Teodor Salmen
Doctoral School of Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
Correspondance to: Teodor Salmen, MD, PhD student, Diabetes Mellitus, Nutriton and Metabolic Disorders, teodor.salmen@gmail.com
Abstract
Diabetes Mellitus (DM) is one of the most important health issues worldwide and a substantial cardiovascular risk factor. To assure DM prophylaxis, both physicians and patients should identify the individual factors that are in favor of further developing DM and find ways to obtain a normal glycaemic index and ensure a healthy metabolism. One special risk category of developing DM is represented by pregnant women with gestational DM (GDM). Screening for GDM, and applying lifestyle and dietary intervention will surely improve the maternal and fetal outcome and also the long-term well-being of the mother.
Keywords: diabetes mellitus, gestational diabetes, nutrition, lifestyle, prophylaxis
Diabetes Mellitus alongside obesity are two chronic diseases with a certain genetic predisposition, the manifestation of which is greatly potentiated by environmental factors; there are two pandemics of the modern lifestyle and socio-economic context of the 21st-century society. Type 2 DM is the most prevalent form of DM that is secondary to the current way of living and its pathophysiologic mechanisms include progressive exhaustion of the pancreatic cells, with secondary development of clinical symptoms or direct onset of micro- and macro-vascular complications of DM.
When talking about lifestyle, the increment of sedentariness, alongside highly processed fast food, leads to a high caloric input unbalanced to a low caloric use.
Moreover, especially after the Covid-19 pandemic, the socio-economic characteristics could represent another side of the issue, as the number of remote jobs has increased fantastically, causing a concomitant decrease in people’s interest in self-care and healthy lifestyles.
The environmental aspects include several issues such as the industrialization of agriculture production, easy accessibility to higher processed food, while the resulting food, fruits, and vegetables, available without the need for a significant effort from humans, leading, also, to a negative balance in between a high caloric, easily available intake opposed to a low caloric consumption in the process of obtaining it.
After this introspect into the lifestyle, socioeconomic, and environmental aspects that be improved by, not necessarily medical prevention, we should look further into the aspects that are in our hands.
So, we should start at the educational level, respectively, by educating our patients that suffer only from being overweight or obese on healthy eating and sleeping habits, concluding the caring process with dietary, physical activity, hydration, and body mass index management advice. An important aspect is the counseling for smoking cessation which is, also, a pillar of our patient management.
Every overweight or obese patient who is sedentary, or presents with high blood pressure (HBP), cardiovascular (CV) disease history, anomalies in the blood test (high-density lipoprotein cholesterol <35 mg/dL, triglycerides >250 mg/dL, HbA1c≥5.7%, impaired fasting glucose), personal history of conditions associated with insulin resistance (polycystic ovary syndrome, severe obesity), or belongs to certain races or ethnicities or has a family history of first degree relative with diabetes, should be tested for DM.
Moreover, when the patients develop or present with elements of metabolic syndrome, respectively, obesity, dyslipidemia, HBP, or impaired glucose tolerance, we should add to our approach specific medical therapies that are indicated for normalizing blood pressure, glycaemic levels, weight gain or lipidic levels. This fact is more important recently, while the novel non-insulinemic drugs used in patients with T2DM have not only benefits on metabolic control, on weight, but also, they are proven in CV outcome trials as having protective effects both on CV and renal levels.
An important category of patients is females with gestational DM. Screening for GDM is realized in the first trimester by measuring the fasting plasma glucose, permitting early nutritional intervention and lifestyle changes to prevent or even diminish the risk of developing GDM or the necessity of insulin therapy, and also in the second trimester between 24-28 weeks of gestation using the oral glucose tolerance test (OGTT). Patients with a high risk for GDM but with a normal OGTT at the end of the second trimester should be retested with OGTT at 32 weeks of gestation and receive further nutritional or medical therapy. The management doesn’t vary a lot from the general one, with lifestyle and dietary interventions, but the only uniformly agreed treatment is represented by insulin therapy, in case the first line fails to achieve the desired glucose plasma values. This fact emphasizes the need for a very cautious approach to preventing its need. Caring for the patients does not end here, as 50% of women with GDM are at risk to develop T2DM; an OGTT should be performed 6-8 weeks after delivery and after that, these women should be screened every year.
So, prevention in DM is a complex process that starts from the primary level, to prevent the ailment appearance and includes pillars such as lifestyle intervention, smoking cessation, weight loss, dietary intervention, and physical activities, and can be extended to the secondary levels, to prevent the ailments evolution and complication, that requires adding of insulin therapy in case of GDM and/or novel antidiabetic non-insulin drugs in case of T2DM, to benefit from their decrease in the CV mortality rates alongside with the decrease of the CV risk.