Dr Jay Deshmukh MD, FOPS, MNAMS
Diabetes Mellitus is a major risk factor for early coronary la artery disease, hypertension, stroke, kidney failure, and blindness. It is also known to reduce life expectancy. It is important to know which parameters along with blood glucose need to be evaluated on a periodic basis. A stands for A1C, B stands for blood pressure, while C stands for cholesterol. The expanded version also involves E for diabetes education, E for an eye examination, F for foot examination, G for glucose monitoring, and H for health maintenance. Hence knowing ABC and beyond in diabetology is Important from the patient’s perspective.
What does A stand for?
A1C reminds the care provider and receiver about the importance of getting this test done at least twice a year. Each 1% reduction in A1C reduces the risk of microvascular complications by about 35%. Though it estimates the average blood glucose of the previous 8 months, a combination of the patient’s self-monitoring of blood glucose (SMBG), and current A1C results are most important. A value below 7% is recommended. In individuals with limited life expectancy or very young or very elderly, or those with many other associated illnesses, very stringent control of A1C is not recommended.
The letter B reminds us about blood pressure control in diabetics.
Almost 90% of individuals with diabetes have hypertension. The incidence depends on age, obesity, and ethnicity. Hypertension is also a major risk factor for microvascular complications like retinopathy and kidney disease. Blood pressure of less than 140/90 is strongly recommended in diabetics. B also reminds us about microalbuminuria.
What is microalbumin aria?
The persistent presence of albumin in the urine in the range of 30 to 299 mg in 24 hours has been shown to be the earliest manifestation of kidney disease in diabetics. Microalbuminuria also increases the risk of cardiovascular disease. Certain drugs known as ACE inhibitors are known to be beneficial in reducing microalbuminuria and thus are known to protect the kidneys and heart from diabetes-related complications.
What about D?
Diabetes is a chronic illness. This requires continuous patient health education to prevent acute and chronic complications due to diabetes. Self-medical education helps the patient to adopt good medical nutrition therapy and encourages him to exercises and quitting alcohol and smoking.
E is important as it means how you care for your eyes if you are diabetic.
A regular eye examination is necessary to prevent blindness from diabetes. Good control of blood glucose and blood pressure is likely to prevent diabetic retinopathy. Timely laser photocoagulation can prevent loss of vision in patients with severe nonproliferative and proliferative retinopathy with or without macular edema. In patients with diabetes who are planning pregnancy assessment for retinopathy before pregnancy and in the first three months of pregnancy is important as the retinopathy is likely to get worse. This however is not seen in those who become diabetic during pregnancy.
What about the letter C?
This reminds us about the importance of cholesterol that is lipid management and Aspirin in diabetics. Lowering LDL cholesterol and total cholesterol and increasing HDL cholesterol is important. Along with this, the normalization of triglycerides is important too. The LDL cholesterol should be targeted below 100 mg, the HDL above 40 mg, and triglycerides below 150 mg are ideal in diabetics.
F stands for foot care and is extremely important.
The incidence of complications related to a diabetic foot is generally associated with other fac-tors. This includes loss of sensation over the feet, peripheral vascular dis-ease, nail disease, corns and callosities and associated smoking habits, and uncontrolled hypertension and diabetes. Diabetics are known to lose their foot due to gangrene unless taken care for.
G stands for glucose monitoring.
Daily SMBG is necessary for the patient’s on insulin therapy. For most patients who are pregnant or with type 1 diabetes, monitoring of blood glucose 4 times daily is recommended. SMBG helps in all types of diabetes. This helps to adjust diet, exercise, and medications. SMBG is a component of effective therapy. This is considered to be a cornerstone for diabetes care.
What about H?
Health maintenance practice is extremely important in diabetes care. One can prevent pneumonia from influenza virus or coronavirus or pneumonia due to pneumococcal infections. Safe and effective vaccines are available to prevent this pneumonia. Vaccination against coronavirus is safe and effective in diabetics and is strongly recommended along with other vaccinations.
The ABC and beyond of diabetes care is strongly recommended by the American Diabetes Association to prevent or reduce the dangerous complications due to diabetes. Besides our physician who helps you to control diabetes, referring to the eye, cardiovascular and kidney specialists may be required at some time in the diabetic patient’s life.