Category: News

Diabetes is a progressive disease; therefore, a single treatment regimen cannot be followed for long. Also it is a complex disease with genetic predisposition; hence, a single therapeutic regimen is not applicable in all cases.

The prevalence of diabetes has reached epidemic proportions, resulting in an enormous increase in the need for dialysis and coronary artery bypass grafts. Treatments are also needed for eye disease ,neuropathy, sexual dysfunction depression and leg ulcers. According to the international Diabetes Federation (IDF), in 2011, the number of persons suffering from diabetes in india was 61.3 million and is estimated to reach 101.2 million by 2030. Diabetes is a complex metabolic disorder, with a multitude of components, one of which is the elevation or excursion in blood sugar .The complexity of the disease urgently requires technological interventions to be a part of day to day management in the absence of which the therapy fails, as is happening with more than 80 % of patients on conventional diabetes treatment.

After the publication of the Diabetes Control and Complications Trial (DCCT) with type 1 diabetes , and the United Kingdom Prospective Diabetes Study (UKPDS) with type 2 diabetes, the management of diabetes has radically changed in the past decade. Now, self –monitoring of blood glucose (SMBG) with a glucometer , has become indispensable, whatever may be the type and stage of the illness. Technology in diabetes is linked to blood glucose monitoring and delivery devices. Blood Glucose monitors and insulin pens have been popular for years. Continuous glucose monitoring (CGM) and insulin pump therapy are being incorporated gradually and systematically into routine diabetes therapy. The idea behind incorporating technology in diabetes care is to ensure success in maintaining healthy levels of HbA1c,blood pressure and LDL cholesterol thereby , preventing the onset of micro and macro vascular complications of diabetes.

Diabetes is a progressive disease therefore a single treatment regimen cannot be followed for long Also, it is a complex disease with genetic predisposition hence , a single therapeutic regimen is not applicable in all cases.CGM replaces the pricking of a finger tip to get a drop of blood , which is used ia a glucometer to measure the blood glucose with a stand alone tiny sensor needle with measures up to 288 blood glucose values over a period of 24 hours and can be situ from three days to three weeks. This device can be used as a blindor a real time device where the patient will be able to see the change in the blood glucose trends, the lows the highs , the excursions, the trend during sleep etc, This is the first in a series of columns that will deal with technological innovations in diabetes.

Source: DOC N DOC, February 2012 by Jothydev Kesavadev, MD

Washington, Jan 10 : Middle-aged adults who are recently diagnosed with diabetes and hypertension have at least one year time to try to learn how to control their high blood pressure without medications, but further delay can increase damage, a new study has suggested.
The consequences of delaying effective hypertension treatment for up to a year were small-a two-day reduction in quality-adjusted life expectancy-according to University of Chicago researchers
But as the delay gets longer, the damages multiply. A ten-year delay decreased life expectancy by almost five months.
“For newly diagnosed patients, this means we have time,” said study author Neda Laiteerapong, MD, instructor of medicine at the University of Chicago.
“Most patients would prefer to control their blood pressure through diet and exercise rather than with medications, and it can take months to learn how to change old habits and master new skills. Our results indicate that it’s ok to spend from six months to a year, perhaps even longer, to make the difficult lifestyle changes that are necessary and will pay off in the long run,” she explained.
The study was published online for the Journal of General Internal Medicine. (ANI)

Over 30 lakh diabetes patients across the country were on pioglitazone drug banned last week
City doctors are receiving anxious calls from diabetic patients worried about ban on anti-diabetic drug pioglitazone.
“Pioglitazone is a good drug. The only issue is that it should be used with certain restrictions,” said Dr KP Singh, senior consultant, endocrinology, Fortis Hospital, SAS Nagar.
He said, “It is an affordable drug, which is at least 10 times cheaper as compared to other medicines. So we were prescribing it commonly.” Following the ban, now Dr Singh is getting 30-40 queries every day from his patients regarding the medicine. The medicine, Dr Singh said, should not be used for patients suffering from urinary bladder cancer, heart problems, kidney failure. “The patients can now either switch to insulin or opt for costlier yet less effective drugs,” Dr Singh said. According to experts, Pioglitazone is the second and third line of treatment for Type 2 diabetes.
According to data available, over 30-lakh diabetes patients across the country were on pioglitazone drug banned last week. The union health ministry had issued a notification announcing the ban on June 18. Along with pioglitazone, two other drugs – analgin (painkiller) and deanxit (anti-depressant) – were also banned due to alleged health risks associated with the drugs.
Doctors complained that the Indian government relied on foreign data which links urinary bladder cancer with the intake of pioglitazone. Some doctors allege that scientific evidence was ignored before banning the drug and that its benefits outweigh the risk factors.
However, Dr RJ Dash, considered a pioneer in endocrinology in the country, believes that it was a right decision to ban the medicine. “When it is established that there are serious side effects of the medicine then there is no question of continuing the sale of medicine,” he said.
He added that some physicians were using this medicine mindlessly without knowing its side effects, so it was right to stop the sale of this medicine.
Ref: HT live Chandigarh- Tuesday, July 9,2013

