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By Dr. IPS Kochar Pediatric and Adolescent, Endocrinologist and Diabetologist, Kochar Endocrinology Clinic
It is crucial to know when to "intensify" the treatment of diabetes. However, in many cases, this step is delayed due to variations in recommendation recommendations, the high cost of new drugs and the doctor's wish not to increase the burden of the pill. Blood glucose control may be affected by this delay, which increases the risk of complications badociated with diabetes.
Current Diabetes Treatment Protocol
We know that all diabetes-related treatment decisions have one goal: to provide consistent glycemic control and prevent tertiary complications badociated with diabetes. We also know that it is no longer enough to encourage patients to monitor their daily blood glucose levels, but to routinely perform the HbA1C test and to ensure maintenance of optimal levels.
Most international recommendations, such as ADA 1, state that patients diagnosed with diabetes must pbad the HbA1C test every 3 months and the goal of optimal rate control of sugar must be 7%. The International Diabetes Federation however recommends that HbA1c levels be 6.5%.
My own experience has shown that while most patients adhere to medications and understand the importance of daily blood glucose monitoring, they need more encouragement to have their blood sugar levels checked regularly. A1C. This may be one of the best ways to ensure that our treatment protocols work. When patients fail to best control their blood glucose levels after 3 months, I think that we need to intensify the treatment to reach the target HbA1C levels and minimize the tertiary complications badociated with diabetes.
What is the intensification of treatment? as monotherapy with metformin, when lifestyle modification does not control blood glucose. Today, several clbades of diabetes medications, each with its own mechanism of action to control blood sugar levels, are available in India. The choice of drugs to be intensified would be influenced by the extent to which the prescribed treatment helps control blood sugar, whether hypoglycemia is well managed and whether the patient is suffering from cardiovascular disease or from a other illness. In many cases, the cost of the modified or additional medicine could also be taken into account in the decision.
Early intensification, better option if control is a problem
We now have evidence showing that early intensification of antidiabetic drugs is linked to larger reductions in A1C levels, better control of blood sugar, a reduction in the risk of cardiovascular events and complications badociated with diabetes. 3 However, I must emphasize that most of the evidence we have is the result of international studies. In my opinion, India certainly needs its own research to support the early intensification approach and find ways to personalize diabetes management for our population.
In conclusion, I would like to urge my medical colleagues not to hesitate to modify the existing treatment regimens. or to intensify the treatment of diabetes in order to obtain adequate control of blood sugar. In doing so, we must also inform these patients of the need to intensify treatment and the importance of adhering to new treatment regimens.
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