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Preventing and controlling ‘the silent killer’

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By Michelle Anne P. Soliman

DIABETES is a very common disease in the country. In fact, diabetes is the 8th leading cause of death in the Philippines — most patients are unaware that they have the disease and it is left untreated, earning it the moniker “silent killer.”

To increase people’s awareness of the disease, pharmaceutical company AstraZeneca and the Philippine Academy of Family Physicians launched Mission: Diabetes Early Control (EC) 365, a collaborative effort to address the detection and treatment of diabetes, at a media briefing on Oct. 12 at the SM Aura Premier, SMX Convention Center, Bonifacio Global City, Taguig.

Dr. Araceli Panelo, chairman of the board of the Institute for the Study of Diabetes Foundation, Inc., presented data from the International Diabetes Federation which stated that there were about 415 million diabetics worldwide in 2015. The organization has projected a 55% increase by 2040 — 642 million diabetic patients; 79.1% of the increase will come from Southeast Asia. Currently, the Philippines is the 11th top producer of diabetics worldwide. It is projected that the country will be in the top 10 by 2030.

“Diabetes is not just one disease. It is a group of heterogeneous disorders. The common denominator is high blood sugar. [It is] high blood sugar that is instrumental in bringing about complications,” Dr. Panelo said.

A patient whose glucose number is 5.6% or below is normal. A patient whose glucose number is 5.7-6.4% is considered to be in the pre-diabetic stage, while a glucose number of 6.5% and above means the person is diabetic.

‘WHAT IS HBA1C?’
Beyond blood glucose levels, diabetics should keep in mind their HbA1c levels.

According to Diabetes.co.uk, “HbA1c refers to glycated hemoglobin. It develops when hemoglobin, a protein within red blood cells that carries oxygen throughout your body, joins with glucose in the blood, becoming ‘glycated.’

“By measuring glycated hemoglobin (HbA1c), clinicians are able to get an overall picture of what our average blood sugar levels have been over a period of weeks/months.”

“For people with diabetes this is important as the higher the HbA1c, the greater the risk of developing diabetes-related complications.”

“HbA1c is also referred to as hemoglobin A1c or simply A1c.”

As Dr. Panelo explained, “HbA1c in the blood provides evidence of an individual’s average blood glucose levels during the past two to three months.”   

A normal HbA1c level is below 6%, prediabetics’ levels will range from 6-6.4%, while diabetics will register 6.5% and above.

Barely two out of 10 treated patients are achieving their A1c goal. Eight out of 10 treated patients are at risk of heart attack, stroke, high blood pressure, nerve damage, kidney damage, blindness, and even death, due to diabetes.

Dr. Panelo pointed out that in 2016, PhilHealth spent P7.6 billion for patients to undergo dialysis.

‘THE IMPORTANCE OF EARLY CONTROL OF DIABETES’
Dr. Aurora Macaballug, member of the Board of Directors of the Philippine Society of Endocrinology, Diabetes and Metabolism cited a study on early tight blood sugar control which predicted persistence of blood sugar control.

The study maintained a population of patients whose HbA1c was controlled. After a period of time, doctors allowed the relaxation of glycemic control as patients were permitted to perform daily activities without monitoring their sugar level. The results showed that those who were controlled early on in their disease showed better results. “Those who were initially controlled early on — who had HbA1c’s of 6.5% — most of them, had better HbA1c control after. [Meaning], if they had bad HbA1c early on, it’s difficult to control. A reduction of the complications follows with better control.”

She stressed the importance of controlling patients early in the disease, “There’s a metabolic memory. If you’re not able to control the patients in the early years [of diabetes] and then, [we] try to catch up to control them years after, [we] would have a hard time removing all the complications.”

She added that complications may be reduced and slowed down, but it can no longer go back to zero. “Prevention is knowing your risk and doing something about it.”

‘ROLE OF PRIMARY CARE’
Primary care physicians are at the forefront of diabetes care. Dr. Karin Garcia, executive secretary of the Philippine Academy of Family Physicians, highlighted the challenges faced by primary care physicians in the country. These include the need for updates and consistency in diagnosis, evaluation, and management, and long intervals between patients’ visits due to scheduling problems.

Primary care physicians are called to stop the consequences of poor adherence by patients to medications which lead to microvascular and macrovascular complications.

Dr. Garcia said that lifestyle modification, counseling, and motivation to change are essential to the patient’s recovery. “Mapakadaling mag-change (It is very easy to change), but the maintenance is the hardest part in the motivational circle.”

MISSION: DIABETES EARLY CONTROL 365
So we come to Mission: Diabetes Early Control 365, which is a nationwide reduction movement of 365,000 HbA1c in 365 days.

The mission will focus on the “4Ms” of diabetes prevention and management: motivation, mentoring, monitoring, and medication.

“If we can put all our patients in three months time of achieving the goal of 6.5% of HbA1c, then we have achieved our goal,” said Dr. Joey Miranda, a member of the steering committee of Mission: Diabetes Early Control 365. 

To achieve their goal, Dr. Miranda listed strategies such as continuing education and awareness about the disease, enhancing the training of health care professionals, and promoting nutrition counseling and exercise tips to patients.

“Though we are a Third World country, it does not mean we cannot achieve it. We can,” he said.

As part of Mission: Diabetes Early Control 365, AstraZeneca is hosting a Diabetes Fair this month in 12 cities around the country. It will include risk factor screening, tips on healthy food options, an educational talk, and a dance routine session.

The cities and provinces covered in the mission are Taguig City, Parañaque City, Marikina City, Lipa City, Bulacan, Pangasinan, Baguio, Cavite, Batangas, Cebu, Iloilo, and Cabanatuan.

For more information, visit www.astrazeneca.com or the Philippine Academy of Family Physicians’ official Facebook page. 

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