Episode 102. What's new in Diabetes with Dr Elif Ekinci (Part 2)
In the last 12 months, 121,000 Australians were diagnosed with diabetes, this statistic represents a 7% increase from the preceding year. There are now over 1.236 million Australians with type 2 diabetes and over 129,000 with type 1 diabetes and about 50,000 Australians have gestational diabetes each year -these staggering figures mean that 332 new diagnoses occur each day, about one new case every 5 minutes.
In respect to type 2 diabetes, the metabolic syndrome secondary to the obesity epidemic would appear to be a major contributor to new diagnoses. Australia ranks 6th highest amongst OECD countries (Organisation for Economic Cooperation and Development) in relation to its overweight and obese citizen with 67% characterised as overweight or obese (36% overweight, 31% obese).
In the last 12 months, 121,000 Australians were diagnosed with diabetes, this statistic represents a 7% increase from the preceding year. There are now over 1.236 million Australians with type 2 diabetes and over 129,000 with type 1 diabetes and about 50,000 Australians have gestational diabetes each year -these staggering figures mean that 332 new diagnoses occur each day, about one new case every 5 minutes.
In respect to type 2 diabetes, the metabolic syndrome secondary to the obesity epidemic would appear to be a major contributor to new diagnoses. Australia ranks 6th highest amongst OECD countries (Organisation for Economic Cooperation and Development) in relation to its overweight and obese citizen with 67% characterised as overweight or obese (36% overweight, 31% obese).
In this podcast, I was curious to explore how our society might stem the increasing number of cases that are contributing to the major public health epidemic we are facing. Is a sugar tax warranted for example as has been introduced in the United Kingdom? Do we need more health campaigns explaining what a healthy lifestyle and eating plan should look like?
From the pharmacological perspective we are fortunate in having some relatively new and effective drugs added to our therapeutic armamentarium available to tackle type 2 diabetes and these have opened up some exciting new management possibilities with impressive outcomes.
In this conversation with Associate Professor Ekinci, I was keen to understand the place of all these new medications in treatment strategies and the target haemoglobin A1C clinicians should be aiming for.
I was also keen to discuss when insulin should be added to manage type 2 diabetes noting that 40 to 50% of Beta cell function is lost by the time of diagnosis and it is estimated that a further 4-5% of function is lost each subsequent year.
Another exciting line of conversation I had hoped to explore related to new initiatives in the management of type one diabetes in relation to continuous glucose monitoring which in the lead-up to the federal election both major political parties have made firm commitments to support.
Assoc Professor Elif Ekinci is the Sir Edward Dunlop Principal Research Fellow in Medicine at Austin Health and the Dame Kate Campbell Fellow at the University of Melbourne. Elif is a clinician-researcher and an academic endocrinologist who is working to translate research into improved outcomes for people with type one and type 2 diabetes. Her research is focused on the pathophysiology, prevention, detection and treatment of diabetes and its complications through mechanistic studies, observation studies and clinical trials. Elif has received multiple awards for her work in diabetes and is clearly on a stellar career trajectory. It was an incredible privilege to have this conversation with her. Please welcome Assoc Prof Elif Ekinci to the next two episodes.
References:
Assoc Professor Elif Ekinci-Endocrinology Melbourne-www.endocrinologymelb.com.au
Diabetes-Australian Institute of Health and Welfare: www.aihw.gov.au
www.uptodate.com
Episode 101. What's new in Diabetes with Dr Elif Ekinci (Part 1)
In the last 12 months, 121,000 Australians were diagnosed with diabetes, this statistic represents a 7% increase from the preceding year. There are now over 1.236 million Australians with type 2 diabetes and over 129,000 with type 1 diabetes and about 50,000 Australians have gestational diabetes each year -these staggering figures mean that 332 new diagnoses occur each day, about one new case every 5 minutes.
With respect to type 2 diabetes, the metabolic syndrome secondary to the obesity epidemic would appear to be a major contributor to new diagnoses. Australia ranks 6th highest amongst OECD countries (Organisation for Economic Cooperation and Development) in relation to its overweight and obese citizen with 67% characterised as overweight or obese (36% overweight, 31% obese).
In the last 12 months, 121,000 Australians were diagnosed with diabetes, this statistic represents a 7% increase from the preceding year. There are now over 1.236 million Australians with type 2 diabetes and over 129,000 with type 1 diabetes and about 50,000 Australians have gestational diabetes each year -these staggering figures mean that 332 new diagnoses occur each day, about one new case every 5 minutes.
With respect to type 2 diabetes, the metabolic syndrome secondary to the obesity epidemic would appear to be a major contributor to new diagnoses. Australia ranks 6th highest amongst OECD countries (Organisation for Economic Cooperation and Development) in relation to its overweight and obese citizen with 67% characterised as overweight or obese (36% overweight, 31% obese).
In this podcast, I was curious to explore how our society might stem the increasing number of cases that are contributing to the major public health epidemic we are facing. Is a sugar tax warranted for example as has been introduced in the United Kingdom? Do we need more health campaigns explaining what a healthy lifestyle and eating plan should look like?
