From control to remission: Empowering change in type 2 diabetes care
Madam, Pakistan currently ranks third globally in terms of its diabetic population, with approximately 33 million diagnosed cases of Type 2 Diabetes Mellitus (T2DM). Additionally, there are 11 million individuals living with impaired glucose tolerance and 8.9 million people in Pakistan are unawar...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Pakistan Medical Association
2023-11-01
|
| Series: | Journal of the Pakistan Medical Association |
| Online Access: | https://www.ojs.jpma.org.pk/index.php/public_html/article/view/10076 |
| _version_ | 1797435709517201408 |
|---|---|
| author | Hassan Waseem Asfand Bangash Amna Aamir |
| author_facet | Hassan Waseem Asfand Bangash Amna Aamir |
| author_sort | Hassan Waseem |
| collection | DOAJ |
| description |
Madam,
Pakistan currently ranks third globally in terms of its diabetic population, with approximately 33 million diagnosed cases of Type 2 Diabetes Mellitus (T2DM). Additionally, there are 11 million individuals living with impaired glucose tolerance and 8.9 million people in Pakistan are unaware that they have diabetes1. Poor dietary habits and sedentary lifestyles are the major factors contributing to Pakistan's high prevalence of diabetes2. Metformin is commonly prescribed as the leading therapeutic choice for type 2 diabetes, either as a standalone treatment or combined with insulin or other glucose-lowering therapies3. However, despite adherence to guidelines-based practices, a significant number of individuals fail to achieve remission in T2DM which has led to the exploration of alternative approaches.
The DiRECT trial, which primarily involved ethnically white participants, aimed to reverse the diagnosis of T2DM and restore normal metabolic features through a weight-loss protocol. Within 12 months, nearly 50% of the participants achieved remission to a non-diabetic state and discontinued antidiabetic medications. The trial also highlighted the significant role of visceral fat in the development and remission of T2DM 4. However, the trial's lack of South Asian participants and the well-documented variations in disease severity and average body fat levels between South Asians and other populations raised concerns about its relevance to this particular group. To address this, the STANDby trial was conducted which showed that the remission rates observed in UK-based South Asians were similar to those in white cohorts5.
These trials have demonstrated the possibility of achieving T2DM remission, particularly within the first six years following diagnosis. Given these findings, we propose that implementing this weight management program in Pakistan could be a suitable alternative to the current guidelines. This program effectively targets the key factors contributing to the high prevalence of diabetes in the country and emphasizes the importance of facilitating the remission of T2DM rather than just disease control. By addressing dietary habits, promoting physical activity, and targeting visceral fat reduction, this protocol can potentially bring about significant improvements in T2DM outcomes in Pakistan.
|
| first_indexed | 2024-03-09T10:52:10Z |
| format | Article |
| id | doaj.art-29a4f73046284f238cedf6a34d42ad15 |
| institution | Directory Open Access Journal |
| issn | 0030-9982 |
| language | English |
| last_indexed | 2024-03-09T10:52:10Z |
| publishDate | 2023-11-01 |
| publisher | Pakistan Medical Association |
| record_format | Article |
| series | Journal of the Pakistan Medical Association |
| spelling | doaj.art-29a4f73046284f238cedf6a34d42ad152023-12-01T05:13:59ZengPakistan Medical AssociationJournal of the Pakistan Medical Association0030-99822023-11-01731210.47391/JPMA.10076From control to remission: Empowering change in type 2 diabetes careHassan Waseem0Asfand Bangash1Amna Aamir2Final Year MBBS Student, Shifa College of Medicine, Islamabad, PakistanFinal Year MBBS Student, Shifa College of Medicine, Islamabad, PakistanFinal Year MBBS Student, Shifa College of Medicine, Islamabad, Pakistan Madam, Pakistan currently ranks third globally in terms of its diabetic population, with approximately 33 million diagnosed cases of Type 2 Diabetes Mellitus (T2DM). Additionally, there are 11 million individuals living with impaired glucose tolerance and 8.9 million people in Pakistan are unaware that they have diabetes1. Poor dietary habits and sedentary lifestyles are the major factors contributing to Pakistan's high prevalence of diabetes2. Metformin is commonly prescribed as the leading therapeutic choice for type 2 diabetes, either as a standalone treatment or combined with insulin or other glucose-lowering therapies3. However, despite adherence to guidelines-based practices, a significant number of individuals fail to achieve remission in T2DM which has led to the exploration of alternative approaches. The DiRECT trial, which primarily involved ethnically white participants, aimed to reverse the diagnosis of T2DM and restore normal metabolic features through a weight-loss protocol. Within 12 months, nearly 50% of the participants achieved remission to a non-diabetic state and discontinued antidiabetic medications. The trial also highlighted the significant role of visceral fat in the development and remission of T2DM 4. However, the trial's lack of South Asian participants and the well-documented variations in disease severity and average body fat levels between South Asians and other populations raised concerns about its relevance to this particular group. To address this, the STANDby trial was conducted which showed that the remission rates observed in UK-based South Asians were similar to those in white cohorts5. These trials have demonstrated the possibility of achieving T2DM remission, particularly within the first six years following diagnosis. Given these findings, we propose that implementing this weight management program in Pakistan could be a suitable alternative to the current guidelines. This program effectively targets the key factors contributing to the high prevalence of diabetes in the country and emphasizes the importance of facilitating the remission of T2DM rather than just disease control. By addressing dietary habits, promoting physical activity, and targeting visceral fat reduction, this protocol can potentially bring about significant improvements in T2DM outcomes in Pakistan. https://www.ojs.jpma.org.pk/index.php/public_html/article/view/10076 |
| spellingShingle | Hassan Waseem Asfand Bangash Amna Aamir From control to remission: Empowering change in type 2 diabetes care Journal of the Pakistan Medical Association |
| title | From control to remission: Empowering change in type 2 diabetes care |
| title_full | From control to remission: Empowering change in type 2 diabetes care |
| title_fullStr | From control to remission: Empowering change in type 2 diabetes care |
| title_full_unstemmed | From control to remission: Empowering change in type 2 diabetes care |
| title_short | From control to remission: Empowering change in type 2 diabetes care |
| title_sort | from control to remission empowering change in type 2 diabetes care |
| url | https://www.ojs.jpma.org.pk/index.php/public_html/article/view/10076 |
| work_keys_str_mv | AT hassanwaseem fromcontroltoremissionempoweringchangeintype2diabetescare AT asfandbangash fromcontroltoremissionempoweringchangeintype2diabetescare AT amnaaamir fromcontroltoremissionempoweringchangeintype2diabetescare |