diabetes. Yet going into remission can be life-affirming for those who have been dealing with a disease that requires 24/7 attention.

According to a team of experts from Diabetes UK, the American Diabetes Association and the European Association for the Study of Diabetes, remission is “when long-term blood sugar levels remain below the diabetic range for at least three months without diabetes medication”. [Source]

Achieving diabetes remission is no easy task nor is it a quick fix. It is also not for every diabetic. Studies show that weight loss plays a definitive role, and why diabetes remission is more likely to be achieved by those who are obese or overweight.

Reducing one's weight by 10% to 15% when at an unhealthy weight and maintaining it is the foundation of achieving diabetes remission. However, this will not apply to those who are already below their healthy weight or to a diabetic who is genetically predisposed to diabetes as not every Type 2 diabetic struggle with excess weight. Therefore, weight loss is not the solution for some individuals with diabetes.

A lifelong commitment to maintaining a certain weight is a must, and as a result, gaining healthy levels of blood glucose sugar, blood pressure and cholesterol. One is in remission as long as these levels are maintained. The ultimate benefit of being in a diabetes remission is a life where one will no longer require daily medication to keep blood sugar and insulin in good control. For those who suffer from a disease that requires regular daily monitoring, this is liberating.

Diabetes remission is not only dependent on dietary changes but also physical activity. With the body typically geared towards regaining weight, it is vital to understand this 10% to 15% in weight loss is just the beginning of the journey of being in remission. To sustain the status, one must be prepared to adopt lifestyle changes for life as regaining weight is inevitable if control is relaxed. With discipline, monitoring and medical support, one can remain in diabetes remission.

People living with Type 2 diabetes are well aware that poor glucose control can have devastating complications, especially for the heart and kidney, with amputation risk a possibility. Two new classes of medicines are now proving to be game-changers, with ‘target organ protective benefits’ reducing the impact of diabetes on the heart and kidney by safeguarding the health of these organs. Recent research has confirmed that these medicines can reduce risk of heart attacks, strokes and death from cardiovascular disease and also protect the kidneys; beyond their impact on lowering blood glucose. These impressive results have changed the way that doctors are managing their patients with diabetes.

The search for a cure continues but living a fuller life as a diabetic with the support of technology and smart medicine or as a non-diabetic is very much a possibility today and within reach. It is important for patients to get the right advice, education and other information that will allow them to understand and make timely and informed choices.

Managing diabetes requires self-care knowledge

Ms Yong Lai Mee, Senior Nurse and Diabetes Educator, Subang Jaya Medical Centre

Unlike Type 1 diabetes where the pancreatic cells are destroyed totally and there is absolutely no insulin produced, Type 2 is about insulin being ineffective due to the body being insulin resistance. Being overweight, obese and inactive increase insulin resistance, says Ms Yong Lai Mee, Senior Nurse and Diabetes Educator at SJMC.

There are two components in managing diabetes – the disease itself and the person having the disease. It is a complex multifactorial disease. A change in body weight, lifestyle, comorbidity, and even age can change how the disease progresses. People living with diabetes must do the same tasks daily to achieve and maintain the targeted blood glucose level. As such, it is understandable why being motivated to do this day in, day out repeatedly is truly a challenge. Having self-care knowledge and healthcare professionals to monitor the disease are both vital to avoid complications. The International Diabetes Federation set the theme for World Diabetes Day 2022 as ‘Education to Protect Tomorrow’. Education works like a steering to empower people with diabetes to control the disease and stay on track.

In diabetes, high blood glucose levels can cause plaque formation around the blood vessel wall. As the plaque builds up, it narrows the blood vessels opening and decreases the blood circulation to all parts of the body. Therefore, high blood sugar increases the risk by 2 to 4 folds of having a stroke, heart attack, kidney damage, blindness, sexual dysfunction, and limb amputation. Making regular follow up visits with the doctor helps to detect early disease changes. A 2-way communication, discuss self-care issues and present sufficient blood glucose monitoring data to the healthcare professionals are some of the strategies to improve health outcomes and lower healthcare cost.

Source: Hibbard JH, Cunningham P. How Engaged Are Consumers In Their Health And Health Care, And Why Does It Matter? Center for Studying Health System Change: Washington, DC; 2008.

Sugar is a fuel for body cells. It circulates in the blood and is supplied to the cells to support normal body function, but with people with diabetes, this process malfunctions. Managing blood sugar levels is a 24-hour challenge for diabetics as their blood glucose levels fluctuate easily and can be easily affected by food intake, medication, exercise, and illness. It is literally a round-the-clock battle for diabetics to maintain ideal sugar levels, with new technologies like the 24-hour glucose monitoring device that can also be monitored remotely by healthcare professionals to provide better sugar control considered a game-changer.

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