2.13 CME

Not Just Sugar: Understanding the Systemic Impact of Diabetes

Speaker: Dr. Ajay Vasant Rotte

Medical Director at Kamalnayan Bajaj Hospital and nursing college, Maharashtra

Description

Not Just Sugar: Understanding the Systemic Impact of Diabetes explores how diabetes affects far more than just blood glucose levels. This session highlights the widespread impact of the disease on vital organs including the heart, kidneys, eyes, nerves, and blood vessels. By understanding these systemic complications, healthcare providers can adopt a more comprehensive approach to prevention and management. It also emphasizes the importance of early detection, lifestyle modification, and multidisciplinary care. The goal is to shift the focus from sugar control alone to whole-body health in diabetic patients.

Summary

Diabetes is a systemic disease affecting nearly every organ, causing cardiovascular issues (2-4 times increased risk of heart disease and stroke), eye damage (leading cause of blindness), kidney failure, and nervous system problems (up to 50% of patients). It is often misunderstood and the number of diabetic patients is rapidly increasing globally, making it a significant health concern.
Type 2 diabetes predominates, accounting for 80-85% of cases, while type 1 accounts for only about 5-7%. The disease's systemic nature extends beyond blood sugar, impacting cardiovascular health, vision, kidney function, and the nervous system, emphasizing the need to consider the increased risk of complications like heart and kidney disease.
Cardiovascular complications remain the leading cause of death in diabetic individuals, with increased risks of heart disease, heart failure, and stroke. Diabetic patients often experience heart conditions equivalent to someone who has already had a myocardial infarction, highlighting the severity of the cardiovascular impact.
Kidney complications affect 20-40% of diabetic patients, potentially leading to end-stage renal disease. Nervous system disorders, including neuropathy, are common and can cause pain, injuries, and silent myocardial infarctions. Optometric complications can lead to vision loss, with diabetic retinopathy affecting up to 80% of patients within 20 years of diagnosis.
Foot complications can lead to foot ulcers and a 15-40 times increased risk of amputation, emphasizing the importance of foot care and prompt treatment of injuries. The comprehensive management plan includes glucose control, blood pressure management, cholesterol control, regular screening, and lifestyle changes to minimize these complications.
Early indicators of organ damage include microalbuminuria, reduced heart rate variability, and retinal microvascular changes. Glycemic control can be measured with HbA1c and time-in-range, with targets tailored to each patient. Indicators such as the absence of normal nocturnal blood pressure dip, also warrants consideration.
Silent heart disease in diabetic patients can manifest through atypical symptoms like fatigue or shortness of breath, due to autonomic neuropathy masking typical warning signs. Strict glycemic control, combined with blood pressure, lipid management, and lifestyle modifications, can delay the onset of diabetic nephropathy.
Diabetes affects the gut microbiome by decreasing beneficial bacteria and increasing pathogenic species, impacting short-chain fatty acid production and glucose homeostasis. This alteration can lead to leaky gut syndrome and persistent inflammation, suggesting a potential role for probiotics and prebiotics in diabetes management.
Diabetic gastroparesis, where the stomach empties too slowly, affects up to 50% of long-standing uncontrolled diabetic patients, causing nausea, vomiting, and erratic blood glucose levels. Treatment includes dietary modifications, pro-kinetic medications, antiemetics, and glycemic control.
Chronic diabetes affects hormonal balance, increasing the risk of thyroid disorders, altering sex hormone levels, creating growth hormone resistance, and dysregulating cortisol levels. This highlights the importance of a holistic, multidisciplinary approach to diabetes management that goes beyond glucose control.