Man-made chemicals in everyday items such as paint, plastics and mattresses may be linked to the sharp rise in obesity and diabetes in western societies, researchers have warned.
Analysis of 240 scientific papers on obesity, pollution and type 2 diabetes suggests increasing exposure to chemicals, such as pesticides, paint additives, flame retardants, diesel and common substances in food packaging and plastic bottles, play an important role in the development of both conditions.
The chemicals enter the food chain and build up in the body where they mimic or interfere with the effect of hormones to encourage the storage of fat, alter appetite and slow the rate at which fat is burned, the researchers claim.
Co-author Professor Miquel Porta, from the School of Public health at the University of North Carolina, said: “The epidemics in obesity and diabetes are extremely worrying. The role of hormone disrupting chemicals in this must be addressed. The number of such chemicals that contaminate humans is considerable.”
“We must encourage new policies that help minimise human exposure to all relevant hormone disrupters, especially women planning pregnancy, as it appears to be the foetus developing in utero that is at greatest risk.
He added that the link between environmental chemicals and diabetes in people was first made more than 15 years ago and that the volume and strength of evidence has been ‘particularly persuasive’ since 2006.

People who need treating with repeated courses of antibiotics may be at increased risk of developing type 2 diabetes, researchers have found.
The European Journal of Endocrinology study traced antibiotic prescriptions given out to a million UK patients.
The authors say the findings do not necessarily mean that the drugs trigger diabetes – instead, infections may be a warning sign that diabetes is imminent.
They say more work is now needed to understand the link.
This is a very large and helpful study linking diabetes with antibiotic consumption in the UK public, but at this stage we don’t know which is the chicken and which is the eggJodi Lindsay , Professor of Microbial Pathogenesis at St George’s, University of London
The study looked at how many antibiotic prescriptions had been given to 208,000 diabetic patients – both type 1 and type 2 diabetics – at least one year before they were diagnosed with their condition, compared with 816,000 non-diabetic patients of the same age and sex.
Nearly half of the patients had been prescribed antibiotics at some point over the course of the study period.
And the researchers found the risk of type 2 diabetes went up with the number of antibiotic prescriptions a patient received.
For example:
The risk of type 2 diabetes was 8% higher among patients prescribed two to five courses of penicillin-type antibiotics, and 23% higher among those given more than five courses of these drugs
For another class of antibiotics known as quinolones, type 2 diabetes risk was 15% higher among patients prescribed two to five courses and 37% higher among those given more than five courses
No link was found with antifungal drugs and antiviral drugs. And antibiotic use did not appear to affect risk of type 1 diabetes.
At least half of human faeces is made up of bacteria shed from the gut
The researchers, Dr Ben Boursi and colleagues from the University of Pennsylvania in the US, believe changes to gut bacteria triggered by taking antibiotics might explain their findings.
Our guts are lined with billions of bacteria and antibiotics can wipe some of these out.
Studies in animals and humans have hinted that changes to this “digestive ecosystem” might contribute to conditions such as diabetes and obesity.
Dr Boursi said: “Over-prescription of antibiotics is already a problem around the world as bacteria become increasingly resistant to their effects.
“Our findings are important, not only for understanding how diabetes may develop, but as a warning to reduce unnecessary antibiotic treatments that might do more harm than good.”
But some say repeated infections could be a sign that diabetes is developing. People with type 2 diabetes are prone to skin and urine infections, for example.
Prof Jodi Lindsay from St George’s, University of London, said that since people with type 2 diabetes were at increased risk of developing infections, it was hard to tease the two apart.
“This is a very large and helpful study linking diabetes with antibiotic consumption in the UK public, but at this stage we don’t know which is the chicken and which is the egg.
“The idea that antibiotics might contribute to diabetes development might be important and more research needs to be done.”

By Michelle RobertsHealth editor, BBC News online
25 March 2015