New guidelines on diabetes self-management education and support

Management of diabetes is multidisciplinary and a team approach is the basis of care of the patient with diabetes, who is at the center of this team.

Diabetes self-management education (DSME) is a very important aspect of management in all patients with diabetes, including those with prediabetes. Optimal control of blood sugar is important; but, it is also important to control other risk factors such as hypertension, dyslipidemia in order to prevent the macrovascular and microvascular complications of diabetes. Because of the need for lifestyle modifications, patients with diabetes are themselves responsible for the day to day management of diabetes, but with the support of the doctor.

For the first time, the American Diabetes Association (ADA) and American Association of Diabetes Educators (AADE) have combined education and support (DSMES) and released new standards to help diabetes educators and medical providers establish and sustain patient care models, programs and teams for people with diabetes and their caregivers. These guidelines will be published in the September 2017 issues of Diabetes Care and The Diabetes Educator. 

These standards relate to organizational structure, participation of community stakeholders, access, program coordination, instructional staff, individualizing diabetes education to the need of each patient, monitoring of patient progress and quality improvement. An up-to-date, evidence-based, and flexible curriculum provides education.

These standards emphasize that DSME alone does not translate into effective self care. Ongoing support is very important to improve patient outcomes.

The standards defined in these recommendations can be applied to both small solo practices, as well as large, multicenter facilities.

(ADA Press Release, July 28, 2017)

Children increasingly becoming susceptible to asthma

Timely and accurate diagnosis as important as equipping children in being self sufficient to handle this condition

New Delhi, 30 July, 2017: Statistics indicate that about 700 million people in India inhale smoke from biomass and kerosene stoves and other sources that spew carbon particles, carbon monoxide, nitrous oxides, sulphur oxides, formaldehyde and cancer-causing substances such as benzene. This smoke is a leading cause of asthma in the country. Estimates by the WHO show that between 15 and 20 million people have asthma in India, and the numbers do not show any signs of decreasing.

Studies also indicate that the prevalence is higher in children as they have smaller airways which become constricted due to all the pollutants. Schoolchildren are the worst affected and many are growing up with irreversible lung damage. All this can be blamed on the rising pollution levels which cause fatal lungs disorders, severe respiratory problems, nausea, palpitation, loss of vision, blood pressure, and fatigue.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said "Asthma is a chronic respiratory disorder triggered by allergic reactions. It leads to breathing difficulties as a result of narrowing of the bronchial passage, which is responsible for carrying oxygen to the lungs. Asthma can have two affects: swelling in the lungs due to accumulation of mucus in the airways; and inflammation due to tightening of the muscles around the airways. What exacerbates the situation is that asthma is often mistaken as a recurrent cough. Due to this, it is not taken seriously or treated with cough syrups. In kids, it is difficult to assess symptoms because they may not show the typical symptoms of asthma such as breathlessness, wheezing, coughing, and chest tightness. Besides, every child’s asthma is different."

Certain triggers can make an asthma attack worse. Once asthma is diagnosed in a child, it is imperative to remove triggers from the house or keep the child away from these.

Adding further, Dr Aggarwal, said, "Young children may not understand how chronic this condition is or how it can affect their daily life. Education is the key here. Parents of children with asthma should ensure that the child is well aware of his/her condition and teach them steps to be followed during a possible emergency."

Some tips for managing asthma and associated symptoms in children are as follows.

·  Help them take medications daily without fail.

·  Visit the doctor regularly.

·  Give them only the prescribed medicines.

·  Take precautionary measures to avoid any triggers.

·  Always carry their inhaler with you and encourage them to never feel shy to use it in public.

·  Inform the doctor if any other health ailment is bothering the child.

·  Lastly, help them reduce stress and try to remain calm and happy.

Gift a Tulsi plant: Live in harmony with nature

Plants and trees are vital to life and are an integral part of our environment. They provide oxygen, conserve water, improve air quality, reduce noise pollution and help control climate, to name a few. Nature is not called ‘Mother Nature’ for nothing. Nature is life-giving; it nurtures. Nature provides us with food, water and medicines. And, we need to look after it and live in harmony with it.

The green cover in the country is fast disappearing in the name of development. Ongoing construction activities clear land and forests of trees. Deforestation is a major contributor to climate change, which directly affects five components of the environment: water, air, weather, oceans, and ecosystems and adversely affects human health. Hence, the disturbed ecological balance needs to be restored.

One way to do this is by planting more trees. Another way to create awareness about preserve and protect our environment is by gifting plants. Choose medicinal plants such as Tulsi.

