Novo Nordisk celebrated from the 12th and 13th of April in Santo Domingo, Dominican Republic, the Diabetes Regional Expert Annual Meeting -DREAM-, an innovative scientific event for Central America and the Caribbean.
The meeting addressed important aspects to consider in the management of diabetes: the reduction of cardiovascular risk and prevention of hypoglycemia.
DREAM welcomed renowned endocrinologists and diabetologists from Cuba, Panama, Colombia, Mexico and the Dominican Republic, who shared the latest updates in the guidelines for diabetes treatment, in an event organized by the public relations agency AF Comunicación Estrategica.
dohealthwell had the opportunity to interview Dr. Maria Leticia Mateo Rodriguez, a Dominican endocrinologist, nutritionist, and internist.
JM: Thank you very much for offering us this conversation, Dr. Mateo, which will undoubtedly help us to fulfill our journalistic mission of spreading this knowledge that can serve those people who have diabetes and encourage prevention.
To establish a context, please tell our audience what is endocrinology and what is the importance of this specialty.
Also, we would like to know the preventive characteristics of your specialty.
Dr. Mateo Rodriguez: Thank you very much for the interview Jairo.
Part of our work as specialists is to guide the population in the management and prevention of diabetes.
Endocrinology is the branch of internal medicine that is responsible for the evaluation of all hormonal alterations.
Many times we believe that endocrinology only deals with diabetes and thyroids, but it goes a little bit further since we have the responsibility to evaluate and treat the alterations that are metabolic and functional from the pituitary, hypothalamus, and its repercussions in all other organs and systems.
In this sense, the treatment and management of obesity belong directly to the endocrinologist; as well as the alterations in bone mineral metabolism that have an impact on metabolic diseases such as osteoporosis and osteopenia.
JM: Yesterday, Dr. Enrique Morales, from Mexico, was commenting that a diabetic usually, according to statistics, mostly does not die or does not have a serious complication because diabetes but rather from cardiovascular factors.
Please detail what the doctor refers to when he says that the main thing that the diabetic person should take into account is his cardiovascular health.
Dr. Mateo Rodriguez: Diabetic patients, unfortunately in most cases, die from cardiovascular complications.
What’s going on? Years ago it was estimated that management of diabetes limited to simply control the levels of glycemia.
Today the spectrum of treatment of diabetes goes further.
We should focus on controlling glycemia but also that the metabolic and cardiovascular systems are in homeostasis, in harmony.
When a diabetic patient is found with high levels of glycemia, outside the target, metabolic alterations are unleashed that have negative repercussions in the endothelial and vascular system.
If we only take into account the glycosylated hemoglobin or the fasting glycemia, and we deviate from the control of blood pressure levels, cholesterol, HDL and LDL, the percentage of triglycerides and others, then we are cutting off a patient’s treatment.
Moreover, this is how the microvascular complications typical of diabetes begin to proliferate.
That is why today the management of diabetes is more structured, where we focus on the patient as a whole, where all the factors that may trigger or lead the patient to suffer a secondary complication to these global complications, are also encompassed within the therapeutic control.
JM: Diabetes is not yet curable but it is manageable.
However, I have read about cases in which a patient has ‘cured’ diabetes after undergoing bariatric surgery.
Can an obese person, because of genetic or induced factors, undergo bariatric surgery and skip have diabetes?
What is true about this information?
Dr. Mateo Rodriguez: Studies have shown that if a diabetic patient undergoes bariatric surgery, which we prefer to call metabolic surgery, within the first five years of diagnosis there is a percentage of reversibility of the disease up to 90% of the cases.
There are even patients who are already in therapy, with double therapy or triple therapy, which decrease both the requirements by decreasing the inputs based on the limitation of nutrition, which manages to decrease or remain with therapy requirements for null diabetes.
Of course, it has been shown that the progression of the disease has decreased and that in a certain number of patients it could be considered positive, but always maintaining the expectation, because if the bad habits or the old lifestyle of the patient after undergoing the procedure resume, the progression of the disease continues and reappears in time.
This is secondary to an increase in weight gain in the patient, if he is already neglecting the therapy and changing the nutritional approaches that are given, the disease may reappear over time because it remains dormant.
JM: Why does it stay dormant?
Dr. Mateo Rodriguez: Because is not about that your pancreatic system is healed, rather a stop is made from then on; but if the patient changes his eating habits or bad habits reappear again in his lifestyle, the percentage where the disease was stopped increases, it is not reversible.
JM: Have you heard about intermittent fasting?
Dr. Mateo Rodríguez: Yes, I have.
