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Erschienen in:
26.10.2017 | Letter to the Editor
Diabetes: the disease of the 10 D
Erschienen in: Endocrine | Ausgabe 2/2018
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Dear Editor, here we present a decalogue of D easy to recall to educate and train patients for a disease will inevitably change his life. The first 4D answer this question: “what is diabetes?” the following 3D answer “how the disease will impact my life?” and the last 3D “how can we tackle diabetes?”
1.
Deficiency in insulin secretion and/or action characterize type 1 and type 2 diabetes. The preservation of insulin production should be a crucial goal of diabetes treatment, as well as hyperglycemia control. It is now well recognized that a higher beta-cell reservoir is associated with better clinical outcomes in terms of both metabolic control and complications’ prevention.
2.
Duration: Diabetes is a chronic disease, characterized by long latency period, a protracted clinical course, no definitive cure and gradual changes over time. The improvements in quality of care has lengthened life expectancy, changing the landscape of diabetes. Diabetes has been consistently related to age-related disorders with challenges and uncertainties about the impact and management of long standing diabetes in elderly and frail patients [1].
3.
Devastating: Diabetes is the leading cause of cardiovascular disease, end-stage renal disease, blindness and non-traumatic lower-limb amputation. Prevention and treatment of complications are crucial to achieve satisfactory clinical outcomes. A multifactorial risk-reduction framework has led to consistent reductions in macrovascular complications, spreading hopes for the future of people with diabetes, but the war against this devastating disease is still far to be won.
4.
Diversity in genetic background, adiposity distribution, diets, habits and socioeconomic status causes significant differences in clinical features and pathophysiology of diabetes between different regions and ethnicities [1]. This cause differences in the efficacy of anti-diabetes drugs [1]. The knowledge of these differences is crucial to tailor new strategies to manage this disease in a globalized world.
5.
Daily: Diabetes challenges patients with daily problems difficult to manage. In the easiest case, patients should modify diet and life-style, affecting daily schedule, social behaviors and even his relatives’ habits. This burden gets worse when drugs become necessary, challenging patients with the risk of hypoglycaemia and drugs’ adverse effects. In such setting, the role of physicians is to motivate patients’ adherence to treatment plan by setting appropriate short- and long-term goals, by frequently monitoring patient’s mental and physical conditions, and by guaranteeing effective problem solving programs.
6.
Demanding: The above features imply diabetes requests continuous attention by the patient who is the main actor of diabetes management. Thus, the physician should empower the patient to take control of the disease [2]. People with diabetes need to cope with problems derived by diabetes and to be actively involved in the disease care. Patient education programs are able to improve clinical outcomes and are therefore essential for diabetes management [3]. People with diabetes should learn how to deal with the practical aspects of the disease by acquiring self-management skills and self-awareness of the associated risks.
7.
Depression affects up to 30% of diabetic patients. The required changes in lifestyle and diet, fear of the disease consequences, feelings of inadequacy and the lack of a definitive cure contribute to psychological distress in diabetes. Therefore, an appropriate screening for depressive disorders and therapeutic strategies such as cognitive behavior therapy should be offered to diabetic patients who showed higher rates of treatment satisfaction when receiving psychological support [4].
8.
Diet: Nutrition is among the foundations of diabetes care. Nutritional intervention is associated with significant improvements in HbA1c, blood pressure, lipids and body weight. Mediterranean-style diets, macrobiotic diet and Asian-style eating patterns have shown significant benefits in different aspects of diabetes management. Thus, diet can be individualized balancing patients’ preferences with therapeutic needs.
9.
Drugs: A huge number of different therapeutic strategies derives from the combination of the different drug classes approved for diabetes treatment, allowing a real tailored therapy. As different compounds act on different disease pathways, physicians should identify the most appropriate by considering clinical and biochemical features including age, body mass index, duration, autoantibody positivity, C-peptide, etc. A pathophysiology-oriented stepwise approach considering efficacy, risks and costs is suggested.
10.
Devices: Diabetes therapy is taking advantage from an impressive spread of new technologies. Evidence suggests that a careful evaluation of patient’s features is needed to target his needs with the appropriate device. If correctly used, new technologies allow better glycaemic control, lower hypoglycaemic risk and improve patient’s adherence to treatment. Overall, devices for diabetes care are now well-established in the management of the disease and future devices are among the greatest hopes for future diabetes management.