Table of Contents  
LETTER TO THE EDITOR
Year : 2013  |  Volume : 6  |  Issue : 1  |  Page : 111-112  

Concept of specialty - OPD for diabetes


Department of Medicine, Padmashree Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune, India

Date of Web Publication14-Mar-2013

Correspondence Address:
Vijayashree Gokhale
Department of Medicine, Padmashree Dr. D. Y. Patil Medical College, Hospital & Research Centre, Dr. D. Y. Patil Vidyapeeth, Pimpri, Pune
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.108669

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How to cite this article:
Gokhale V, Chaudhary N. Concept of specialty - OPD for diabetes. Med J DY Patil Univ 2013;6:111-2

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Gokhale V, Chaudhary N. Concept of specialty - OPD for diabetes. Med J DY Patil Univ [serial online] 2013 [cited 2024 Mar 29];6:111-2. Available from: https://journals.lww.com/mjdy/pages/default.aspx/text.asp?2013/6/1/111/108669

Dear Sir,

Diabetes is gaining epidemic proportions in India, with more and more younger people being diagnosed, and they may be the sole "bread earners" of the family who will have to bear not only the extra cost of managing their own disease, but also preventing its morbid complications. What we have observed about Indian type 2 diabetes is that it also affects farmers, who are non-obese, who live in open countryside, do hard physical work in fields, and eat a low fat, simple diet with fresh farm produce, a stark contrast to their city-dwelling, sedentary, processed food eating counterparts. [1]

So, a dedicated diabetes OPD should have the following agenda:

  1. Early detection and treatment of diabetes and its complications
  2. Optimizing treatment goals
  3. Education, counseling, [2] and awareness
  4. Preventing, postponing diabetes in the nondiabetic population and "next generation" [3]
  5. Research in Indian diabetes
"Research" of course covers every existing and as yet unexplored areas of diabetes. In our diabetes OPD, studying Indian diabetes and all its parameters, data entry, and analysis are carried out by physicians and residents of medicine department. Our strategies are the following:

1. Optimizing treatment goals

  1. Tight control of blood sugar and HbA1C for this has been proved beyond doubt to be beneficial in postponing onset of complications. The above is achieved with the help of diet, exercise, and medications. [3]
  2. Dyslipidemia which usually accompanies diabetes is diagnosed and taken care of, again with diet, exercise, and medications.
  3. Aspirin in anti-platelet activity dose is given to all diabetics unless contraindicated as it has a preventive role in macrovascular complications.
  4. Hypertension if detected is treated aggressively. [4]
2. Educating the patients

  1. Patients are educated regarding the disease, its permanent nature, and its complications. The best time to counsel as per our experience is just when diagnosis is made for at this time the patient is highly motivated and acceptance of the disease and its permanent nature is easy. This is half the battle won!
  2. Physicians at diabetes OPD try to eradicate the two most "upsetting" worries in patient's mind:
    1. Will I have to take injections? and
    2. Will I have to give up my favorite food?
    Once reassured, the physician and patient "team up" against the disease and achieve set goals.
  3. Since insulin is still an injectable drug, a lot of misconceptions and fear exist regarding its use. In our diabetes OPD, insulin delivery devices like "pens" with a very fine needle are shown to patients at the very beginning. This reassures them that insulin is not delivered through a big syringe and needle and that it is minimally painful. This makes them readily accept insulin therapy as and when required even in type II diabetes.
  4. Early detection and treatment of complications is our forte. Every diabetic patient is encouraged to follow a "diabetes calendar." Months are assigned for carrying out various tests which include:
    1. Once a year "eye check-up with fundoscopy" [5]
    2. Once a year renal function tests (RFT); this includes urine - microalbuminurea, urinary albumin creatinine ratio [6]
    3. An ECG and Stress Test besides regular tests of glycemic control: blood sugars and HbA1C
    4. Regular assessment of feet to identify evidence of foot ulcers
  5. Our OPD also encompasses the all-important diet advice by the physician or dietician. Today in diabetes "staple diet," i.e. what patient has been eating since childhood is not changed (e.g. someone whose staple diet has been rice is not asked to make a complete switch to wheat!). A switch from the staple diet is devastating for the patient, and can itself become an acute "stress" leading to worsening of diabetes.
  6. Our OPD also focuses on the importance of weight reduction in the obese patients and the benefits of exercise in diabetes control. [7]


3. Registration and research

From our experience of running a dedicated specialty OPD for diabetes, we have realized that this very atmosphere of a specialty OPD where patients feel "they are not alone in their suffering" and feel encouraged by other's success in managing diabetes, acts as a "booster" in treatment of diabetes.

Thus, the need of the hour is setting up of specialty or dedicated OPDs especially for diabetes, where treatment, education, awareness, and research can be integrated.

 
  References Top

1.Rao CR, Kamath VG. A study of the prevalence of type 2 diabetes in coastal Karnataka. Int J Diabetes Dev Ctries 2010;30:80-4.  Back to cited text no. 1
    
2.Iyer U, Joshi A. Impact of interpersonal counseling on the blood sugar and lipid profile of type 2 diabetes mellitus subjects (nutrition health education and diabetes mellitus). Int J Diabetes Dev Ctries 2010;30:129-34.  Back to cited text no. 2
    
3.Stratton IM, Adler AI. Association of glycemia with microvascular and macrovascular complications of type 2 diabetes (UKPDS 35): Prospective observational study. BMJ 2000;321:405-12.  Back to cited text no. 3
    
4.Adler AI, Stratton IM. Association of systolic blood pressure with macrovascular complications of type 2 diabetes (UKPDS 36): Prospective observational study. BMJ 2000;321:412-9.  Back to cited text no. 4
    
5.Kumar B, Gupta SK. Current trends in the pharmacotherapy of diabetic retinopathy. J Postgrad Med 2012;58:132-9.  Back to cited text no. 5
[PUBMED]  Medknow Journal  
6.Mohan S, Kalia K, Mannari J. Diabetic nephropathy and associated risk factors for renal deterioration. Int J Diabetes Dev Ctries2012;32:52-9.  Back to cited text no. 6
    
7.Mukhopadhyay P, Paul B. Perceptions and practices of type 2 diabetics: A cross-sectional study in a tertiary care hospital in Kolkata. Int J Diabetes Dev Ctries 2010;30:143-9.  Back to cited text no. 7
    




 

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