Wednesday, June 11, 2014
Risk complications and premature deaths due to Type 2 Diabetes Mellitus has long concerned medical professionals globally. While researches have been and are being conducted incessantly, clinicians should consider adopting all approaches of proven benefit in screening and managing their patients which include adjunctive drug therapies to therapeutic lifestyle changes aimed at sustained weight loss, increase in physical activity, lipid, blood pressure and glycemic control.
Dr. Charles H. Hennekens, MD, Charles E. Schmidt College of Medicine, Florida Atlantic University, said that, “There is an emerging pandemic of type 2 diabetes that is related to the dramatic increase in obesity, fast becoming the leading avoidable cause of death worldwide. People with type 2 diabetes have twice the risk for premature death due to complications from kidney failure, stroke, heart failure, and blindness due to retinopathy.”
Intensive glucose control, a diabetes mellitus treatment, is necessary but not sufficient to achieve the maximum benefits in reducing complications and premature death.
According to National Center of Health Statistics data from a random sample of the U.S. population aged 20 years and older, 20 percent have metabolic syndrome, a constellation of high blood pressure, obesity, insulin resistance and high cholesterol. In those who are 50 years or older, 40 percent have metabolic syndrome and their 10-year risk for a first coronary event is 16 to 18 percent.
In the medical report, the authors advise that evidence-based doses of statins, aspirin, ACE inhibitors or ARBs should be prescribed as adjuncts to therapeutic lifestyle changes in the aggressive management of diabetes.
"The adoption of therapeutic lifestyle changes, which include weight loss and increased physical activity would preclude the need for pharmacologic interventions for most people with type 2 diabetes," added Dr. Hennekens. He further mentioned that, “Unfortunately, in the U.S., many patients prefer the prescription of pills to the prescription of a healthier lifestyle.”
U.S. adolescents today are already heavier and not active physically, adding to the causes of diabetes mellitus. They smoke more and have already developed type 2 diabetes at a higher rate than their parents’ generation did in their adolescence. Thus, they may become the first U.S. generation since 1950 to have higher rates of cardiovascular disease than their parents. It is estimated that if present trends in obesity and physical inactivity continue, it is likely that one-third of U.S. adults will have diabetes by 2050!
Gestational diabetes mellitus is also on the rise wherein women with no record of previously diagnosed diabetes display high blood glucose (blood sugar) levels especially during the third trimester of their pregnancy. Gestational diabetes is triggered when insulin receptors do not function appropriately.
The authors also express their concern about the alarming findings regarding the under-treatment of type 2 diabetes in sub-populations in the U.S. and many other countries worldwide such as the mentally ill. They provide best practices guidelines for blood pressure and cholesterol screenings, while urging clinicians and policy makers to implement multifactorial interventions.