Principle of Management of Type 2 Diabetes: From Clinical, Public Health and Research Perspectives

Abstract

Apart from stopping smoking, controlling hypertension and using statin, losing possible excess bodyweight and regular physical activity and exercise are the cornerstones in diabetes management. There is often need of controlling blood glucose immediately. Approach of 'dynamic dose management of medications likely to cause hypoglycemia' helps to control high blood glucose immediately as and when required with sulfonylurea or insulin and to taper off their dose later. Anti-hyperglycemic medications which are unlikely to cause hypoglycemia are continued to control hyperglycemia. The diagnosis of gestational diabetes usually made at 24-28 weeks is applicable for clinical management of mother and child and for possible prevention of diabetes later in the mother. From the public health perspectives, however, protection of the susceptible in utero population from maternal malnutrition or clinical or subclinical hyperglycemia right from the time of conception itself also needs to be considered to control the diabetes epidemic at the population level. Campaigns and programmes for maintenance of optimal pre-pregnancy body weight as per the recommended body mass index of the respective populations along with regular physical activity and exercise during pregnancy are the essential measures available at hand to prevent the possibility of maternal hyperglycemia right from the early pregnancy.

Diabetes among Patients with Overt Primary Hypothyroidism Visiting the Outpatient Department of General Medicine of a Tertiary Care Centre: A Descriptive Cross-sectional Study

“…We recommend larger studies of diabetes and thyroid function tests in the general population, of diabetes in patients with primary overt hypothyroidism in the community, and of thyroid function tests in people with diabetes in the community to reach a consensus in the first place whether there is a such high prevalence of diabetes in the patients with overt primary hypothyroidism or not. Whether the such association is caused by the three groups of factors mentioned above, 11 - 13 or by other autoimmune and metabolic factors, 14 , 15 may also be then subsequently considered.…”

“…A meta-analysis reports that increased TSH and decreased FT3 and FT4 are associated with a higher risk of type 2 diabetes in a J-shaped and inverted J-shaped relationship, respectively. 10 The increased diabetes prevalence in hypothyroid patients could be due to the three factors such as the three groups of risk-factors, namely ageing, sedentary life, and obesity; maternal malnutrition; and maternal hyperglycemia during pregnancy, [11][12][13] or other autoimmune and metabolic factors. Review articles on the relationship between thyroid disease and diabetes and metabolic diseases discuss the other possible metabolic and autoimmune factors involved in such a relationship.…”

“…high prevalence of diabetes in the patients with overt primary hypothyroidism or not. Whether the such association is caused by the three groups of factors mentioned above, [11][12][13] or by other autoimmune and metabolic factors, 14,15 may also be then subsequently considered.…”

Fundus Photography as the Base of Three-Tier Diabetic Retinopathy Care System to Its Wider Roles: Learning from a Case Experience

“…16 Apart from controlling and monitoring blood glucose, the management of diabetes includes the management of its risk factors, including obesity and comorbidities, especially hypertension, and the prevention of the complication of CVD. 17 The inclusion of the use of inhaled steroids and bronchodilators in chronic respiratory disease and identification of presenting features of cancer along with other interventions indicated in the WHO PEN in the curriculum can complete the areas of training of traditional diabetes educator as that of educator for the four major NCD for primary care and education of the patients. 14,15…”

Fellowship Training in Nepal: Current Prospects

“…Healthcare and medical professionals require adequate training and certification to work in the health system to fill the gap between the available scientific knowledge and technologies and the effective utilization by the patients. 30 Fellowship programs for the medical professionals are the cornerstone of providing specialized care to patients. Nepal should focus on providing all the prerequisites, infrastructure and human resource for expanding fellowship programs in the country and thereby enhancing the standard of patient care.…”