We often hear of tree plantation drives in the country. So why not a campaign to gift a tulsi plant?

Tulsi is a plant, which is common to most households. There is a saying in Sanskrit: “Tulanaa naasti athaiva tulsi” meaning that which is incomparable in its qualities is the tulsi. It has both spiritual and health significance.

The health benefits of Tulsi are known to all since ancient times. It has a multitude of beneficial actions in the body such as antimicrobial, antioxidant, anti-inflammatory, anti-pyretic, anti-allergic, immunomodulatory, diaphoretic, adaptogenic, anti-stress, neuro-protective, cardio-protective, anti-diabetic, anti-hypercholesterolemia, anti-hypertensive, anti-carcinogenic,  chemopreventive, radioprotective, to name a few.

Gifting plants is environment-friendly. It is a gift for many occasions, be it housewarming, birthdays, weddings, etc. You can also give plant saplings as a return gift for birthdays of your children. This is one way by which you can instill in them the need to look after the environment right from an early age.

Gift potted plants instead of gifting flower bouquets or other gifts. Choose Tulsi plant or any other medicinal plant such as Stevia. These are long-lasting gifts.

To control the alarming increases in non-communicable diseases, it is important to change our lifestyle and live in harmony with nature by protecting the environment. The proximity with nature helps in the inward spiritual journey and shifts one from the sympathetic (disturbed) to parasympathetic (relaxed) mode described by lowering of blood pressure and pulse rate and rise in skin resistance. A balance between the sympathetic and the parasympathetic modes is required for optimum health and well-being.

Dr KK Aggarwal

National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award, Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award

Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)

Past Honorary Secretary General IMA

Past Senior National Vice President IMA  

President Heart Care Foundation of India

Gold Medalist Nagpur University

Limca Book of Record Holder in CPR 10

Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre  
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS

Member Ethics Committee Medical Council of India (2013-14)  

Chairman Ethics Committee Delhi Medical Council (2009-15)

Elected Member Delhi Medical Council (2004-2009)

Chairman IMSA Delhi Chapter (March 10- March 13)

Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)

IMA starts 80:80 Anti-Pollution Campaign

Air pollution is a major health and environmental hazard causing about 1.2 million deaths every year

New Delhi, 29 July 2017: As per statistics obtained from a report published early this year, about 1.2 million people die due to air pollution in India every year. And, of the 168 cities assessed, none were found to comply with the air quality standards as prescribed by the World Health Organization (WHO). Air pollution is now a matter of great concern as it is affecting not only the health of our citizens but also medical tourism in India, says IMA. 

Keeping this in consideration, the IMA is starting a campaign “Kahin aapke area mein pollution to nahi?” Under this campaign, all state/local branches as well as medical professionals are requested to make efforts to bring down the atmospheric pollution level to less than 80 μg/m³ ​on normal days and to less than 90 μg/m³ during festivals such as Diwali.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “Air pollution is not only a major environmental hazard but also a major health hazard. It is one of the major causes of non-communicable diseases such as cardiovascular diseases, stroke, chronic obstructive pulmonary disease, lung cancer, and other acute respiratory problems. The need of the hour is to bring out stringent guidelines against inefficient modes of transport, household fuel and waste burning, coal-fired power plants, and industrial activities, as these are some of the major sources of air pollution. At any given time, the PM 2.5 levels should be less than 80 μg/m3 ​ and noise level should be less than 80 dB. We expect all medical professionals to also educate their patients on a daily basis about the hazards of air pollution. Additionally, there is also a need to follow some measures at an individual level because every small contribution can lead to a big change.”

Evidence suggests that household air pollution in developing countries can increase risk conditions such as low birth-weight and perinatal mortality (still births and deaths in the first week of life), asthma, otitis media (middle ear infection) and other acute upper respiratory infections, tuberculosis, nasopharyngeal cancer, laryngeal cancer, and cervical cancer.

Adding further, Dr Aggarwal, said, “Although there is a provision for environmental protection in our Constitution and steps have been taken by the government to address this issue, there is still a long way to go before the country can breathe clean air. The need of the hour is dedicated and sustained efforts which involve the public as well. And IMA’s current campaign is a first step towards this effort.”

Here are some ways in which you can help reduce air pollution at an individual level.

• Get your vehicle pollution checked regularly.
• Use eco-friendly products at home.
• Plant trees around your house.
• Avoid smoking inside the house although it is better to quit the habit altogether.
• Choose and buy sustainable and recycled products.
• Use energy-efficient devices at home.

