Diabetes is spiraling out of control worldwide with ‘Every 10 seconds, 3 people developing diabetes’.The number of patients with diabetes globally are increasing alarmingly and expect to reach 592 million by 2035. On the other hand, every 6 seconds 1 person dies from diabetes-related complications (IDF Atlas 6th ed). People with type 2 diabetes (T2D) are at the highest risk of renal disease. And hyperglycemia is one of the leading risk factors along with hypertension, dyslipidemia, and genetic factors. According to the latest National Health and Nutrition Examination Survey (NHANES) data on adults with diabetes, ~50% of patients did not achieve an A1C &lt;7% (Fang M et.al 2021). Most patients with T2D from a study in Europe also did not achieve the desired HbA1c goals. Only 31% of individuals were seen to achieve good glycemic control (HbA1c&lt;/=6.5%) according to current European guidelines (Leibel A et.al 2002). DAR global survey 2020 accommodating 15 different countries highlighted, that 5865 patients globally with type 2 diabetes had an average HbA1c of 8.4%. Out of these, those having HbA1c &lt;7.5% are only 36%, thus posing as a huge gap for hyperglycemia consequences.&nbsp;This has led to ponder upon the reasons whether hyperglycemia is the forgotten enemy?&nbsp;Multiple factors contribute to clinical inertia. Physician-related, Patient-related, and Healthcare-system related are three major areas responsible for clinical inertia. The average GP consultation time and the highest globally is in most of the European countries amounting to 15-20 mins. Most of the regions worldwide have an average consultation time of 5 min or less. That leaves almost negligible time for the physician to spend on patient education and counselling. This therapeutic inertia from the physicians is the reason for a delay in time to treatment intensification. The inertia is responsible for contributing to the development of complications and cost of T2D.&nbsp;Data have shown that early treatment intensification and glycemic control in patients with T2D is important. A retrospective analysis from the UK CPRD database of patients with T2D (2000-2014) showed patients who were rapidly intensified achieved a maintained reduction in HbA1c faster than those with delayed intensification or no second-line therapy, despite a higher baseline HbA1c (Watson L et al. 2016). And the role of education for better diabetes care is what makes the difference in such cases.&nbsp;In conclusion, hyperglycemia is directly related to all diabetes-related complications. Early treatment intensification is the key to tackle diabetes and improve glycemic control. However, measures to improve treatment adherence and physicians’ inertia must be adopted and encouraged. Patient educators play a key role in overall management of type 2 diabetes patients. A holistic approach should be used to address all the cardiovascular risk factors needed to minimize diabetes related complications.&nbsp;Our reporting is based on the information presented during the 58th EASD Annual meeting 2022.

Hyperglycemia – 'The forgotten' enemy: DESG Symposium: Therapeutic Patient Education - past, present and the future

Early treatment intensification is the key to tackle diabetes and improve glycemic control

Heart failure is the most common cause of hospitalization worldwide. Heart failures are categorized based on ejection fraction. There is heart failure with reduced ejection fraction (HFrEF, LVEF &lt; 40%), heart failure with mildly reduced ejection fraction (HFmrEF, LVEF 40%-49%), and heart failure with preserved ejection fraction (HFpEF, LVEF ≥50%) with lower limit of normal is men being 52% and 54% in women.Heart failure with reduced ejection fraction (HFrEF) or mildly reduced ejection fraction (HFmrEF) occurs due to secondary compensatory activation of renin-angiotensin-aldosterone system, adrenergic system which leads to adverse remodeling causing maladaptive compensation. It is also called as systolic heart failure or systolic dysfunction. HFpEF is much more complex and is referred to as diastolic dysfunction.&nbsp;Type 2 diabetes (T2D) has a unique relationship with HFpEF.A large cohort study Swedish Diabetes Registry (Rawshani, et al. NEJM 2018) assessed risk of outcomes such as death, acute myocardial infarction, stroke, and hospitalization for heart failure in patients with type 2 diabetes. The risk of hospitalization for heart failure was consistently higher among patients with diabetes than among controls (hazard ratio, 1.45; 95% CI, 1.34 to 1.57). For patients with type 2 diabetes, if all the other risk factors such as smoking, lipid, blood pressure are controlled, the excess risk of death, myocardial infarction, and stroke can be eliminated whereas risk of heart failure remains unaffected.&nbsp;In another population-based study (Thrainsdottir et al, Diabetes care 2005), strong association between any form of diabetes and heart failure. The prevalence of heart failure is doubled in subjects with type 2 diabetes. In a Swedish Heart Failure registry (Johansson, diabetes, and Vascular Disease Research 2018) study, type 2 diabetes was independently associated with increased mortality (hazard ratio 1.5) in subjects with heart failure. Similar clinical studies have demonstrated that diabetes is the strongest risk factor in subjects with heart failure.&nbsp;Obesity is also a risk factor for HFpEF. In a study by Pandey, JACC 2017 as the BMI increases there is no increase in HFrEF but there is a dramatic increase in HFpEF. BMI predicts new onset HFpEF but not HFrEF. 85% of subjects with HFpEF are overweight or obese. HFpEF associated with obesity can easily be treated with aerobic training and caloric restriction.In recent years, few trials demonstrating efficacy or non-inferiority of SGLT2 inhibitors in heart failure in patients with T2D have been published showing relative reduction in the rate of cardiovascular death or heart failure hospitalizations.T2D increases the risk of heart failure especially HFpEF. The mechanisms are hypothesized to involve systemic inflammation and microvascular endothelial function, leading to altered metabolism and cardiac fibrosis, stiffness, and impaired relaxation, as well as vascular, kidney and multi-organ involvement. These mechanisms may be especially amenable to treatment with SGLT2 inhibitors and in future they may also be amenable to treatment of emerging agents for T2D/obesity/NASH.Our reporting is based on the information presented during the 58th EASD Annual meeting 2022.

