DIABETES mellitus (DM) is a common chronic metabolic disorder that affects almost all body systems either directly or indirectly.
Because of its strong predisposition to cardiovascular diseases, diabetes has been recently labelled as a cardiovascular equivalent even if the patient has no clinical cardiovascular disease. Besides other complications, diabetes mellitus is a major risk factor for high blood pressure (HBP), ischaemic heart disease (IHD), heart failure (HF), strokes and end-stage renal disease (ESRD). Diabetes mellitus, HBP and hyper cholestrolaemia usually occur in association and together multiply the risk for IHD. It has been postulated that the above mentioned three apparently silent diseases have a common underlying pathology.
Diabetes mellitus and HBP make a lethal combination. Both diseases have the potential to affect vital organs like the brain, the heart, kidneys and the eyes. Both conditions affects blood vessels and cause their narrowing producing regional ischaemia. This adversely affects the function of the organ supplied with diseased arteries.
More than one-third of IHD patients suffer from diabetes mellitus. Diabetic IHD patients have special diagnostic, clinical and prognostic features. Diabetic patients suffering from various subsets of IHD may not experience the typical chest pain and can often have silent heart attacks (myocardial infarction). This silent nature of their ischaemia often leads to missed diagnosis, with resultant adverse consequences.
Diabetic IHD patients, in particular females, are the most difficult group as far as the diagnostic modalities are concerned.
On coronary angiography, diabetic patients have shown to have small calibre vessels that are often diffusely diseased. This compromises their suitability for percutaneous coronary intervention (angioplasty and stent implantation).
Surgical options (coronary artery bypass surgery) also has limitations and inherent problems in diabetic patients. Diabetes mellitus therefore is not only a common disease but it is serious and if left unattended can lead to life-threatening complications.
The diagnostic criteria for diabetes mellitus has been a subject of constant review. Blood sugar readings that were once thought to be normal are now considered worth treating. Whereas on the one hand the incidence of diabetes mellitus has for various reasons increased in our population, on the other significant advancements have also taken place in the understanding and therapeutics of the disease over the past two decades.
Public and patient education on the awareness, diagnosis, treatment and follow-up of diabetes has changed the entire outlook on the disease in the western countries. Not only diabetics are leading normal life, they are taking part in sports and physical activities. The situation in our part of the world, though not satisfactory, has also definitely changed. Thanks to the Diabetic Association of Pakistan awareness on the subject and physicians’ realization of the problem have increased. Various other societies and associations are also contributing towards better diabetic control.
The problem, however, is multi-dimensional. Though scarcity of resources is a fundamental issue in all areas it is illiteracy, ignorance and the presence of quackery that make the task of diabetes control difficult. A country where even the urban population is not immune to quackery and mumbo-jumbo treatments, one can realize the challenges faced by the physicians.
Type 2 Diabetes Mellitus, which is also called adult onset diabetes or non-insulin dependent diabetes, is the commonest type of diabetes mellitus. This disease which is related to age is often associated with obesity and is to a great extent preventable. Unfortunately, preventive medicine has not yet received any serious attention from the profession, policy makers and the public. Our population is only tuned to emergency medical care. The entire health system operates on a ‘crisis oriented’ approach and no preventive measures are considered for practice during normal circumstances.
If we are serious about our health and realize the scarcity of resources available to deal with disease, we have to introduce preventive medical education in our school and college curriculum. Chairs of preventive medicine must be established in all medical Institutions. Modern pharmacotherapy, cost-effective home blood-sugar monitoring equipment and laboratories must be optimally utilized to achieve diabetic control at the community level. The need for healthy diets, combined with some degree of physical activity (perhaps simple walking), needs to be emphasized.
Smoking is poison for everybody, but for diabetics this is more than poison. Diabetic smokers get vascular complications much earlier. This menace also needs to be contained through education campaigns and by forcing the government to enforce necessary legislative measures.
Diabetes is a serious multi-system disease but with earnest preventive efforts initiated at an early age, proper diagnostic and therapeutic approaches and regular followup, we can ensure a normal and complication-free life with normal life expectancy.