Universal screening for alcohol misuse at hospitalization is a feasible strategy

A study published online July 27, 2017 in the Journal of Hepatology has demonstrated that universal screening for alcohol misuse at the time of hospitalization to identify patients at risk of developing alcohol-related liver disease, is a feasible strategy.

Researchers from the UK screened all admissions to the Acute Medical Unit of a large acute hospital using an electronic data capture system. At the time of admission, information about the amount of alcohol consumed, previous visits and or admissions and whether they were alcohol-related was recorded.

Around 91% patients completed the screening; of these, around 3% of the patients were grouped as “increasing”, and 4% as “high” risk of alcohol harm. The high risk group had more frequent emergency room (ER) visits and higher re-admission rates; gastrointestinal bleeding, mental health disorders, poisoning and liver disease were the most common diagnoses for hospitalization.

What this study showed was that it is possible to screen patients for alcohol misuse at hospitalization, identify patients with a very high unit consumption and then to refer them for appropriate intervention, potentially reducing the burden of alcohol-related harm. While, lower risk patients can be given brief advice by any trained healthcare professional

This study assumes all the more importance because alcohol misuse is a major cause of preventable death. It also offers a solution to the unmet need to identify patients with alcohol-related liver disease at an earlier stage.

According to the WHO, 3.3 million deaths (~6% of all deaths) globally every year are due to alcohol-related harm. It is all the more worrisome because alcohol consumption causes death and disability relatively early in life, particularly in the younger age group. Alcohol has been linked to many noncommunicable diseases, including alcohol-related liver disease and injuries. Overall 5.1 % of the global burden of disease and injury is attributable to alcohol, as measured in disability-adjusted life years (DALYs).

Source

1.    Westwood G, et al. Universal screening for alcohol misuse in acute medical admissions is feasible and identifies patients at high risk of liver disease. Journal of Hepatology, published 27 July 2017.

Dr KK Aggarwal

National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award, Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award

Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)

Past Honorary Secretary General IMA

Past Senior National Vice President IMA  

President Heart Care Foundation of India

Gold Medalist Nagpur University

Limca Book of Record Holder in CPR 10

Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre  
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS

Member Ethics Committee Medical Council of India (2013-14)  

Chairman Ethics Committee Delhi Medical Council (2009-15)

Elected Member Delhi Medical Council (2004-2009)

Chairman IMSA Delhi Chapter (March 10- March 13)

Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)

 

Children with dyslexia can learn normally with the right approach

Early detection imperative in providing the right treatment and helping manage condition better

New Delhi, 28 July, 2017: Statistics indicate that Dyslexia is one of the most common learning disabilities affecting 1 in 10 children worldwide. The Dyslexia Association of India estimates that about 10% to 15% of school-going children in India suffer from some type of Dyslexia. Multilingualism, which is common in the country, can also impact the difficulty. This condition can affect boys and girls alike. If undetected by Class 2, dyslexic children can grow up to be dyslexic adults, at which point, this condition cannot be cured.

A developmental reading disorder, Dyslexia occurs in children with normal intelligence. It is caused when the brain is unable to translate images received from the eyes or ears into understandable language. Although there is evidence to suggest that dyslexic children can excel in other areas such as sports and extracurricular activities, lack of awareness is an impediment to the progress of such children in India.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said "The brain of a dyslexic person is structurally and functionally different from others. The inborn wiring system of the brain responsible for development of mental skills is different in a dyslexic person, making this the root cause for this condition. It is due to this that even minor acts of comprehension and usage can take longer in such children. The sad part about this condition in our country is that children can be classified as under achievers. They are also labeled as lazy, having low intellect, and unmotivated. All this affects their personality and results in low confidence and self esteem. Early detection can play a major role in helping such children. Assessment of the child's family history and other related information can help trace the causes."

Some symptoms of dyslexia in children include difficulty in verbal skills; abstract reasoning; impaired hand-eye coordination; poor concentration, perception, and memory; and impaired social adjustment.

Adding further, Dr Aggarwal, said, "The first line of understanding for a child is his/her parents. They should ensure that instead of running away from the problem, the child undergoes proper assessment to diagnose the difficulty. If the child is diagnosed with dyslexia, understand that it is not the end of everything. Understanding, acknowledging, and supporting your child in his/her efforts can help in handling this condition in a better and more informed manner."

There are some techniques that can be used to help dyslexic children overcome their learning and comprehension problems.