Heart failure in type 2 diabetes: Is it about HFpEF, HFrEF or both? Status and the next step

The Effects of Type 2 Diabetes on Heart

INTRODUCTIONThis educational video draws attention to the theme of World Diabetes Day 2021-2023, access to diabetes care. This theme emphasizes the need to provide ongoing care and support to patients with type 2 diabetes (T2D), which can be achieved through educational interventions delivered at the appropriate time. The video highlights ways healthcare professionals can make the most of the limited time they have when counseling their patients, as well as different ways to improve diabetes self-management education for patients. patients. This session is intended for primary care physicians, family physicians, general practitioners, endocrinologists, diabetologists, cardiologists, and other physicians involved in diabetes management.The session consists of the following lectures:<ul><li class="ql-align-justify">Education to control diabetes </li></ul>After attending the interactive session, the learner should be able to:<ul><li>Understand the importance of diabetes self-management education and support to improve patient compliance.</li><li>Focus on the four critical moments when diabetes education needs to be improved effectively</li><li>List the measures to adopt at each of these four critical moments to reduce the complications of T2D</li><li>Understand the WHO targets for diabetes coverage and understand how to achieve them by 2030.</li></ul>Expert facultyDr. Eva NjengaMedical consultant in endocrinology and diabetesChairman of the NCD Alliance of Kenya

Education to control diabetes

Super Module 1: Laying the Foundations

World Diabetes Day

Highlights from the 58th EASD Annual Meeting

Early diagnosis and treatment start for type 2 diabetes

Join our celebration on World Diabetes Day

Dr. Eva Njenga

INTRODUCTIONThis educational video is an overview of the East Africa Diabetes Study Group (EADSG) insulin therapy in type 1 diabetes (T1D). It focusses on safety and efficacy parameters which need to be examined when prescribing insulin therapy. Glycemic targets should be individualized, based on education and socio-economic status of patients. Furthermore, it is of prime importance to assess resources available to manage hypoglycemia when a particular type of insulin is prescribed in T1D. This session is aimed at primary care physicians, family physicians, general practitioners, endocrinologists, diabetologists, cardiologists, and other physicians involved in the management of diabetes. The session consists of the following lectures:<ul><li class="ql-align-justify">EADSG: Insulin therapy in Type 1 diabetes </li></ul>After attending the interactive session, the learner should be able to:<ul><li class="ql-align-justify">Understand the organization of guidelines produced to suit the population of East Africa </li><li class="ql-align-justify">Highlight safety and efficacy parameters such as ideal glycemic targets and different types of insulins available for patients with T1D</li><li class="ql-align-justify">Create a stepwise approach for insulin initiation and intensification in patients with T1D</li><li class="ql-align-justify">Help patients acquire the knowledge of closely monitoring of blood glucose at home, as well as methods to combat hypoglycemia </li></ul>Expert facultyProf. Silver Bahendeka, FRCPI, PhDMKPGMS-Uganda Martyrs University,St. Francis Hospital, Nsambya, Uganda