Prescribe exercise, diet to fight diabetes better, doctors told

Hundreds of general practitioners gathered at a city hotel for the international diabetes update were repeatedly told one thing to go back in time by making lengthy notes, prescribing diet and exercise as the choice of treatment ahead of medication, and choosing old-style cheaper drugs unless newer and expensive medicines are absolutely necessary. While most speakers insisted on the need to strengthen the battle against the epidemic of diabetes, they said it would be a disaster to leave behind the strengths of the past.
Dr Louis H Philipson from the US, who spoke about personalised genetic medicine for diabetes, said doctors should make a detailed record of the family history of diabetes in at least three generations before writing prescriptions.
This, he said, will help doctors diagnose monogenic diabetes, the genetic form of the disease. The genetic form is different from either type 1 or type 2 and can be successfully treated with an inexpensive and commonly used drug, sulfonylurea, instead of expensive insulin shots. It reduces cost and liberates patients, he said.
Up to 95% of people with monogenic diabetes in the US are misdiagnosed. In Chennai, doctors at Madras Diabetes Research Foundation say they have identified at least 150 people with monogenic diabetes.
"Like in the West, Mody-3 is the most common genetic mutation we find here. But then we are finding more mutations in our country. We are presently researching on it," said senior endocrinologist Dr V Mohan. His research team is screening people with type 1 and type 2 diabetes to identify people who could be having genetic mutations. "We will not be able to identify these unless we talk to our patients in detail," he said.
International Diabetes Federation president Dr SM Sadikot said, "We are losing (the war against diabetes). In 2011, we said 1% die every 7 seconds due to complications of diabetes. Now, it is 1% every six seconds. We have had new medicines, guidelines, lectures and symposiums. But none of this has any value unless the patients become better." He insisted on the need to improve doctor-patient relationships for better treatment outcomes.
Posters around the conference venue also asked doctors to write down the two words ­diet and exercise ­on the prescriptions before they begin writing down the names of drugs that they would like the patients to take or inject.
"A diet sheet containing practical and possible practices should be attached to the prescription. Patients must be told to exercise ­walk, swim, cycle, run or gym ­for at least 30 minutes every day. This should be a part of the prescription," said Dr Mohan.
The three-day conference was inaugurated by senior cardiologist Dr S Mullasari Ajit.