OPINIONPeople Daily

Diabetes should be managed by team of specialists

Sairabanu Sokwalla

Do you or anyone close to you has diabetes? Are you in a dilemma on where best to visit for its management? What are the criteria for choosing the right doctor or facility for diabetes management? Well, here are some tips to guide you in your choice.

Diabetes is a chronic disease with implications on various aspects of life including, but not limited to, social, emotional, financial, psychological and physical aspects. It is a condition associated with co-morbidities like high blood pressure, fat abnormalities, obesity, depression, sleep disturbances amongst others, each of which independently increase risk for cardiovascular diseases and when in combination multiply the risk several fold.

In addition, diabetes predisposes one to numerous complications such as eye disease with blindness, kidney failure, heart attacks, stroke and nerve damage.

To manage such a complex condition requires a multidisciplinary team effort and immense support aimed at empowering the patient to self-manage the disease. Furthermore, with all the implications stated, it is imperative to focus on early detection and prevention of diabetes, early detection of complications and prevention of progression.

Keeping all the above in mind, it is evident that diabetes cannot be managed by a single physician. It is, therefore, important to seek medical care for diabetes in a facility which can provide the patient with a multi-disciplinary team approach.

Through this approach, the increasing healthcare costs associated with diabetes care can be lowered and patients’ health risks can be minimised through collective assessment, early surveillance and timely intervention.

Core members of the multidisciplinary team in diabetes management include diabetes specialist, nurse, diabetes educator, diabetes counsellor, foot and eye specialists. Other members that should be available on need basis would be heart specialist, kidney specialist, exercise consultant, gynecologist, dentist, obesity management surgeon, vascular surgeon and child diabetes specialist.

The team should work in close collaboration with the patient who is at the center of the team, and family members. Basic support services provided in a diabetes centre would include laboratory testing, wound management services, in-patient services, diabetes education, preventive and pre-conception counselling services.

Also of note is that at least once in three months, it is necessary for a patient living with diabetes to visit a diabetes centre, even if their sugar levels are seemingly under control. On a routine, people with diabetes should do their blood sugar testing at home using a glucometer (device to check sugars using a finger prick test) at a frequency advised by their diabetes team.

Once every 3-6 months, a patient needs to check the HBA1C (three months glucose control test) to assess three monthly glucose controls. A diabetes team will advise the patient on the most suitable targets depending on their overall status and type of diabetes. Currently, with the rise in numbers of people living with diabetes, there is a rise in awareness of the disease and its implications.

This has led to the coming up of several multidisciplinary centres across the country, particularly in tertiary referral hospitals, both public and private. A patient’s choice of a facility to manage diabetes depends on several factors such as availability of the necessary services or team, ease of access, cost, complications and co- morbidities.

A team based approach is the preferred way of diabetes management and to achieve long-term cost effectiveness, the patients should try to the best of their capacity to enrol in a multidisciplinary team centre which is a “one stop shop’” for all their diabetes management requirements. —The writer is diabetologist at the Diabetes Care Centre, MP Shah Hospital

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