Take Home Message

  1. Pregnancy offers a huge window of opportunity to not only improve pregnancy outcomes in GDM but also to address intergenerational prevention of NCD’s, such as diabetes and CVD
  2. Drugs acting on the incretin axis is currently one of the mainstays in effective T2D management
  3. Vildagliptin is chirally pure anti-diabetic drug, developed as S-enantiomer
  4. As per UKPDS-34, the risk of MI is 39% lower with metformin vs. conventional therapy in obese patients
  5. Patients with diabetes often fail to reach glycemic targets; treatment for diabetes is therefore not optimized and needs to be improved
  6. Patients with diabetes should aim for holistic approach i.e not medication alone but also lifestyle changes with emphasis on psycho-sexual health life is increasing recognized

 

1. Diabetes In Pregnancy: Window of Opportunity For Diabetes Prevention In India

Appropriate screening, early detection and effective treatment of GDM can prevent several adverse outcomes of pregnancy. This helps in favorable outcomes like a normal, healthy mother and baby after delivery. Detection of GDM helps to identify high-risk women for future diabetes and CVD. Various strategies for diabetes prevention can be implemented effectively as pregnancy offers a huge window of opportunity to not only improve pregnancy outcomes in GDM but also to address intergenerational prevention of NCD’s, such as diabetes and CVD.

2. Dysregulation of Incretin System: A Missing Link For Dysglycemia

Incretins assume a significant role in blood glucose regulation, particularly in post prandial state. Dysregulation of defective incretin discharge is one of the major pathophysiologies adding to hyperglycemia in T2DM. Though both GLP1 and GIP stimulate beta cells to discharge insulin in a glucose dependent way, however they have contrasting actions on alpha cells, which is increasingly prominent as blood sugars close to hypoglycemic range. Medications following up on the incretin axis are presently one of the pillars in effective T2DM management.

3. Concept Of Chirality & Its Implementation in Diabetes and Cardiovascular Diseases

Chirality has important pharmacologic implications interms of pharmacokinetic/pharmacodynamic (PK-PD) behavior. The developments of chirally as a pure drug is recommended by regulatory organizations like: US FDA, EMA, and ICH. Chirality has a significant role in development of anti-diabetic drugs. Vildagliptin, a chirally pure anti-diabetic drug, is developed as S-enantiomer.

4. Risk Prediction in Patients with Type 2 Diabetes

Classification of CV risk (moderate to very high risk) is adapted from 2016 ESC Guidelines on CVD prevention in clinical practice to the DM setting. As per UKPDS 34 Metformin exerts beneficial CV effects in overweight patients. With use of Metformin, risk of MI is 39% lower as compared to conventional therapy in obese patients. As per guideline recommendations for glucose lowering treatment in DM – Metformin should be considered in overweight patients with T2DM without CVD and at moderate CV risk and Insulin-based glycaemic control should be considered in patients with ACS with significant hyperglycaemia (>10 mmol/L or >180 mg/dL), with the target adapted according to co-morbidities. It has been observed from clinical studies that SGLT2 inhibitors or GLP-1 receptor agonists have similar cardiorenal protection.

5. Are We Doing Enough For Our Type 2 Diabetic Patients?

Coeliac disease, Rheumatoid arthritis, Addisons disease and Autoimmune thyroid disease are linked to type 1 DM and Alzheimer’s disease, Polycystic ovary syndrome (PCOS), Cushing’s syndrome and Pancreatic cancerare linked to type 2 DM. Treatment of DM includes Insulinization (too early or too late) and targeting the “dirty dozen”.Diabetes patients often fail to reach optimal glycemic targets as treatment for diabetes is not optimized and needsimprovement. Insulin is very effective is treating type 2 DM. As per ADA consensus statement of 2016; while targeting the “dirty dozen”, irrespective of initial glucose levels, early treatment of organ damage should be targeted. Infection leading to and associated with DKA like: Mucormycosis, external otitis media, emphysematous pyelonephritis should be considered. When well- controlled diabetes patients become acutely uncontrolled, one should look for underlying infections. Link between vasculopathy exists: If retinopathy present look for nephropathy, If microalbuminuria present and retinopathy absent, look for causes beyond DM and  If erectile dysfunction is present, work up toward e/o IHD. Only remission is possible in diabetes, not cure as diabetes is lifelong disease.

6.Quality of Life: An Important Parameter In Diabetes Management

Disease, economic, family disharmony, social conflict, psycho- social mismatch are the factors that influence quality of life. Diabetes being a chronic illness requires lifelong medication. Maintaining good quality of life is  of utmost importance. The ten commandants for improving quality of life in diabetics include: diet, salt, sweeteners, micronutrients, exercise, psycho-social management like sleep, yoga, music and meditation, sex, tobacco, alcohol, and pollution- air, water, earth. Diabetic patients should aim for holistic approach i.e. not medication alone but also lifestyle modifications with emphasis on psycho-sexual health.