New Findings in Diabetes

Awareness and knowledge can help prevent health complications. Education plays an important role in informing people about the condition and how best to manage it through a healthy diet, regular exercise and necessary medication. This holds especially true for Diabetes which is a chronic condition caused by high blood sugar levels.

The 6th International Diabetes Summit (Virtual) - 2022 organised by Chellaram Diabetes Institute, Pune was one such attempt to make an impact in the field of Diabetes. The three-day summit witnessed numerous national and international dignitaries connect virtually and speak on the latest findings, techniques and technologies in the field of Diabetes - from clinical management to patient care, from the current challenges to the latest innovations in the world of Diabetes.

Following are some of the topics discussed during the three-day summit:

Perioperative Diabetes management

Dr Vinaya Simha (Consultant Endocrinologist in the Division of Endocrinology, and Assistant Professor, Department of Internal Medicine at Mayo Clinic, USA) discussed perioperative Diabetes

management. Perioperative means around the time of surgery. This usually lasts from the time the patient goes into the hospital for surgery until the time the patient is discharged. Management of blood sugar levels in the perioperative period is critical, especially in people with Diabetes. People with high blood sugar levels (> 300 mg/dL) are prone to wound infection, sepsis, urinary tract infection and pneumonia post- surgery. Post-surgery death is also seen to be commoner in people who have very high blood sugar levels.

Therefore, it is important to check blood sugar levels of all people undergoing surgery irrespective of whether they have been diagnosed to have Diabetes. Dr Simha advised that all people undergoing surgery should receive written/printed instructions about how to manage medication and insulin before and after surgery. This will ensure good outcomes after surgery, especially in people with Diabetes.

Improving patient care through Diabetes care app / digital technology

Dr Sanjay Kalra (President elect, South Asian Federation of Endocrine Societies Board member, International Society of Endocrinology, Kalra) discusses how advancements in technology have created novel

opportunities for healthcare services. Technology allows us to disseminate and share appropriate health education and medical services. By creating useful tools for screening, diagnosing, treating and monitoring diseases, technology has helped us bring down mortality for many of the common diseases.

Technological advancements ease self-monitoring and allow people with Diabetes to access tools through phones and computers. It becomes easier to monitor blood glucose and A1C levels in the comfort of their own homes using mobile apps which contain simple ways to track and monitor relevant labs as well as diet and exercise habits. Using mobile apps, people with Diabetes can track their average blood glucose readings, food intake, medication dosing, and activity data. Apps also allow people to set lifestyle goals, receive alerts about low or high blood glucose readings and even share their data directly with their health care providers. Some apps allow alerts which intimate about impending hypoglycaemia or hyperglycaemia.

People with Type 1 Diabetes need more frequent monitoring of their insulin intake and blood glucose levels. Some apps contain a recording option for self- monitoring blood glucose and an insulin bolus calculator. This calculator is comprehensive, using an algorithm to consider self-monitored blood glucose values, carbohydrate intake, and physical activity. It also takes into account clinician-set parameters for the insulin-carbohydrate ratio, correction factor and basal insulin dose.

Unusual infections in Diabetes

Diabetes is a multi-system disorder of metabolic origin. It is characterised by high blood sugar levels. Dr Bharat Purandare (Infectious Disease Physician, Pune) discussed the unique relation between Infection and Diabetes. Infections worsen insulin resistance and vice versa. Diabetes is associated with infections of skin, mucous membrane, soft tissue, respiratory and urinary tract and many other organ systems. Infections can be classified as viral, bacterial and fungal infections. High blood sugar levels and poor immunity increase the risk of infections in people with Diabetes. Certain infections are seen exclusively in people with Diabetes.

Rhinocerebral mucormycosis (infection of the sinuses, nasal cavity, oral cavity and brain), malignant otitis externa (infection of the ear canal and temporal bone), urinary tract infections (infection of the kidneys, ureters, bladder and urethra), emphysematous pyelonephritis (flesh eating bacterial infection of the kidneys and surrounding tissue) and skin and soft tissue infections (infection of skin, muscles, tendons, ligaments and fascia). Dr Purandare also emphasized that people with Diabetes are not at a higher risk of contracting Covid-19 but if they are infected then they are at a higher risk of severe, critical and fatal forms of Covid-19.

Vaccination is an effective tool to protect people with Diabetes against vaccine preventable infectious diseases.