Redefining Diabetes Strategies in Primary Care: Four New Pillars of Management

Authors

  • Akshay Jain, MD, FRCPC, FACE, CCD, ECNU, DABIM, DABOM Division of Endocrinology and Metabolism, University of British Columbia; TLC Diabetes and Endocrinology, Surrey, BC

DOI:

https://doi.org/10.58931/cpct.2023.1322

Abstract

The management of Type 2 diabetes mellitus (T2DM) is possibly becoming one of the most challenging aspects of primary care. With millions of individuals worldwide living with T2DM, who are at a higher risk of developing multiple additional chronic conditions including cardiovascular disease (CVD) and renal disease, it is imperative that primary care practitioners (PCPs) around the world are comfortable with the management of T2DM. However, with dozens of T2DM medications available, many of which have associated risks of side effects such as hypoglycemia, the management of T2DM can be quite time-consuming for the busy family physician.

In light of the above, it is important that we look at T2DM through a new lens. It is imperative that clinicians view the management of T2DM not just as “blood glucose management” but rather, that they adopt a person-centric, holistic management approach that takes into account the mitigation of microvascular and macrovascular complications, in order to reduce the morbidity and mortality associated with the condition. When it comes to the management of this condition, one needs to be less of a “glucologist” and more of a “diabetologist”. In order to develop this approach, with the busy PCP in mind, I suggest four pillars on which to focus during a T2DM appointment, that are beyond the laboratory HbA1c measurement.

Author Biography

Akshay Jain, MD, FRCPC, FACE, CCD, ECNU, DABIM, DABOM, Division of Endocrinology and Metabolism, University of British Columbia; TLC Diabetes and Endocrinology, Surrey, BC

Dr. Akshay Jain is the first Canadian physician to be triple board-certified by the American Boards in Endocrinology, Internal Medicine and Obesity Medicine. He is the only Canadian to win the AACE Rising Star in Endocrinology Award (2022) and to feature on Medscape’s list of 25 Top Rising Stars of Medicine (2020). He practices in Surrey, BC. He is fluent in 6 languages including English, Hindi, Gujarati, Marathi, Marwari and Urdu. In 2022, he won the Top 25 Canadian Immigrant Award.

References

Diabetes Canada Clinical Practice Guidelines Expert Committee; Wharton S, Pedersen SD, Lau DCW, Sharma AM. Weight Management in Diabetes. Can J Diabetes. 2018 Apr;42(Suppl 1):S124-S129. DOI: https://doi.org/10.1016/j.jcjd.2017.10.015

MacKay D, Chan C, Dasgupta K, Dominy C, Gagner M, et al; Diabetes Canada Clinical Practice Guidelines Steering Committee. Remission of Type 2 Diabetes: Diabetes Canada Clinical Practice Guidelines Expert Working Group. Can J Diabetes. 2022 Dec 1;46(8):753-61. DOI: https://doi.org/10.1016/j.jcjd.2022.10.009

Wharton S, Lau DC, Vallis M, Sharma AM, Biertho L, Campbell-Scherer D, et al. Obesity in adults: a clinical practice guideline. CMAJ. 2020 Aug 4;192(31):E875-91. DOI: https://doi.org/10.1503/cmaj.191707

Diabetes Canada Clinical Practice Guidelines Expert Commitee; Lipscombe L, Booth G, Butalia S, Dasgupta K, Eurich DT, et al. Pharmacologic Glycemic Management of Type 2 Diabetes in Adults. Can J Diabetes. 2018;42:S88-103. DOI: https://doi.org/10.1016/j.jcjd.2017.10.034

ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. Pharmacologic approaches to glycemic treatment: Standards of care in diabetes–2023. Diabetes Care. 2023 Jan;46(Suppl 1):S140-57. DOI: https://doi.org/10.2337/dc23-S009

Diabetes Canada Clinical Practice Guidelines Expert Committee; Lipscombe L, Butalia S, Dasgupta K, Eurich DT, MacCallum L, et al. Pharmacologic glycemic management of type 2 diabetes in adults: 2020 update. Can J Diabetes. 2020 Oct 1;44(7):575-91. DOI: https://doi.org/10.1016/j.jcjd.2020.08.001

Diabetes Canada Clinical Practice Guidelines Expert Working Group; Robinson DJ, Hanson K, Jain AB, Kichler JC, Mehta G, et al. Diabetes and Mental Health. Can J Diabetes. 2023 Jun;47(4):308-344. DOI: https://doi.org/10.1016/j.jcjd.2023.04.009

Beck RW, Bergenstal RM, Riddlesworth TD, Kollman C, Li Z, Brown AS, Close KL. Validation of time in range as an outcome measure for diabetes clinical trials. Diabetes Care. 2019 Mar 1;42(3):400-5. DOI: https://doi.org/10.2337/dc18-1444

Published

2023-10-25

How to Cite

1.
Jain A. Redefining Diabetes Strategies in Primary Care: Four New Pillars of Management. Can Prim Care Today [Internet]. 2023 Oct. 25 [cited 2024 Nov. 21];1(3):29-31. Available from: https://canadianprimarycaretoday.com/article/view/1-3-jain

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Articles