Diabetic patients who abstain too much can be life-threatening.

According to Dr. Nguyen Quang Bay - Head of the Department of Endocrinology and Diabetes - Bach Mai Hospital, to achieve the target blood sugar index (HbA1C), patients are often given intensive treatment and strict diets, so the price to pay is hypoglycemia. For example, a 65-year-old female patient in Hanoi was diagnosed with diabetes for 2 years and is being treated with Gliclazide 80mg x 2 tablets/day and Metformin 1000mg/day.

Before being admitted to the hospital, the patient fell off his motorbike, then regained consciousness, and had a CT scan of his skull that showed no injuries. After that, he felt pain in his elbow and went for a check-up. His capillary blood sugar was measured at 2.4 mmol/L, so he was admitted to the hospital for emergency treatment for hypoglycemia.

During clinical examination, the patient shared that there were many times when he went to the clinic and had blood sugar tests that were not low but were always at <5.5 mmol/L, which was considered well controlled, so he was given a maintenance dose of medication.

On this hospital admission, the patient's HbA1C test was 6.7%, which is the target (<7.0%) according to treatment guidelines. "According to experience, this patient may have had many episodes of hypoglycemia, and that may have been the cause of this "self" fall" - Dr. Quang Bay shared.

"However, to achieve the HbA1C target, patients are often given intensive treatment, so the price to pay is hypoglycemia. To avoid hypoglycemia, patients need to use drugs that cause less hypoglycemia (but are expensive drugs), measure capillary blood sugar regularly or wear a continuous glucose monitor (CGM), have a stable diet... in short, they must be people with economic conditions.

Otherwise, patients should accept that blood sugar and HbA1C may be slightly higher than the target, for example HbA1C < 7.5%, but the risk of hypoglycemia will be limited. Of course, patients will be more susceptible to chronic complications of diabetes" - Dr. Quang Bay shared more.

Notes on treatment of type 2 diabetes

According to Dr. Nguyen Quang Bay, at the ADA Conference in San Francisco in 2019, there was a debate between two representatives of the American Diabetes Association - ADA of specialists (setting the target HbA1C < 7.0%) and the American College of Physicians - ACP of internists (setting the target HbA1C < 7.5%). "After a while of debate, they agreed on the common point that the treatment goal depends on each specific patient" - Dr. Quang Bay shared.

In fact, there are many questions about what is noteworthy in the new AACE type 2 diabetes treatment guidelines in 2023? According to Dr. Nguyen Quang Bay, this guideline emphasizes the following 10 points:

1. Lifestyle changes must be the foundation of any therapy

2. Need to maintain or achieve optimal weight

3. The choice of antihyperglycemic agents should target glycemic targets, atherosclerotic cardiovascular disease, congestive heart failure, chronic kidney disease, overweight/obesity, and non-alcoholic fatty liver disease (NAFLD).

4. Prescribe medications that are easy for patients to access (buy) and use.

5. The optimal HbA1C target is 6.5% or as close to normal as is safe and achievable.

6. All glycemic targets (HbA1C, glucose management index [GMI], time in target [TIR], fasting and postprandial blood glucose [FBG], and PPG) need to be individualized for each patient.

7. Try to reach your blood sugar target as soon as possible (within 3 months)

8. Avoid hypoglycemia

9. Encourage patients to use a continuous glucose monitor (CGM) to help them safely reach their goals.

10. Comprehensive treatment of associated diseases such as high blood pressure, dyslipidemia, etc. is required.

In short,It can be said that the causes of diabetes are very complex. Both genes and lifestyle factors play a role in causing diabetes. While type 1 diabetes is mainly caused by an autoimmune mechanism, the risk of type 2 diabetes is mainly due to an unhealthy lifestyle.

Most people can prevent diabetes by eating a healthy diet, increasing physical activity, maintaining a reasonable weight and leading a healthy lifestyle. Therefore, in addition to taking medication as prescribed by doctors, patients also need to have a scientific, healthy diet suitable for their own physical condition. Do not abstain too harshly, do not abuse because it can cause hypoglycemia, which is dangerous to life.

According to WHO, there are currently about 422 million people in the world with diabetes, a four-fold increase since 1980. In 2019 alone, diabetes was the direct cause of 1.5 million deaths. In a national survey by the Central Endocrinology Hospital on a national scale, in 2002, 2.7% of people aged 30-69 had diabetes. In 2012 (after 10 years), it increased to 5.4%, and by 2020 it increased to 7.3%.

The rise in diabetes is partly due to the rise in overweight, obesity and physical inactivity. Diabetes mellitus is a disorder of carbohydrate, protein and lipid metabolism, characterized by increased blood glucose due to relative or absolute reduction in insulin secretion, insulin action or both. When blood glucose exceeds the renal threshold, glycosuria (glucose in the urine) occurs.