Physicians World Wide Complacent About
Tight Blood Glucose Control
When physicians are complacent, so are their patients. "Diabetes could become the AIDS of the 21st century"
The International Diabetes Federation (IDF)
has called for urgent action to stem the growing epidemic of type 2
diabetes by identifying those at high-risk and prevent complications by
more aggressive management of blood glucose control.
Many physicians have been too complacent about
the need for tight blood glucose control. This complacency has been passed
on to patients, who are often poorly motivated to control their condition.
"Type 2 diabetes is not a 'mild' form of diabetes" says IDF President,
Professor Sir George Alberti, speaking today at a Federation meeting in
Montreux. "More aggressive control of the whole blood glucose profile is
essential if we are to prevent the life-threatening complications of
diabetes".
Diabetes remains the industrialised world's
leading cause of blindness, end-stage renal disease, and non-traumatic
limb amputations. Type 2 diabetes increases the risk of cardiovascular
diseases by two or three fold, and eight out of ten people with the
condition will die from a cardiovascular disease.
The key to preventing diabetic complications
is to achieve tight control of blood glucose as well as meticulous control
of other cardiovascular disease risk factors. The UK Prospective Diabetes
Study showed that if HbA1c (a marker of blood glucose control) is reduced
by 1%, the risk of heart attack is reduced by 14%, and the risk of eye and
kidney damage by up to nearly 45%. Yet the vast majority of patients with
type 2 diabetes do not achieve adequate control of their blood glucose
levels, particularly their post-meal glucose.
Early detection of the condition is also
vital. "Affluent nations should be screening high-risk groups, such as
people who are obese, have a family history, or are from ethnic groups
pre-disposed to the condition" says Professor Alberti. Earlier detection
and treatment would not only reduce the suffering caused by diabetic
complications, but would reduce the huge burden that diabetes places on
healthcare services. Type 2 diabetes already accounts for 10-15% of
European healthcare budgets and this is set to rise.
It is essential that more resources be devoted
to diabetes prevention programs. Unless significant efforts are made to
stem the rise in diabetes, healthcare services across the world will soon
be crippled by the costs of treating the diseases and its complications.
"Diabetes could become the AIDS of the 21st century" warns Professor
Alberti. "The importance of diabetes prevention cannot be underestimated".
Type 2 diabetes currently affects 1 in 20
European adults (22.5 million). A further 1 in 7 adults over 40 years of
age have a condition known as impaired glucose tolerance (IGT), which
confers a high risk of diabetes and a significantly increased risk of
cardiovascular disease. Approximately half of people with IGT will develop
diabetes within ten years, but the vast majority of people with IGT will
never be diagnosed, or offered advice on how to reduce their risk of
progressing to diabetes.
Recent large-scale clinical trials have shown
that frequent lifestyle advice, delivered by a health professional, is
effective at reducing diabetes incidence in people at high risk. Clinical
trials are also underway to investigate whether drugs that improve insulin
secretion or insulin sensitivity reduce the risk of diabetes and
cardiovascular disease in high-risk groups. The largest of these is the
NAVIGATOR trial launched in November 2001, which will involve 7,500 people
with IGT in 41 countries across the world.
Professor Alberti today called for people with
impaired glucose tolerance to be managed much more aggressively with
lifestyle change and weight control and drug therapy for lifestyle advice
failures. |