JM: I bring it up because yesterday Dr. Morales mentioned a city in Africa where there is practically no diabetes.
He cited two fundamental factors: on average, its inhabitants walked about 20 kilometers, and the number of calories consumed per day was 1200.
With intermittent fasting, although it is not a diet, it is a tool in which you consume food in a window of a specific time that can be 8 hours of 6 or 4, greatly decreasing the daily caloric intake.
If diabetes does not exist in that city because the number of calories consumed is much less than the intake, can a person with diabetes benefit from intermittent fasting or are there risks?
Dr. Mateo Rodriguez: That depends because the requirements of each person are individual and depend a lot on the physical activities that the patient performs each day and based on that will go their needs or nutritional requirements.
In that sense, under no circumstances, no guide favors that patients are put under a restriction of carbohydrates or minimal calories.
All management guidelines still agree that the diabetic or pre-diabetic patient should have a carbohydrate intake of 45-65% of the total calories in their diet, with the exception of choosing foods that are more complex and that do not alter the patient’s glycemic index too much.
It is a case by case situation and it will go in hand by considering the metabolic needs of each patient according to the functionality of each individual.
JM: And the percentage of carbohydrates from 45 to 60% that you comment, do they come from unprocessed foods?
Dr. Mateo Rodriguez: Exactly, it is preferred that they are complex and not industrialized, because of the additives and the sweeteners that are used, which are practically artificial and have a negative impact on the glycemic index in patients.
The simpler the carbohydrate is, the easier it is to absorb it and the easier it is to have a negative impact on the patient’s glycemic index.
JM: Please list three or five risk factors for diabetes.
Dr. Mateo Rodriguez: Without a doubt, the number one is obesity, followed by a sedentary lifestyle and in third place, a first-degree relative affected by the disease.
Fourth, women who had alterations during pregnancy of what is known as gestational diabetes, which occurs when having a child over 9 pounds.
All these are factors that already sets you and makes us doctors be more vigilant because of the high risk of developing the disease.
Another risk factor is for those patients who do not have the diagnosis of diabetes but have presented impaired fasting glucose levels or an altered tolerance to carbohydrates, which is known as pre-diabetes.
The patient with pre-diabetes who does not change her lifestyle and does not perform physical activity routinely, in an average 8 to 10 years will be a diabetic patient.
JM: In our country, there is an idea that people with diabetes have problems with alcohol.
To put it in Dominican language is something like saying ‘if you drink alcohol you burn sugar’.
Is alcohol a negative influence for the diabetic, or can it be taken with restrictions?
Dr. Mateo Rodriguez: That depends on the patient’s alcohol dependence.
Many patients while they are consuming alcohol do not consume any type of food, and obviously as they are doing a nutritional restriction because they are not in taking any glycemic load, or any food burden so to speak, they can perhaps think that alcohol is making glycemia go down, and it is not that alcohol is making it go down, the person is not eating food.
On the other hand, the guidelines recommend that diabetic and pre-diabetic men limit themselves to two drinks a week and to women a drink.
What they are a bit more limiting is the consumption of distillates, which are authorized to three ounces on the weekend.
Wine is limited to five ounces and beer to 12, always trying not to exceed two drinks for men and one drink for women.
It has been observed that drinks that coastal-type drinks, in which the alcohol to be consumed are mixed with other drinks, mostly sweetened, are not recommended because the glycemic index is higher, that is to say, the glycemic load of the fruits or the signs that are used to prepare them.
JM: And this sugar consumed tends to encourage a greater intake of the same beverage and other similar ones.
On the other hand, can we say that other impacts include the consumption of high-fat foods, especially at night?
Dr. Mateo Rodríguez: Yes, and the impact is worse when you eat high-fat foods after consuming alcohol.
JM: Finally, what is the importance of this type of events that promote education about diabetes.
Dr. Mateo Rodriguez: For me, the realization of activities where everyone is educated, including health professionals, is fundamental.
Many times we are guided as doctors or health professionals to treat the illnesses of the patient, but nowadays we have to perform more preventive than curative medicine.
This type of activities where we see the impact of the diseases, even before the complications occur or that is diagnosed, is extremely important.
Basically, because it helps us, obliges us, and commits us to take precautions and to intervene from before, in order to avoid complications arising.
JM: Thank you very much Dr. Maria Leticia Mateo Rodriguez.
For dohealthwell, it was an honor to have shared these minutes to educate ourselves and educate the population on the subject.
Dr. Mateo Rodriguez: Thanks for opening this set for reflexion about the management and prevention of diabetes.