New guidelines on diabetes self-management education and support

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Management of diabetes is multidisciplinary and a team approach is the basis of care of the patient with diabetes, who is at the center of this team.

Diabetes self-management education (DSME) is a very important aspect of management in all patients with diabetes, including those with prediabetes. Optimal control of blood sugar is important; but, it is also important to control other risk factors such as hypertension, dyslipidemia in order to prevent the macrovascular and microvascular complications of diabetes. Because of the need for lifestyle modifications, patients with diabetes are themselves responsible for the day to day management of diabetes, but with the support of the doctor.

For the first time, the American Diabetes Association (ADA) and American Association of Diabetes Educators (AADE) have combined education and support (DSMES) and released new standards to help diabetes educators and medical providers establish and sustain patient care models, programs and teams for people with diabetes and their caregivers. These guidelines will be published in the September 2017 issues of Diabetes Care and The Diabetes Educator.

These standards relate to organizational structure, participation of community stakeholders, access, program coordination, instructional staff, individualizing diabetes education to the need of each patient, monitoring of patient progress and quality improvement. An up-to-date, evidence-based, and flexible curriculum provides education.

These standards emphasize that DSME alone does not translate into effective self care. Ongoing support is very important to improve patient outcomes.

The standards defined in these recommendations can be applied to both small solo practices, as well as large, multicenter facilities.

(ADA Press Release, July 28, 2017)
Dr KK Aggarwal
National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award, Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award
Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)
Past Honorary Secretary General IMA
Past Senior National Vice President IMA
President Heart Care Foundation of India
Gold Medalist Nagpur University
Limca Book of Record Holder in CPR 10
Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS
Member Ethics Committee Medical Council of India (2013-14)
Chairman Ethics Committee Delhi Medical Council (2009-15)
Elected Member Delhi Medical Council (2004-2009)
Chairman IMSA Delhi Chapter (March 10- March 13)
Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)

A healthy lifestyle can reduce risk of dementia

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Lifestyle has a major role to play in the health and well-being of a person. It’s not just physical health that benefits from a healthy lifestyle, but also mental health.

Dementia is usually regarded as a part of the normal aging process. But it is not always so. Dementia is also associated with lifestyle factors. And, the risk of dementia can be reduced by simple but effective lifestyle modifications. This is the key message from a new report of The Lancet Commission on Dementia Prevention, Intervention, and Care, presented at the recently concluded Alzheimer’s Association International Conference (AAIC) 2017 on July 20, 2017 and also published in The Lancet.

The report has identified nine lifestyle factors (as below) during the course of life – early, middle and later – that influence the risk of dementia. Many of these factors can co-occur.

The Report has for the first time considered social isolation and hearing as being pertinent to dementia. The level of education was also found to be an important risk factor. Poor education has been correlated with poor cognition.

1. Early life level of education
2. Midlife hypertension
3. Midlife obesity
4. Midlife hearing loss
5. Later life smoking
6. Later life physical inactivity
7. Later life social isolation
8. Later life depression
9. Later life diabetes

Prevention is always better than cure. These factors are potentially modifiable and addressing them timely can prevent dementia in a large number of people.

In addition to well-controlled hypertension and diabetes, early treatment of depression, weight loss, smoking cessation, being socially active, increasing physical activity, it is also important to engage in mentally stimulating and challenging exercises to keep the brain active. Develop a hobby, solve crossword puzzles, play chess or such challenging games to stay mentally active.

A healthy lifestyle adopted early in life builds up cognitive reserve for later life. It is important that we also advise our patients to start making positive lifestyle changes for a healthy old age.

(Source: Medscape)

Dr KK Aggarwal
National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award, Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award
Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)
Past Honorary Secretary General IMA
Past Senior National Vice President IMA
President Heart Care Foundation of India
Gold Medalist Nagpur University
Limca Book of Record Holder in CPR 10
Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS
Member Ethics Committee Medical Council of India (2013-14)
Chairman Ethics Committee Delhi Medical Council (2009-15)
Elected Member Delhi Medical Council (2004-2009)
Chairman IMSA Delhi Chapter (March 10- March 13)
Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)

Vitamin D supplementation: Choose vitamin D3 over D2

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Vitamin D deficiency is highly prevalent in India, almost in epidemic proportions. There are several reasons for deficiency of vitamin D. Lack of food fortification policies and more commonly our sociocultural practices, ‘sun-fleeing’ behavior, are major factors contributing to deficiency of this ‘sunshine vitamin’ in India which has abundant sunshine. Many people are unaware that they are vitamin D deficient.

Vitamin D, as we know, is essential for bone health. Evidence has also demonstrated its role in chronic diseases such as cardiovascular disease, cancer, diabetes, infertility, dementia and autism, among others.

There are two forms of vitamin D: vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). D2 is plant-based and D3 is derived from animal sources.

Vitamin D levels below 20 ng/ml need to be treated and are an indication for vitamin D supplementation.

The question arises which one to choose: vitamin D2 or D3?

Several international guidelines have recommended either D2 or D3 for vitamin D deficient patients stating that the two forms of vitamin D are equivalent and are equivalent in their effectiveness in treating patients with low vitamin D levels.

However, findings of a new randomized-controlled trial from the UK have raised questions on these recommendations as the study found that vitamin D3 was twice as effective in increasing levels of serum 25-hydroxyvitamin D (25[OH]D) compared to vitamin D2 at a low dose of 15 μg daily.

In the study published online July 5, 2017 in the American Journal of Clinical Nutrition, vitamin D3 fortified foods (juice, biscuits) during winters led to higher serum 25[OH]D levels after 12 weeks of supplementation compared to D2 fortified foods (juice, biscuits) in healthy South Asian and white European women.

Vitamin D levels in women who received vitamin D3 via juice or a biscuit increased by 75% and 74%, respectively vs those who were given D2 through the same methods. Those given D2 saw an increase of 33% and 34% over the course of the 12-week intervention.

Therefore, D3 should be the preferred form when advising vitamin D supplementation as it is the most effective form of increasing vitamin D levels in the body.

Even low doses of vitamin D3 are effective in achieving the desired levels as demonstrated in this study.

Sources

1. University of Surrey, Eurekalert Press Release, July 5, 2017.
2. Tripkovic L, et al. Am J Clin Nutr. 2017 Jul 5. Epub ahead of print

Dr KK Aggarwal
National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award, Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award
Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)
Past Honorary Secretary General IMA
Past Senior National Vice President IMA
President Heart Care Foundation of India
Gold Medalist Nagpur University
Limca Book of Record Holder in CPR 10
Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS
Member Ethics Committee Medical Council of India (2013-14)
Chairman Ethics Committee Delhi Medical Council (2009-15)
Elected Member Delhi Medical Council (2004-2009)
Chairman IMSA Delhi Chapter (March 10- March 13)
Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)

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