Masterclass 4 - Diabetes Care

A growing diabetes pandemic is unfolding with rapid increases in the prevalence of type 2 diabetes, which affects more than 530 million adults in 2021 globally. In South-East Asia, 1 in 11 adults (90 million) are living with diabetes, and the number of adults with diabetes is expected to exceed 110 million by 2030. Diabetic complications constitute the leading causes of morbidity and mortality for individuals with diabetes. Since 1990s large-scale clinical trials have demonstrated that intensive glycaemic control reduced the risk of developing microvascular (and, to a lesser extent, macrovascular) complications, and they were no longer considered inevitable. Therefore, the aim of diabetes management was shifted from sustaining life and relieving hyperglycaemic symptoms, to preventing diabetic complications through optimizing glycaemic status and cardiovascular risk factor control. However, diabetic patients are still at excess risk despite standard care. In recent years, two new classes of anti-diabetic agents, namely sodium-glucose co-transporter 2 inhibitor (SGLT2i) and glucagon-like peptide 1 receptor agonist (GLP1Ra), have demonstrated remarkable cardiovascular and kidney protection independent of effective glucose control, and they have been incorporated into the latest international guidelines on diabetes management, which emphasize a risk-based approach to choosing anti-diabetic agents. The benefits, risks and precautions, and the practical tips on applying these new agents in diabetes management will be illustrated in clinical case presentations.

When managing diabetes, patient education and empowerment are two pivotal components in equipping patients to develop the ability to make informed decision about their own treatment and care plans. Clinical guidelines have long adopted self-monitoring blood glucose (SMBG) as a useful tool in helping diabetes patient to maintain glycemic control, and glucometer is a standard home monitoring tool for every newly diagnosed diabetic patient. Since the year 2000, the emergence of Continuous Glucose Monitoring (CGM) has become a game-changer for SMBG. This painless glucose monitoring tool allows instantaneous real-time display of glucose levels, trends and variabilities with 24/7 coverage. Alerts and alarms can be set for informing patients about actual or impending hypo- and hyperglycemia. The widespread use of smartphone popularized the use of CGM as an Internet-of-things (IoT) health care wearable among the diabetes population. And the COVID-19 epidemic has accelerated the clinical use of CGM in inpatient glucose monitoring. It is foreseeable that the use of CGM will expand in chronic care management in patients with diabetes. In the era of big data, large scale data analysis of CGM glucose data is underway. The upcoming development in CGM technology may provide new insight and new changes to our clinical practice in diabetes care in the years to come.