Interview with Josep Franch about diabetes and primary care

Josep Franch.AP doctor.ABS Raval Sud. Barcelona.Member of the REDGDPS Foundation (Diabetes Study Group Network in Primary Health Care)

"Diabetes management is much more than blood glucose control"

- What signs and symptoms are indicative that a person can be diabetic?

- There are clinical criteria that suspect the existence of diabetes.The main one, without a doubt, is obesity, that if it is accompanied by sedentary lifestyle and a non -healthy lifestyle causes the probability of diabetes to be much higher.Doctors try to diagnose the disease when there is still no symptoms.When there are, it means that we have been late.When there is sustained blood glucose, classic symptoms are a lot of hunger, a lot of thirst and frequent need to urinate.And later we would arrive in the case of observing the symptoms of the chronic complications of the disease.Therefore, the ideal is to detect diabetes when the person is asymptomatic in the presence of risk factors to develop it.

- What importance is in the management of diabetes an adequate glycemic control?

- Diabetes management is much more than glycemia control.The importance of the disease is that it increases the probability of developing complications that will make people's quality of life worse.If we want to avoid these complications, it is not enough to control blood glucose, but we must control other factors such as blood pressure, lipid levels, advise the patient not to smoke, follow a healthy life, etc.Relative control of all risk factors is better than an intensive control of one.

- Why glycemia is not controlled in all patients?

- Many factors include, from the natural history of the disease, which is progressive and more difficult to control as it advances, to other derivatives of the health system, the type of medicines used or existing limitations related to health care measures.Nor should we forget the factors that are direct responsibility of the patient, as a possible lack of health education or adherence to treatment.

- What progress have occurred in recent years in the approach of diabetes?

- During the last years several new therapeutic families have appeared, endorsed with in -depth studies and with monitoring of large volumes of patients.These therapeutic advances have shown not only that it is possible to control risk factors and reduce glycemia, but also in some cases it is feasible to reduce complications, including cardiovascular disease.In some studies it has been observed that the use of certain drugs manages to reduce mortality in diabetic patients and have less myocardial or less stroke infarcts.At the moment we have a wide pharmacopoeia, different therapeutic families with different mechanisms of action that we can combine to attack the disease from several fronts.This possibility of combining drugs of different types is what is getting better control.

- What are the main challenges currently facing diabetes?

- The future offers many possibilities.More drug families are being investigated with new mechanisms of action in order to better control the disease with the minimum side effects.On the other hand, it is also advancing in the field of technology: glucose meters, sensors, continuous monitoring, etc., which allow the patient to know at all times what their glycemic levels are to make decisions to maintain adequate control.If all this we combine with a better educationDiabetological For the patient to assume responsibility for control of their disease, all this will allow diabetes to be better and less complications.