Of Dr. IPS Kochar, Children and adolescents, endocrinologist and diabetologist, kochers endocrine clinic
Knowing when to intensify diabetes treatment is crucial. However, in many cases, this step is delayed due to variations in guidelines, the high cost of newer medications and the doctor's desire not to increase the pills load. Blood sugar control can lead to this delay increasing the risk of diabetes-related complications.
Current diabetes treatment protocol
We know that all therapeutic decisions for diabetes have one goal: ensure consistent blood sugar control and prevent tertiary complications associated with diabetes. We also know that now it is no longer enough to encourage patients to simply monitor their daily blood sugar levels, but to consistently do the HbA1C test and ensure optimal levels are maintained.
Most international guidelines like ADA 1 indicate that patients diagnosed with diabetes should take the HbA1C test every three months and the goal of optimal sugar control should be 7%. However, the International Diabetes Association recommends that HbA1c levels be 6.5%.
My own experience has shown that while most patients are on medication and understand the importance of daily blood glucose monitoring, they need more encouragement to have their A1C levels checked regularly. This may be one of the better ways to make sure our treatment protocols work. When patients fail to achieve optimal blood sugar control within 3 months, I believe that the intensification of treatment must be initiated to achieve target HbA1C levels and minimize diabetes-related tertiary complications.
What is treatment thought?
ADA guidelines recommend starting new patients on metformin monotherapy when lifestyle modification fails to achieve blood sugar control. Today, there are several classes of diabetes drugs, all of which have their own mechanism of action to control blood sugar levels in India. The choice of drug for intensification would be affected by how well the prescribed treatment controls blood glucose levels, whether hypoglycaemia is well managed and if the patient has any cardiovascular disease or other condition. In many cases, the cost of the altered or additional medicine can also be included in the decision.
Early intensification, the better options for control is a problem
We now have evidence that early anti-diabetic intensification is associated with higher reductions in A1C levels, better blood sugar control, reduced risk of cardiovascular disease and diabetes-related complications. 3 However, I have to point out that most of the evidence at our disposal is the result of international studies. India, in my opinion, really needs its own research to support the early intensification method and find ways to adapt diabetes care for our population.
In the end, I would urge my doctors not to hesitate to change existing treatment systems or to intensify diabetes treatment to achieve adequate blood sugar control. When we do, we must also consult these patients about the need for intensive care and the importance of following new regimes.