EFFECTIVE WAYS TO KEEP DIABETES AT BAY

Diabetes mellitus is a group of metabolic disorders associated with HYPERGLYCEMIA. The factors contributing to hyperglycemia include reduced insulin secretion, decreased glucose utilization, and increased glucose production. The metabolic dysregulation leads to secondary pathophysiologic changes in multiple organ systems. It is estimated that Type-2 Diabetes mellitus accounts for nearly 90% of cases of Diabetes mellitus, making it the most prevalent form of the disease. Thus, it is also called a silent pandemic.

There is a rising prevalence of diabetes in urban as well as rural areas. The younger population is affected more due to various genetic and environmental factors. At the time of diagnosis, 50% of patients already have complications. Early aggressive control is crucial for preventing long-term manifestations. Strict early control during the first year of diabetes can prevent the future risk of complications. This is called the Legacy effect. Nearly two-thirds of dysglycemic individuals are prediabetic.

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Diabetes remission is possible in the following situations:

HbA1c not very high.

High body weight.

C-peptide levels are good.

Duration of diabetes is short.

Motivated individual.

The WHO report on diabetes acknowledged that remission can be achieved by weight loss and calorie restriction. Currently, remission of diabetes mellitus is demonstrated to last up to 2 years. Remission of diabetes can be achieved currently in T2 diabetes by several methods, including bariatric surgery, significant weight loss, gestational diabetes, stress-induced diabetes, drug-induced diabetes on withdrawing the drug, and early aggressive treatment in the first year.

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We can keep diabetes at bay at the prediabetic stage by lifestyle modification of diet, such as consuming a very low-calorie diet of 800 calories/day and very low carbohydrates (less than 10%). Regular exercise to burn calories and regular morning walking to raise BMR are essential. According to the American Diabetes Association (ADA), if HbA1c is less than 6.5% for at least 3 months without medication but only on diet, it is considered remission of diabetes.

(Author Credits: Dr. T. Radhakrishna, Senior Consultant, Internal Medicine, Fortis Hospital, Richmond Road, Bangalore)