Diabetes - A spectrum of diseases Q & A Session with an Expert
Diabetes, a very common chronic disease, but have several different aspects that a person should have an idea of. Here, we present to you a general discussion on diabetes that we had with a renowned Indian endocrinologist Dr. Praveen Ramchandra, to understand the other facets of the disease.
Dr. Praveen Ramchandra is a leading endocrinologist and is presently serving as a Consultant Endocrinologist at ARKA Hospital, Yelahanka, Bangalore.
When the insulin resistance and obesity are there for a longer time, the person will start having an intolerance to glucose, and will be not able to dispose of the glucose in the body the way it should. This is called pre-diabetes.
So, Doctor, we can start the interview with a brief introduction to the different types of diabetes:
Dr. Praveen: There are multiple types of diabetes, but we majorly focus on two of them, and those are Type 1 and Type 2 diabetes. We also have Type 3, one and a half diabetes, secondary diabetes, so on, Type 1 diabetes and Type 2 diabetes are the most common types of diabetes.
Could you please discuss Type 1 and Type 2 diabetes in a bit in detail?
Dr. Praveen: Yeah, Type 1 diabetes usually occurs in children and in young adults. It is due to the lack of insulin hormone in the body. In Type 2 diabetes, insulin production is all right initially, but due to insulin resistance, the insulin produced in the body is not effective in controlling the uptake of glucose produced in the body after having food. Almost 90% of diabetes in communities are Type 2 diabetes and the most common endocrine disorder. Type 1 diabetes is roughly around 5%.
Are there any early recognizable signs or symptoms to identify or diagnose diabetes?
Dr. Praveen: A person with Type 2 diabetes will start losing weight, have excess urination, feel thirsty, feel hungry, and be fatigued. These are the initial symptoms one should be looking for.
What is Pre-diabetes? Kindly help us in understanding it better.
Dr. Praveen: See, I would say that diabetes is a spectrum of diseases. Many people will have risk factors and insulin resistance even before developing diabetes. An obese person can have insulin resistance, but he may not have what we classically define as diabetes. So, when this insulin resistance and obesity is there for a longer time, the person will start having an intolerance to glucose, meaning he is not able to dispose of the glucose in the body the way it should. This is called as pre-diabetes, and its level is between normal glucose level and glucose level cut off of overt diabetes.
Is diabetes reversible?
Dr. Praveen: Yeah, diabetes is reversible if intervention happens at an early stage. At this time, the phase of inflammation –resistance is predominant, not insulinopenia.
But, when a person has a longer duration of diabetes, then it is not reversible as he has already lost a significant amount of beta cells (insulin-producing cells). At this stage, it can only be controlled through diet and exercise or by medications.
Related to this, I will strongly suggest people to be careful and not get fooled by diabetes reversal schemes. There is a lot of marketing that has no basis in the pathophysiology and natural course of diabetes. For example, for people with 10 to 15 years of diabetes, there are advertisements that their diabetes can be reversed. Diabetes can only be reversed in the very initial stage and not when a person has lost a significant amount of insulin-producing cells, which is the case with many long-term diabetic patients. These promotions are a kind of a scam and should not be encouraged. We should go with the scientific methods used in managing diabetes, as currently available.
Now talking about the pandemic that we all faced, how has COVID 19 pandemic impacted the care of diabetes patients?
Dr. Praveen: The people who had diabetes and got COVID saw worsening of their diabetes condition. This is because certain medicines in COVID infection treatment that increases the glucose level. Also, coronavirus has been found to infect the beta cells in the pancreas, thus impairing glucose metabolism.
The care of diabetic patients was impacted, as not many people were allowed to go out of their hospital and visit their Endocrinologist. During this time, we helped them through teleconsultation, WhatsApp video, and other similar platforms. Online consultation for medical assessment is never complete, at best it can be a temporary measure, something is better than nothing.
So, these situations had made it a bit tough to manage diabetes during COVID & lockdowns. Luckily, there is no third wave and people are now returning to the hospitals/clinics, and overall diabetes management is now improving.
Diabetes, if it is understood well, can be managed easily. That's the reason we educate patients a lot because they're going to live with the disease. Unlike many other diseases, it's a chronic disease because of which patient's contribution in managing this disease is also essential.
As we learned that COVID-19 had a direct negative impact on diabetes patients, is there any special care to be taken by a diabetes patient during this COVID-19 pandemic?
Dr. Praveen: Yeah, if the diabetic patient gets COVID, then the severity of the disease increases, and the death rate will be higher compared to the non-diabetic population. So, controlling diabetes during the pandemic was an important aspect. If the diabetes is controlled well, then the patients are less likely to die from COVID and need admission to ICU, and thus, reducing the severity and death rate.
Thanks for this insight. Doctor, what are the key challenges you face treating diabetes patients?
Dr. Praveen: Diabetes, if it is understood well, can be managed easily. That's the reason we educate patients a lot because they're going to live with the disease. Unlike many other diseases, it's a chronic disease because of which patient's contribution in managing this disease is also essential.
Both the Endocrinologist and the patient should work as a team in managing diabetes. This is the basic. It is co-management from both the patient and the doctor's side. We must remember that diabetes is not just glucose control but involves managing complications in the heart, kidney, nerves, brain, skin, eyes, and other organs. So, if we educate the patient well, motivate them well, alleviate their fears, and inspire them to do regular checkups, managing diabetes is not a big challenge.
According to you, what role do technological advances play in the management of chronic diseases like diabetes?
Dr. Praveen: In chronic diseases like diabetes, technology helps in monitoring a patient’s health records. So, we are using an electronic medical record system nowadays for chronic diseases. We enter the patient’s data and keep tracking their health records. That's one aspect of using technology. As it's a chronic disease, longitudinal follow-up is important, and it's much easier when you have an electronic medical record system.
The second thing is the glucometers. Earlier, patients used to go to the lab and give blood samples, and later he would be asked to come back to collect the report. So, a lot of time was wasted. Nowadays, a patient has a glucometer by which he/she can check himself in a simple way, and then he can bring all these records to the doctor. So, the use of newer technology like glucometer has helped in saving a lot of time and effort.
In the same way, the new technology of monitoring diabetes-like HbA1c point of care machine, which gives HbA1c report that is required to monitor diabetes for three months. The measurement can be done within five minutes. So, technology is becoming more accurate in the measurement of glucose or diabetes parameters. At the same time, it is also cutting down the time, and it is much more convenient for patients to get their glucose levels tested and communicate with their endocrinologists.
Could you let us know if there are any recent advancements in the diagnosis and treatment of diabetes?
Dr. Praveen: Yeah, diabetes is an important area of focus in endocrinology but also in the entire health specialty. And the greatest number of innovations in terms of new molecules and new medications are happening in the segment of diabetes. That's one thing.
The second thing is diagnostics. We have something known as GCMS, which is a Continuous Glucose Monitoring System. That has a lot more insights compared to the older generation's diagnostic parameters. So, many new things are happening, both diagnostic-wise as well as medication-wise, like newer types of medications (GLP 1 analogs, SGLT2 inhibitors, and many different classes of molecules).
Thank you very much for your time and your viewpoints on diabetes.