Overall Type 2 Diabetes treatment
Do you know that the prevalence of type 2 diabetes continues to rise in an exponential rate around the world? This is why we go for this overall type 2 diabetes treatment. From the Third National Health and Morbidity Survey (3rd NHMS) showed that the prevalence of the T2DM for adults aged 30 years old and above are 14.9% in Malaysia. The prevalence of type 2 diabetes is highest in Indian ethnic as it is 19.9% for 30 years and above.
What is Diabetes?
Diabetes is one of the common disorder and it is due to insulin resistance and/or deficiency as well as increased glucose production by the liver. Diabetes is also a risk factor for cardiovascular diseases (heart disease).
Currently, there is no cure for this disease, but this disease can be controlled enabling the person to lead to a healthy and productive life.
According to study, up to 48% of the patients who aged 30 years old and above not aware that they have diabetes. Therefore, it is important to aware of the sign and symptoms of diabetes. If you have type 2, focus on your type 2 diabetes treatment seriously.
The aim of management is to reduce the diabetes complications (microvascular and macrovascular).
DIET and PHYSICAL ACTIVITY is the mainstay of treatment, while medication can be given at diagnosis for appropriate patients.
Recommendation: Screening and Diagnosis
- For those people with risk factors and >30 years old should perform screening for diabetes using fasting blood sugar annually.
- In children and adolescents, who is at risk of developing diabetes should perform screening at 10 years old or at onset of puberty (if puberty occurs at younger age) every two years.
Lifestyle modification in term of healthy diet and exercise is important in type 2 diabetes treatment, preventing diabetes, managing existing diabetes and also delay complications. Proper diet is important in order to manage diabetes including those medication.
The goal is to maintain blood sugar, blood pressure, blood lipid as close to normal as possible in order to reduce the risk of complications.
A weight loss of 5 to 10% of the baseline weight over a six months period is recommended for all overweight and obese patients. This can be achieved by reducing calories or increase exercise
A balanced diet should be practices which compromises of carbohydrate, protein and fats to improve your type 2 diabetes treatment.
A high fiber (20-30g per day) is encouraged which is equivalent to 5 to 7 servings per day which consists of vegetables, fruits, legume, and whole grain products
Meal timing is important for diabetic patient as meal timing should be regular. Do not skip meals (three main meals is a must).
Simple carbohydrate such as sugar, honey, cakes should be avoided or limited to one serving per month. As simple carbohydrate will increase the blood sugar dramatically.
People with diabetes should avoid saturated fats, trans fats and cholesterol containing foods in order to reduce the risk of heart diseases.
2. Physical activity
- The duration of exercise is 150 min per week.
- It should be being divided into 5 days a week, most day of the week with no more than 2 consecutive days without physical activity.
- Brisk walking is recommended for all. Other example of activity is jogging, cycling, swimming, hiking and badminton.
- For a long term major weight loss, overweight and obese people should gradually increase the physical activity (60-90 minutes per day).
- An increase in physical activity level is beneficial as well such as mopping, sweeping, gardening, use the staircase instead of elevator.
- If the glycaemic target is not achieved even with lifestyle modification within 3 months, oral medication should be initiated by the doctor.
- Usually, metformin would be the preferred choice or first line of therapy for diabetes. If metformin alone does not work, doctor will prescribed combination of oral medication.
- Other than that, it could be combination of oral medication and insulin injection. Insulin injection can be increased until fasting blood sugar is achieved.
- Medication should be taken every day without fail. If one forgot to take medication during the meal, do not double the dosage for the next meal.
- For long term insulin injection, make sure that you inject the correct dosage every time.
- Too much insulin or too little carbohydrate food will cause hypoglycaemia which is very dangerous to patients.
Self-monitoring blood glucose (SMBG) can be perform in order to have a better glycaemic control. SMBG should be carried out for patients who are on insulin and patient who take oral anti-diabetic drugs.
For people who is on multiple insulin injection or insulin pump, it is recommended that self-monitoring blood glucose should be carried out three or four times every day. Post prandial blood sugar reading (blood sugar reading after meals) may be appropriate to achieve postprandial glucose targets and it have to be two hours after meal.
- HbA1c will reflect overall glucose control over a three months period and the recommendation target level is 6.5 %.
- Besides that, it should be measured approximately every 3 to 6 months in order to ensure that the glycaemic targets are met.
- In order to achieve HbA1c of <6.5%, aim for fasting blood glucose or pre-prandial blood sugar of 4.4-6.1mmol/L, 2 hours post prandial blood sugar targets of 4.4 to 8.0mmol/L.
- The Third National Health Morbidity Survey (NHMS III) Diabetes Group. Ministry of Health Malaysia, 2006.
- American Diabetes Association (ADA). Consensus Statement on Type 2 Diabetes in Children and Adolescents. Diabetes Care 2000; 23: 381 – 389.
- Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle Among Subjects with Impaired Glucose Tolerance. N Engl J Med 2001; 344: 1343 – 1350.
- Knowler WC, Barrett-Connor E, Fowler SE, et al for the Diabetes Prevention Program (DPP) Research Group. Reduction in The Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. N Engl J Med 2002; 346: 393 – 403.
- Medical Nutrition Therapy Guidelines for Type 2 Diabetes. Malaysian Dietitians’ Association, 2005.
- Schulze MB, Liu S, Rimm EB, et al. Glycemic Index, Glycemic Load and Dietary Fiber Intake and Incidence of Type 2 Diabetes in Younger and Middle-aged Women. Am J Clin Nutr 2004; 80: 348 – 356.
- Boule N, Haddad E, Kenny G, et al. Effects of Exercise on Glycaemic Control and Body Mass in Type 2 Diabetes Mellitus: A Meta-analysis of Controlled Clinical Trials. JAMA 2001; 286: 1218 – 1227
- United Kingdom Prospective Diabetes Study (UKPDS) 33 Group. Intensive Blood-glucose Control with Sulphonylureas or Insulin Compared with Conventional Treatment and Risk of Complications Inpatients with Type 2 Diabetes. Lancet 1998; 352: 837 – 853
- American Diabetes Association (ADA). Position Statement on Standards of Medical Care in Diabetes – 2009. Diabetes Care 2009; 32: S13 – S61.
- International Diabetes Federation (IDF). Global Guidelines for Type 2 Diabetes, 2005. Available at: http://www.idf.org/webdata/docs/IDF%20GGT2D.pdf.