Page 48 - Demo

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HEALTH DIABETES
FROM PAGE 44
fundamental to the management of the condition,” he said. “And pharmacists play a huge role because they’re seeing [patients] regularly for their medications.”
The role of diet
While much controversy surrounds the best dietary management plan for people with type 2 diabetes,
Dr Barclay says it boils down to a “good healthy diet”.
“It can be either high in carbohydrates or low in carbohydrates,” he said.
“The evidence suggests it doesn’t really matter as long as the quality of the foods that you’re eating is high.”
This includes “high quality protein” (animal or vegetable) and “good quality fats, preferably mono- and poly- unsaturated fat and less saturated fat”.
Dr Barclay says that in terms of carbohydrates, it’s not necessarily about whether to include them in the diet or not, but about quality.
“Make sure that the carbohydrate
that they [patients] do eat is quality,”
he said. “So, high in fibre, wholegrains, fruits and vegetables, preferably those with low GI, which is a measure of how carbohydrate foods affect blood glucose levels. So, the low GI options are
better choices.”
Addressing the debate that
often erupts when talk about carbohydrates begins, Dr Barclay said: “Studies show there’s a very slight edge for a low carbohydrate diet in
the first three to six months, but by 12-plus months there’s no difference between the two with respect to
blood glucose levels. So, there’s short- term benefit for some, but it doesn’t mean that everybody needs to go on it. That’s the important point.
“Food isn’t medicine. It’s much more than medicine. We have it for special occasions. It’s about the pleasure of eating [too]. So, just making sure we don’t eat too much and that what we do eat [is] quality – the quality is the important thing rather than following the latest, or what might appear to be the latest, dietary fad.”
When it comes to diet advice, pharmacy staff are well placed to provide education around the basics.
The recommendation should be
“a good healthy diet, reduced in kilojoules to help people lose weight,
making sure that the quality of the
food ... is the best [they] can afford”,
Dr Barclay says, adding that for anything more specific, patients should be referred to an accredited practising dietitian, who is best placed to give individualised advice and can work with a patient to determine “what works for [them] from a metabolic perspective but also from a cultural, family and personal preference [perspective]”.
Diabetes complications
Experts agree that managing blood glucose levels, and keeping them within the optimal range – “6-8mmol/L if you’re fasting, in the morning for example, or 8-10mmol/L two afters after a meal”, according to Dr Barclay – will help to reduce chances of developing diabetes complications.
“There’s very good evidence from randomised control trials around the world that if you keep your blood glucose levels under control then you can reduce your risk of developing complications like diabetic neuropathy,” Dr Barclay said.
“It’s not inevitable. [Diabetic complications] can be prevented if you manage your condition well. That, of course, is easier said than done. If you try very hard and you’re working with your diabetes team, then hopefully you can manage it well enough to keep the complications away.”
Ms Itzstein and Ms Crow added: “Major studies support decreasing persistent hyperglycaemia to reduce the risk of microvascular and macrovascular complications.
“Macrovascular complications are the result of atherosclerosis and include coronary heart disease, cerebrovascular disease and peripheral vascular disease. Microvascular complications include neuropathy, autonomic and peripheral neuropathy and retinopathy.”
Furthermore, they say uncontrolled diabetes and persistent high blood glucose levels may also lead to “erectile dysfunction, periodontal disease, poor wound healing and increased infections”.
A closer look at diabetic peripheral neuropathy (DPN)
Lui et al, in the research article,
‘The risk factors for diabetic peripheral neuropathy: A meta-analysis’, published in PLOS One (2019), state that
“diabetes peripheral neuropathy is the most common cause of neuropathy worldwide [and that] it is estimated
to be present in approximately half of those with diabetes, and 10 to 20 per cent have symptoms that are severe enough to warrant treatment”.
They add that while “patients with diabetes are extremely difficult to treat once they develop neuropathy ... appropriate interventions can reduce ulcers by 60 per cent and amputations by 85 per cent in those with high-risk DPN”.
According to Mr Quigley, DPN
“can happen and is a total result of poorly controlled blood glucose levels”.
“We look at things like tingling, numbness, loss of sensation in the arms and legs, and a burning sensation in the feet and hands,” he said. “So, that sort of person loses their ability to sense temperature and pain – so you can [easily] burn yourself,” he said.
Dr Barclay says DPN “seems to happen over time, so it’s thought to be due to high blood glucose levels”.
“If you haven’t been managing your diabetes well for a long period of time then the slow accumulative damage can affect the nerves and blood vessels in the lower limbs,” he said.
With DPN being largely the result
of uncontrolled blood glucose
levels, Mr Quigley underscores the importance of blood glucose control, adding that there may be some other nutritional issues at play with peripheral neuropathy (PN).
“We know that vitamin B12 plays a role in PN, and sadly the commonly prescribed medication [for diabetes], which is called metformin, can contribute to low levels of vitamin B12,” he said. “It saddens me that vitamin B12 is not more commonly discussed when metformin is dispensed, even to the point of making sure that you have your vitamin B12 levels monitored, if needed. Then we can talk about some sort
of supplement.”
Ms Itzstein and Ms Crow said:
“Addressing lifestyle
factors such as maintaining
healthy eating and daily
regular activity is a lasting
foundation for managing
type 2 diabetes.”
RETAIL PHARMACY ASSISTANTS • JUL 2020