From the pharmacological perspective, we are fortunate in having some relatively new and effective drugs added to our therapeutic armamentarium available to tackle type 2 diabetes and these have opened up some exciting new management possibilities with impressive outcomes.
In this conversation with Associate Professor Ekinci, I was keen to understand the place of all these new medications in treatment strategies and the target haemoglobin A1C clinicians should be aiming for.
I was also keen to discuss when insulin should be added to manage type 2 diabetes noting that 40 to 50% of Beta cell function is lost by the time of diagnosis and it is estimated that a further 4-5% of function is lost each subsequent year.
Another exciting line of conversation I had hoped to explore related to new initiatives in the management of type one diabetes in relation to continuous glucose monitoring which in the lead-up to the federal election both major political parties have made firm commitments to support.
Assoc Professor Elif Ekinci is the Sir Edward Dunlop Principal Research Fellow in Medicine at Austin Health and the Dame Kate Campbell Fellow at the University of Melbourne. Elif is a clinician-researcher and an academic endocrinologist who is working to translate research into improved outcomes for people with type one and type 2 diabetes. Her research is focused on the pathophysiology, prevention, detection and treatment of diabetes and its complications through mechanistic studies, observation studies and clinical trials. Elif has received multiple awards for her work in diabetes and is clearly on a stellar career trajectory. It was an incredible privilege to have this conversation with her. Please welcome Assoc Prof Elif Ekinci to the next two episodes.
References:
Assoc Professor Elif Ekinci- Endocrinology Melbourne-www.endocrinologymelb.com.au
Diabetes-Australian Institute of Health and Welfare: www.aihw.gov.au
www.uptodate.com
Episode 66. Diabetic Foot with Dr Ming Yii
Diabetic foot is the name given to the condition commonly experienced by people with diabetic peripheral neuropathy and results in an insensitive and often deformed foot. Found in both type I and type II diabetic patients (of which there are 1.8 million living in Australia-one new diagnosis is made every 5 minutes), even minor trauma in the diabetic foot may lead to the development of an ulcer. The combination of impaired vascular supply from micro and macro vascular disease and neuropathy presents real challenges for healing. Consequently, diabetic foot ulcer is a major event in 85% of subsequent amputations and is the cause of 20% of hospital admissions related to diabetes. Ten to 15% of diabetic foot ulcers fail to heal and of these, 25% lead to an amputation. In one study up to 50% of diabetic patients undergoing amputation were dead within 2 years. Failure to be seen and managed by medical attendants more than 6 weeks after developing an ulcer in a diabetic foot vastly increases the amputation risk however just one year after appropriate vascular surgical management, between 70 and 90% of limbs will be saved from amputation. Furthermore, one year after vascular intervention up to 60% of diabetic foot ulcers are healed, highlighting the importance of vascular surgical expertise early in the management of the diabetic foot.
Diabetic foot is the name given to the condition commonly experienced by people with diabetic peripheral neuropathy and results in an insensitive and often deformed foot. Found in both type I and type II diabetic patients (of which there are 1.8 million living in Australia-one new diagnosis is made every 5 minutes), even minor trauma in the diabetic foot may lead to the development of an ulcer. The combination of impaired vascular supply from micro and macro vascular disease and neuropathy presents real challenges for healing. Consequently, diabetic foot ulcer is a major event in 85% of subsequent amputations and is the cause of 20% of hospital admissions related to diabetes. Ten to 15% of diabetic foot ulcers fail to heal and of these, 25% lead to an amputation. In one study up to 50% of diabetic patients undergoing amputation were dead within 2 years. Failure to be seen and managed by medical attendants more than 6 weeks after developing an ulcer in a diabetic foot vastly increases the amputation risk however just one year after appropriate vascular surgical management, between 70 and 90% of limbs will be saved from amputation. Furthermore, one year after vascular intervention up to 60% of diabetic foot ulcers are healed, highlighting the importance of vascular surgical expertise early in the management of the diabetic foot.
In this episode we are joined by expert vascular surgeon Mr Ming Yii who is the director of vascular and transplant surgery at Monash Health and adjunct Senior lecturer with Monash University. Ming is part of the Monash transplant team in kidney and pancreas transplantation and brings a wealth of knowledge and experience as well as an effusive personality to accompany his skills. In this episode he discusses his approach to this major problem and the multidisciplinary strategy for management that is needed.
Useful references include:
mingyiivascular.com.au
www.bmj.com Diabetic foot. SC Mishra 2017
www1.racgp.org.au.diabetic foot ulcer
To be a guest on the show or provide some feedback, I’d love to hear from you: manager@gihealth.com.au
Dr Luke Crantock MBBS, FRACP, is a gastroenterologist in practice for over 25 years. He is the founder of The Centre for GI Health, based in Melbourne Australia and is passionate about educating General Practitioners and patients on disease prevention and how to manage and improve their digestive health.