Treat Complications in Diabetes Early and Aggressively

Aggressive, early treatment of diabetes with lifestyle modifications and metformin is key in preventing and treating complications, said family physician Edward Shahady, MD, FAAFP, ABCL, at the 2018 Cardiometabolic Risk Summit (CRS) in San Antonio, Texas.

In his session at CRS on Friday, Dr Shahady, who is the president and medical director of the Diabetes Master Clinician Program and an editorial board member of Consultant, discussed the importance of recognizing diabetes early in its course, especially when it comes to preventing serious complications.

“Type 2 diabetes is a slow developing disease and is seldom recognized early enough,” Dr Shahady told Consultant360. “Hypertension, elevated triglycerides and low levels of high-density lipoprotein (HDL) cholesterol are the earliest signs of T2D. However, most clinicians are not aware of these early signs, so vigilance for appearance of hyperglycemia often does not occur.”

Blood sugar elevation tends to occur 2 to 3 years later, with postprandial blood sugar rising 1 to 2 years before fasting blood sugar rises, he added.

Micro- and Macrovascular Complications in Diabetes

A vast array of serious complications- both microvascular and macrovascular- can occur among patient diabetes and exacerbate outcomes and quality of life. Preventing these complications is a major goal of diabetes treatment, said Dr Shahady.

In his presentation, he outlined the types of macrovascular complications that often occur in diabetes, with cardiovascular disease being the most serious macrovascular complication.

“Cardiovascular disease is the major cause of mortality in diabetes,” Dr Shahady explained.

Cardiovascular complications that occur commonly in diabetes include myocardial infarction, stroke and heart failure.

Other macrovascular complications that can occur in diabetes are:

• • Hypertension
  • Hyperlipidemia
  • Non-alcoholic fatty liver disease (NAFLD)

He also detailed the microvascular complications that can occur in diabetes, such as:

• • Retinopathy
    • Blindness
    • Macular edema
    • Cataracts
  • Neuropathy
    • Foot ulcers
    • Amputations
  • Nephropathy
    • Renal failure

Preventing and managing these complications involves achieving blood sugar control; undergoing appropriate tests of blood sugar, lipids, blood, and urine tests; and visiting a primary care clinician every 3 to 6 months, Dr Shahady said.

Preventing Complications With Lifestyle Modifications and Metformin

Lifestyle modifications can have a profound impact on one’s condition, as their effectiveness is equal to that of 1 diabetes medication, Dr Shahady said.

Incorporating 150 minutes of moderate intensity exercise per week and adopting a diet that yields a 7% reduction in body weight are foundational aspects of diabetes care.

In addition, a treatment plan incorporating metformin can be key in many cases. Metformin is recommended as a first-line medication for type 2 diabetes among patients for whom there is no contraindication.

“Metformin is as effective as lifestyle modifications in diabetes prevention for patients under age 44; 60% as effective between 45 and 60; and minimally effective after age 60,” he explained.

When combined, lifestyle modifications and metformin can significantly improve one’s diabetes. In his presentation, Dr Shahady cited a 2015 study performed by the Diabetes Prevention Program Research group, which showed that lifestyle modifications and metformin reduced the incidence of diabetes by 27% and 18%, respectively, over a follow-up period of 15 years.

What’s the Key Takeaway?

Lifestyle modifications and metformin use often play a key role in proper diabetes care.

“Recognition and early treatment with lifestyle modifications and metformin will decrease the incidence of diabetes complications and improve quality of life,” said Dr Shahady.

However, in order for the full effects of treatment to be achieved, adherence is important.

Although these tenets of treatment play a key role proper diabetes care, promoting treatment adherence is often not a simple task, as many patients have difficulty committing to certain facets of treatment.

“Unfortunately, for many patients with diabetes, taking a pill is easier than committing to lifestyle changes,” Dr Shahady said.

CRS 2018 will continue through Sunday, September 16. For more of our CRS 2018 coverage, visit our Conference Page.

Edward Shahady, MD, FAAP, ABCL, is a family physician; a clinical professor of Family Medicine at University of Florida; an editorial board member of Consultant; and the President and Medical Director of the Diabetes Master Clinician Program, Inc., in Fernandina Beach, Florida

—Christina Vogt

Reference:

Shahady E. Prevention and treatment of diabetes complications. Presented at: Cardiometabolic Risk Summit 2018; September 14-16, 2018; San Antonio, TX.