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Diabetes patients often have difficulties following their treatment.
DIABETES is one of the most common non-communicable diseases and a major public health problem not only in Malaysia but also around the world.
Despite advances in medication and treatment, it remains a difficult disease to manage successfully. As such, the rates of illness and death continue to rise.
In 2019, there were 463 million patients living with diabetes worldwide.
According to our National Health and Morbidity Survey (NHMS IV), the prevalence of diabetes among Malaysians is 11.2% in 2011, 13.4% in 2015, and 18.3% in 2019.
The growing number can be attributed to lifestyle factors such as obesity, lack of physical activity, diet, stress, and urbanization.
According to the Diabcare Study 2013, an observational study of diabetes care in hospitals in Malaysia, only 23.8% of diabetics achieved disease control.
Factors affecting management
Pantai Hospital Kuala Lumpur endocrinologist Dr. Shalini Sree Dharan of Pantai Hospital Kuala Lumpur relates the failure of patients to reach their blood sugar targets primarily with lack of knowledge, inertia of treatment and lack of adherence to your treatment.
“Patients must receive an adequate education to lead a healthy lifestyle; manage your illness, especially in relation to managing your diabetes; prevent complications and recognize symptoms; as well as identifying self-care problems and discussing with caregivers and doctors about how to solve them.
“The lack of such knowledge will make it difficult for them to cope with the high level of necessary self-care, such as following a proper diet for diabetes, self-monitoring of blood glucose and regular exercise,” he explains.
She notes that treatment inertia also plays a major factor in the failed management of diabetes, whether caused by healthcare providers or by the patient.
“Treatment inertia occurs when a healthcare provider does not initiate, intensify, or use combination medications when needed, or does not check patients soon enough after starting treatment.
“This also applies to the delay in patients wanting to start diabetes medications, especially insulin, not wanting too many medications, and not knowing how to adjust insulin doses.
“Therefore, the way forward is education and empowerment of the patient to make correct and meaningful decisions.
“People with hectic lifestyles can find adherence to diabetes treatment cumbersome, resulting in a poor outcome,” says Dr. Shalini.
“For example, healthcare providers need to know why a certain drug is needed and the possible short-term and long-term side effects that they should watch for and warn a patient about. If patients do not understand and are not completely convinced (of the reasons or side effects), they may not want to comply with the treatment.
“On top of that, without proper knowledge of the disease, many patients don’t understand that their kidneys will deteriorate if they take diabetes medications.
“So they delay treatment, which could essentially cause kidney failure (nephropathy) and lead to other complications like cardiovascular disease, nerve damage (neuropathy), eye damage (retinopathy), ulcers, and foot infections.”
Adherence problems
While studies have shown that adherence to treatment is associated with better blood glucose control, nearly half of patients with diabetes fail to achieve their blood glucose goals.
She says: “Lack of adherence to medication represents a major barrier to effective diabetes control.
“For example, some medications and the frequency and timing of injections, especially with insulin, can be quite difficult to follow, especially for older and younger patients.
Many times, patients skip medications due to time constraints, forget to inject before a meal, or do not know how to adjust the dosage to their food portions.
“Adjusting the dose of medication, especially insulin doses, requires close monitoring of blood glucose, which is usually easily done with a home fingerstick test. Many are unaware that insulin can easily be carried with you (when you go out) and self-administer.
“The management of diabetes is highly dependent on the patient’s self-care and those with hectic lifestyles may find adherence to treatment, resulting in a poor outcome.”
Insulin problems
As one of the most powerful glucose-lowering drugs, insulin is capable of lowering the blood glucose level to normal when used correctly at the right dose and timing.
“For type 2 diabetes, it can be given once a day, two or even three times a day, combined with oral medications. Some doctors even recommend taking it up to four times a day to better control high blood glucose throughout the day.
“But more frequent injections contribute to noncompliance, and patients can sometimes skip injecting according to the prescribed frequency, causing their blood glucose to fluctuate,” says Dr. Shalini.
Since diabetes is a progressive disease, effective therapies are essential. Insulin, which is one of the main treatments, also has its downsides or downsides. There are two main side effects with insulin (weight gain and hypoglycemia) that are commonly seen with short-acting insulin and with high doses of insulin.
Physical activity plays an important role in managing diabetes.
“To date, insulin remains the main culprit for hypoglycemia, a state in which blood glucose is below 4.0 mmol / L, which can be dangerous and can prevent the patient from re-injecting. insulin, ”he says.
Two in one
Fixed-ratio combinations (FRC) of basal insulin and glucagon-like peptide 1 receptor (GLP-1 AR) agonists are a recently introduced treatment, combining both drugs in a single device for a single daily injection.
Says Dr. Shalini: “This not only simplifies treatment, but also provides a synergistic effect on glucose lowering by effectively targeting fasting and postprandial glucose (after meals) in a complementary manner.
“GLP-1 RA also helps limit the weight gain and hypoglycemia typically associated with other more complex or intensive insulin regimens.
“GLP-1 RA has been shown to induce weight loss in patients.
“The CRF of these two agents has been shown to achieve significant reductions in HbA1c in a wide variety of patients, bringing their blood glucose levels closer to normal with no increases in hypoglycemia or weight, compared to basal insulin alone and with lower gastrointestinal side effects due to slower titration of the GLP-1 RA dose. “
In short, both pharmacological and non-pharmacological interventions play an important role in the management of diabetes.
Effective treatment and long-term management of diabetes require good communication between the healthcare provider and the patient.
This will help both the healthcare provider and the patient closely monitor the patient’s condition and progress, and will develop a collaborative, patient-centered care approach to help increase adherence rates to medication, keep an eye out for complications related to diabetes and treat it accordingly.
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