• Indulge in positive reinforcement. Communicate with your child in a positive manner and be patient with them when they take time to grasp things.
• Dyslexic children are more inquisitive and hence, it is important to give them logical answers. Help them in getting their doubts cleared.
• Teaching science and math in a tabular manner can help them in understanding the subjects better.
• Use more of audio-visual aids as they can grasp things better with this technique. For younger children, flash cards can be used.
• Yoga is a good way of increasing concentration in children with this condition. Breathing exercises and alternative therapy can help them cope better than medicines.

A healthy lifestyle can reduce risk of dementia

Lifestyle has a major role to play in the health and well-being of a person. It’s not just physical health that benefits from a healthy lifestyle, but also mental health.

Dementia is usually regarded as a part of the normal aging process. But it is not always so. Dementia is also associated with lifestyle factors. And, the risk of dementia can be reduced by simple but effective lifestyle modifications. This is the key message from a new report of The Lancet Commission on Dementia Prevention, Intervention, and Care, presented at the recently concluded Alzheimer's Association International Conference (AAIC) 2017 on July 20, 2017 and also published in The Lancet.

The report has identified nine lifestyle factors (as below) during the course of life - early, middle and later – that influence the risk of dementia. Many of these factors can co-occur. 

The Report has for the first time considered social isolation and hearing as being pertinent to dementia. The level of education was also found to be an important risk factor. Poor education has been correlated with poor cognition.

1.    Early life level of education

2.    Midlife hypertension

3.    Midlife obesity

4.    Midlife hearing loss

5.    Later life smoking

6.    Later life physical inactivity

7.    Later life social isolation

8.    Later life depression

9.    Later life diabetes

Prevention is always better than cure. These factors are potentially modifiable and addressing them timely can prevent dementia in a large number of people.

In addition to well-controlled hypertension and diabetes, early treatment of depression, weight loss, smoking cessation, being socially active, increasing physical activity, it is also important to engage in mentally stimulating and challenging exercises to keep the brain active. Develop a hobby, solve crossword puzzles, play chess or such challenging games to stay mentally active.

A healthy lifestyle adopted early in life builds up cognitive reserve for later life. It is important that we also advise our patients to start making positive lifestyle changes for a healthy old age.

(Source: Medscape)

Dr KK Aggarwal

National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award, Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award

Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)

Past Honorary Secretary General IMA

Past Senior National Vice President IMA  

President Heart Care Foundation of India

Gold Medalist Nagpur University

Limca Book of Record Holder in CPR 10

Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre  
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS

Member Ethics Committee Medical Council of India (2013-14)  

Chairman Ethics Committee Delhi Medical Council (2009-15)

Elected Member Delhi Medical Council (2004-2009)

Chairman IMSA Delhi Chapter (March 10- March 13)

Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)

IBD is a chronic relapsing condition

Lack of awareness about the condition and its seriousness in India, says IMA

New Delhi, 27 July 2017: Statistics indicate that about 50 lakh people around the world have IBD or inflammatory bowel disease. In India, the number of cases exceed 12 lakh annually. However, there is not much awareness on the seriousness and symptoms of this disease in the country. As per the IMA, this is a chronic relapsing condition wherein the symptoms can be managed with a combination of care, medication, hospitalization, and sometimes surgical intervention.

 IBD is an umbrella term for two diseases namely Ulcerative Colitis (UC) and Crohn's disease. The incidence of UC is very high in India when compared to Crohn's disease. While Crohn’s can affect any part of the digestive system, UC affects only the rectum and the colon.

Speaking about this, Padma Shri Awardee Dr K K Aggarwal, National President Indian Medical Association (IMA) and President Heart Care Foundation of India (HCFI) and Dr RN Tandon – Honorary Secretary General IMA in a joint statement, said, “IBD can be a painful and debilitating condition. If left undetected and untreated, it can lead to serious complications such as fistula intestinal obstruction, bowel dysfunction, and even colon cancer. UC causes long-lasting inflammation in a part of the digestive tract. It occurs only through continuous stretches of the colon and the symptoms show up over time. Crohn’s disease, on the other hand, causes inflammation anywhere along the lining of the digestive tract, spreading deep into affected tissues eventually. This further causes abdominal pain, severe diarrhea, and even malnutrition. Surgery may be required in those with Crohn’s disease to remove a damaged or diseased part of the intestine. Sometimes, the entire large intestine is removed, with or without the rectum.”

