For diabetic patients, excessive dietary restrictions can be life-threatening.

According to Dr. Nguyen Quang Bay, Head of the Endocrinology and Diabetes Department at Bach Mai Hospital, to achieve the target blood glucose level (HbA1C), patients are often given intensive treatment and strict dietary restrictions, which often come at the cost of hypoglycemia. For example, a 65-year-old female patient from Hanoi, diagnosed with diabetes two years ago, is currently being treated with Gliclazide 80mg twice daily and Metformin 1000mg daily.

Prior to hospitalization, the patient had fallen off a motorbike, but regained consciousness. A CT scan of the skull showed no injuries. Later, experiencing elbow pain, the patient went for a check-up, where capillary blood glucose was measured at 2.4 mmol/L, leading to emergency treatment for hypoglycemia.

During the clinical examination, the patient shared that on several previous visits, blood sugar levels were not low but consistently below 5.5 mmol/L, which was assessed as well-controlled, so the medication dose was maintained.

During this hospital admission, the patient's HbA1C test result was 6.7%, which is within the target (< 7.0%) according to treatment guidelines. "Based on experience, this patient may have experienced hypoglycemia multiple times, and that could be the cause of this 'spontaneous' fall," shared Dr. Quang Bay.

"However, to achieve the HbA1C target, patients are often given intensive treatment, which comes at the cost of hypoglycemia. To avoid hypoglycemia, patients need to use medications that are less likely to cause hypoglycemia (but these are expensive), monitor capillary blood glucose regularly or wear a continuous glucose meter (CGM), maintain a stable diet... in short, they must be financially well-off."

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

Note on the 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: the American Diabetes Association (ADA) of specialist physicians (setting a target of HbA1C < 7.0%) and the American College of Physicians (ACP) of internists (setting a target of HbA1C < 7.5%). "After some debate, they agreed on a common point: treatment goals should be tailored to each individual patient," Dr. Quang Bay shared.

In fact, there are many questions regarding the new AACE guidelines for treating type 2 diabetes in 2023. What are the key points to note? According to Dr. Nguyen Quang Bay, these guidelines emphasize the following 10 points:

1. Lifestyle changes should be the foundation for all therapies.

2. It is necessary to maintain or achieve an optimal weight.

3. The selection of hypoglycemic drugs should target blood glucose levels, cardiovascular disease due to atherosclerosis, congestive heart failure, chronic kidney disease, overweight/obesity, and non-alcoholic fatty liver disease (NAFLD).

4. Prescribe medications that are easily accessible (available) and easy for patients to use.

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

6. All glycemic targets (HbA1C, glucose management index [GMI], time of target glucose [TIR], postprandial and fasting glucose [FBG] and PPG) should 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 continuous glucose monitoring (CGM) to help them safely achieve their goals.

10. Comprehensive treatment is needed for co-morbidities such as hypertension, dyslipidemia, etc.

In short,The causes of diabetes are quite complex. Both genes and lifestyle factors play a role in causing diabetes. While type 1 diabetes is primarily caused by an autoimmune mechanism, the risk of type 2 diabetes is mainly due to an unhealthy lifestyle.

Most people can prevent diabetes through a healthy diet, increased physical activity, maintaining a healthy weight, and a healthy lifestyle. Therefore, in addition to taking medication as prescribed by doctors, patients also need a scientific and healthy diet that suits their own physical condition. Avoid overly strict diets or excessive consumption, as this can lead to dangerously low blood sugar levels that are life-threatening.

According to the WHO, approximately 422 million people worldwide currently have diabetes, a fourfold increase since 1980. In 2019 alone, diabetes was the direct cause of 1.5 million deaths. A national survey conducted by the National Endocrinology Hospital in 2002 showed that 2.7% of people aged 30-69 had diabetes. This increased to 5.4% in 2012 (after 10 years) and further to 7.3% in 2020.

The increase in diabetes is partly due to the rise in overweight and obesity and lack of physical activity. Diabetes is a metabolic disorder of carbohydrates, proteins, and lipids, characterized by elevated blood glucose due to a relative or absolute decrease in insulin secretion, insulin action, or both. When hyperglycemia exceeds the renal threshold, glucosuria (glucose in the urine) occurs.