Recognizing and Managing Chronic Conditions like Diabetes and Hypertension

What are the common signs and symptoms of diabetes?

The common signs and symptoms of diabetes are:

• Thirst and dry mouth
• Nausea
• Polyuria, which means increased frequency of urine
• Headache
• Nocturia, which means more frequency of urine during the night
• Hyperphagia, which is excess appetite and food intake, with a predilection for sweet foods
• Tiredness, fatigue, and lethargy
• Change in weight, usually weight loss
• Mood change, irritability, and difficulty in concentrating
• Blurring of vision, Pruritus vulvae, and balanitis (genital candidiasis)

It is important to note that while these symptoms may be present in other chronic endocrine conditions, patients and physicians should always rule out common conditions like diabetes through blood glucose analysis

How can these chronic conditions be diagnosed and managed effectively?

Abnormal glucose homeostasis can be diagnosed using three distinct criteria. The first is impaired fasting glucose (IFG), which is defined as a fasting plasma glucose (FPG) value of 5.6–6.9 mmol/L (100–125 mg/dL). The second is impaired glucose tolerance (IGT), which is defined as a plasma glucose level of 7.8–11 mmol/L (140–199 mg/dL) following an oral glucose challenge. The third is an HbA1c of 5.7–6.4%, which indicates dysglycemia by all mechanisms.

Although HbA1c of 5.7–6.4%, IFG, and IGT do not identify the same individuals (as different biological mechanisms are involved), individuals in all three groups are at a greater risk of progressing to type 2 DM and have an increased risk of cardiovascular disease. Therefore, they should be counseled about ways to decrease these risks.

A diagnosis of DM can be made if a patient has a FPG ≥7.0 mmol/L (126 mg/dL), a glucose ≥11.1 mmol/L (200 mg/dL) 2 hours after an oral glucose challenge, or an HbA1c ≥6.5%.

Additionally, a random plasma glucose concentration ≥11.1 mmol/L (200 mg/dL) accompanied by classic symptoms of DM (polyuria, polydipsia, weight loss) is also sufficient for the diagnosis of DM.

Screening

The American Diabetes Association (ADA) recommends that everyone aged 45 years or older should be screened every 3 years for diabetes. If an individual is overweight (BMI >25 kg/m2 or meets an ethnically relevant definition of overweight) and has one additional risk factor for diabetes, they should be screened earlier.

Are there any lifestyle changes that can help in controlling diabetes?

There are several lifestyle changes that can help in controlling diabetes. Regular physical activity and weight reduction significantly improve the quality of life and help control blood sugar levels. It is important to avoid foods that are rich in carbohydrates and saturated fatty acids. Quitting smoking and alcohol consumption can decrease the risk of developing major diabetes-related complications like ketoacidosis or hyperglycemic hyperosmolar state.

What are some potential complications or risks associated with these conditions?

Patients with diabetes are more prone to infections. Those who have untreated chronic diabetes may develop complications such as eye disease, including retinopathy (non-proliferative/proliferative), macular edema, neuropathy (sensory and motor, mono- and polyneuropathy, autonomic), nephropathy (albuminuria and declining renal function), macrovascular disease (coronary heart disease, peripheral arterial disease, cerebrovascular disease), gastrointestinal issues (gastroparesis, diarrhea), genitourinary problems (uropathy/sexual dysfunction), dermatologic infections, cataracts, glaucoma, periodontal disease, and hearing loss.

Are there any new treatment options available for managing chronic conditions like diabetes?

Metformin is the primary drug used for patients with type 2 diabetes. Most guideline-based therapy options recommend using metformin as the first-line treatment and monitoring patients every three months using HBA1C values to adjust the dose and decide whether to add another drug or switch to insulin. After metformin, newer therapies such as DPP4 inhibitors, GLP-1 analogues, and SGLT-4 inhibitors are commonly used.

For patients with type 1 diabetes, insulin is the only treatment available. However, newer insulins are now available that can be taken once a day through injection instead of three times a day.

What are the typical signs and symptoms of hypertension?

Hypertension usually does not have any symptoms until it is diagnosed during a routine physical examination or when a complication arises. Therefore, it is advisable to check blood pressure every five years in adults over 40 years of age to detect any hidden hypertension. Sometimes, certain clinical features may indicate the underlying cause of hypertension, such as radio-femoral delay in patients with coarctation of the aorta, enlarged kidneys in patients with polycystic kidney disease, and abdominal bruits that may suggest renal artery stenosis. Hypertension may also have other signs, such as central obesity and hyperlipidaemia, which are risk factors for hypertension. Additionally, hypertension may cause complications like left ventricular hypertrophy, accentuation of the aortic component of the second heart sound, and a fourth heart sound. AF is common and may be due to diastolic dysfunction caused by left ventricular hypertrophy or the effects of CAD.

Severe hypertension can cause left ventricular failure in the absence of CAD, particularly when there is an impairment of renal function. The optic fundi are often abnormal, and there may be evidence of generalized atheroma or specific complications, such as aortic aneurysm, PAD, or stroke. Examination of the optic fundi reveals a gradation of changes linked to the severity of hypertension. Fundoscopy can, therefore, provide an indication of the arteriolar damage occurring elsewhere. "Cotton wool" exudates are associated with retinal ischemia or infarction and fade in a few weeks. "Hard" exudates (small, white, dense deposits of lipid) and microaneurysms ("dot hemorrhages") are more characteristic of diabetic retinopathy. Hypertension is also associated with central retinal vein thrombosis.

How can these chronic conditions be diagnosed and managed effectively?

	Systolic	Diastolic
Grade 1 (mild)	140-159	90-99
Grade 2 (moderate)	160-179	100-109
Grade 3 (severe)	>/=180	>110

Are there any lifestyle changes that can help control diabetes?

There are a number of lifestyle measures that may help individuals with borderline hypertension avoid the use of drug therapy, and reduce the dosage or number of drugs needed for those with established hypertension. These measures can also directly reduce cardiovascular risk.

To lower blood pressure, it is recommended to address obesity, reduce alcohol intake, limit salt intake, engage in regular physical exercise, and increase consumption of fruits and vegetables. Additional reductions in cardiovascular risk, independent of changes in blood pressure, can be achieved by quitting smoking, eating oily fish, and adopting a diet low in saturated fat.

What are some potential complications or risks associated with these conditions?

The potential complications or risks associated with hypertension include heart attack (MI), stroke, aneurysm, heart failure, retinopathy, nephropathy, neuropathy, dementia, metabolic syndrome, and peripheral artery disease.

Are there any innovative treatment options available for managing hypertension?

Thiazides, ACE inhibitors, beta-blockers, and angiotensin receptor blockers are some of the newer agents being used to manage hypertension.