Some symptoms of inflammation of the intestinal tract include diarrhea, rectal bleeding, urgent need to move bowels, abdominal cramps and pain, sensation of incomplete evacuation, and constipation (which can lead to bowel obstruction). There could also be other general symptoms such as fever, loss of appetite, weight loss, fatigue, night sweats, and loss of normal menstrual cycle.

Adding further, Dr Aggarwal, said, “IBD is generally treated with anti-inflammatory drugs which are special derivatives of 5 ASA derivatives. These are used either orally or through enema, corticosteroids, immunosuppressants, biological agents, antibiotics, anti-diarrheal drugs, and laxatives. Regular treatment and frequent tests are imperative.”

IBD can be controlled through certain lifestyle modifications as follows.

• Identify the triggers For some these triggers could be food such as dairy products. Identifying the foods that trigger the symptoms and avoiding them is crucial.
• Go for less gassy foods Avoid beans, cabbage, and cauliflower as these can cause gas. Consume more of foods that are rich in omega-3 fatty acids.
• Eat smaller meals This will help your digestive system to adjust better to the condition.
• Keep yourself adequately hydrated Drink plenty of water and other fluids. However, limit the consumption of caffeine and alcohol.

Vitamin D supplementation: Choose vitamin D3 over D2

Vitamin D deficiency is highly prevalent in India, almost in epidemic proportions. There are several reasons for deficiency of vitamin D. Lack of food fortification policies and more commonly our sociocultural practices, ‘sun-fleeing’ behavior, are major factors contributing to deficiency of this ‘sunshine vitamin’ in India which has abundant sunshine. Many people are unaware that they are vitamin D deficient.

Vitamin D, as we know, is essential for bone health. Evidence has also demonstrated its role in chronic diseases such as cardiovascular disease, cancer, diabetes, infertility, dementia and autism, among others.

There are two forms of vitamin D: vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol). D2 is plant-based and D3 is derived from animal sources.

Vitamin D levels below 20 ng/ml need to be treated and are an indication for vitamin D supplementation.

The question arises which one to choose: vitamin D2 or D3?

Several international guidelines have recommended either D2 or D3 for vitamin D deficient patients stating that the two forms of vitamin D are equivalent and are equivalent in their effectiveness in treating patients with low vitamin D levels.

However, findings of a new randomized-controlled trial from the UK have raised questions on these recommendations as the study found that vitamin D3 was twice as effective in increasing levels of serum 25-hydroxyvitamin D (25[OH]D) compared to vitamin D2 at a low dose of 15 μg daily.

In the study published online July 5, 2017 in the American Journal of Clinical Nutrition, vitamin D3 fortified foods (juice, biscuits) during winters led to higher serum 25[OH]D levels after 12 weeks of supplementation compared to D2 fortified foods (juice, biscuits) in healthy South Asian and white European women.

Vitamin D levels in women who received vitamin D3 via juice or a biscuit increased by 75% and 74%, respectively vs those who were given D2 through the same methods. Those given D2 saw an increase of 33% and 34% over the course of the 12-week intervention.

Therefore, D3 should be the preferred form when advising vitamin D supplementation as it is the most effective form of increasing vitamin D levels in the body.

Even low doses of vitamin D3 are effective in achieving the desired levels as demonstrated in this study.

Sources

1.    University of Surrey, Eurekalert Press Release, July 5, 2017.
2.    Tripkovic L, et al. Am J Clin Nutr. 2017 Jul 5. Epub ahead of print

Dr KK Aggarwal
National President IMA & HCFI

Recipient of Padma Shri, Dr BC Roy National Award, Vishwa Hindi Samman, National Science Communication Award & FICCI Health Care Personality of the Year Award
Vice President Confederation of Medical Associations of Asia and Oceania (CMAAO)
Past Honorary Secretary General IMA
Past Senior National Vice President IMA
President Heart Care Foundation of India
Gold Medalist Nagpur University
Limca Book of Record Holder in CPR 10
Honorary Professor of Bioethics SRM Medical College Hospital & Research Centre
Sr. Consultant Medicine & Cardiology, Dean Board of Medical Education, Moolchand
Editor in Chief IJCP Group of Publications & eMedinewS
Member Ethics Committee Medical Council of India (2013-14)
Chairman Ethics Committee Delhi Medical Council (2009-15)
Elected Member Delhi Medical Council (2004-2009)
Chairman IMSA Delhi Chapter (March 10- March 13)
Director IMA AKN Sinha Institute (08-09)
Finance Secretary IMA (07-08)
Chairman IMAAMS (06-07)
President Delhi Medical Association (05-06)