Diabetes, Obesity & Metabolic Disorders

Diabetology is a branch of medicine that deals with management of Diabetes Mellitus and associated conditions. It is a discipline that specialises in research and treatment of all types of diabetes.
A diabetologist is a health professional who diagnoses and treats all types of diabetes and diseases that are closely related to diabetes. Diabetes is a very common metabolic disorder with high prevalence in the population. It has both genetic and environmental risk factors and regardless of that, it progresses through different stages during its clinical history.
Uncontrolled diabetes is associated with long term harm and risk of organ failure especially of the nerves, heart, blood vessels, eyes and kidneys. Metabolic disorders like fatty liver, obesity, high cholesterol and thyroid diseases often coexist with diabetes and make treatment challenging, requiring comprehensive specialised care to prevent complications.

What Does a Diabetologist Treat?

Diabetologists specialise in diagnosing and managing various metabolic disorders. Most such conditions stem from hormonal imbalances, poor diet and lifestyle. Some people are at higher risk due to special medical conditions, or having a family history of diabetes. Here are some key areas of treatment provided by diabetologists:

1. Diabetes and Metabolic Disorders

Metabolic disorders, such as diabetes, are perhaps the most common among these conditions. Diabetologists are essential to any treatment regimen for metabolic disorders. The conditions include:

• Type 1 Diabetes: Autoimmune illness where the pancreas fails to produce insulin.
• Type 2 Diabetes:  A condition when the body does not use the insulin effectively produced in the body.
• Fatty Liver Disease:  This condition is associated with metabolic syndrome and insulin resistance.
• Gestational Diabetes: A form of diabetes that occurs only at the time of pregnancy and ends after delivery.
• Post-Pancreatitis Diabetes: Diabetes due to chronic inflammation of the pancreas.
• Brittle Diabetes: Severe diabetes with very extreme fluctuations in blood sugar.
• Polycystic Ovary Disease (PCOD) and Polycystic Ovary Syndrome (PCOS): Hormonal conditions that are typically linked with erratic menstrual patterns, ovarian cysts, and metabolic complications like insulin resistance

Other metabolic disorders include genetic metabolic disorders, metabolic syndrome, and obesity which disrupts the body's metabolism of energy. Diabetologists also coordinate the monitoring of diabetic complications, including diabetic neuropathy (nerve damage) and retinopathy (eye damage), facilitating early detection and treatment.

2. Obesity and Weight Management

Obesity is a chronic condition that is related to other endocrine and metabolic disorders. Thus, the diabetologist primarily focuses on the identification of the underlying hormonal or metabolic cause of obesity and develops individualised treatment plans. These might comprise lifestyle interventions, pharmacological management, and even referral to bariatric surgery in some cases.

3. Thyroid Disorders

The thyroid gland (a butterfly-shaped gland in the front of the neck) plays a crucial role in regulating metabolism. Its dysfunction in the body can give rise to some serious health issues. Some of the common thyroid disorders include the following:

• Goitre: It occurs due to the increase in size of the thyroid gland.
• Graves’ Disease: An autoimmune disease that over stimulates the thyroid gland and causes hyperthyroidism.
• Primary Hypothyroidism: It is due to an underactive thyroid gland producing less hormone, thus TSH levels are high.
• Autoimmune Hypothyroidism: An underactive thyroid gland due to auto-antibodies like anti-TPO antibody, thus raising TSH levels.
• Central Hypothyroidism: This is an underactive thyroid gland due to deficiency of a hormone at the level of brain (pituitary gland)
• Thyroid Inflammation (Thyroiditis): Thyroiditis often gets activated by autoimmune or viral causes.

4. Sarcopenia

Sarcopenia is a type of muscle loss that occurs with aging and/or immobility. It is characterised by the degenerative loss of skeletal muscle mass, quality, and strength. The rate of muscle loss is dependent on exercise level, comorbidities, nutrition and other factors. It can lead to reduced quality of life.

4. Metabolic Dysfunction-associated Fatty Liver Disease (MAFLD)

Fatty liver is when fat accumulates in your liver, causing it to enlarge in size. Risk factors include being overweight and type 2 diabetes. It is the new term used for fatty liver where alcohol intake is not responsible. Alcohol is an independent risk factor for liver damage. Early diagnosis and treatment of liver conditions is paramount in preventing progression of liver damage.

What Are The Various Tests Performed By Diabetologists To Diagnose And Treat Diabetes, Obesity, And Metabolic Disorders?

Diabetologists use a variety of diagnostic tests to assess and manage conditions like diabetes, obesity, and other metabolic disorders. These tests help monitor blood sugar levels, hormonal imbalances, and the overall function of the endocrine system. Here are some of the primary tests performed:

1. Fasting Plasma Glucose (FPG) Test

It's a test that will determine your blood glucose after fasting for a minimum of 8 hours. Fasting Plasma Glucose Test is generally conducted in the morning and determines diabetes and prediabetes. A patient is asked to fast, meaning that he or she should not consume food or liquids except water. This test gives a momentary picture of your blood sugar levels and helps evaluate how well your body is managing glucose.

2. HbA1C Test (Haemoglobin A1C)

The A1C test calculates the average of your blood glucose for the past 2 to 3 months. Unlike the FPG test, this one does not require fasting, which makes it a very useful tool in the assessment of long-term blood sugar control. The result is given in percentage points, where a higher number conveys bad glucose control. However, pregnancy or disorders with the blood may alter the accuracy of the test. In these cases, your doctor might request additional tests.

3. Oral Glucose Tolerance Test (OGTT)

OGTT is usually used to validate or diagnose gestational diabetes or prediabetes. Before the test, you are requested to fast overnight. A sugary solution will be given to you after you fast and your blood glucose levels will be checked frequently at 1 and 2 hours. This test measures how well you can metabolise glucose and is very useful in the diagnosis of insulin resistance.

4. Thyroid Function Tests

Thyroid function tests are done  to screen for disorders such as hypothyroidism or hyperthyroidism, which are associated with metabolic disorders. These tests measure levels of T3, T4, and TSH in the blood. In some cases further testing like thyroid antibodies, thyroid uptake scan etc may be required to establish the diagnosis.

5. Urine Tests

Urine analysis also provides some further information concerning metabolic and kidney function. For instance, tests such as urine protein-to-creatinine ratio (UPCR) assess kidney damage, which is a complication of uncontrolled diabetes.

6. Blood Lipid Profile

Abnormal lipid levels most often accompany obesity and metabolic disorders. A lipid profile is a measure of cholesterol and triglyceride levels, and these values are useful for determining cardiovascular risk assessment. It can even detect a condition like dyslipidemia, which can be present concomitantly with diabetes or obesity.

7. Genetic Testing

In some instances, genetic testing might be advised to help detect hereditary factors that may cause diabetes, obesity, or other metabolic disorders. Maturity-onset diabetes of the young and other such rare forms of diabetes can also be diagnosed through genetic analysis.

8. Continuous Glucose Monitoring (CGM)

In a diabetic patient, a diabetologist may ask to wear a continuous glucose monitoring device to measure changes in glucose levels throughout the day and night. This would give an excellent view of changes in glucose levels and further help refine the treatment plan especially in cases of brittle diabetes and gestational diabetes.

9. Liver Function testing (LFT) and Liver Elastography (Fibroscan)

The Liver is responsible for several functions, including primary detoxification of various metabolites, synthesising proteins, and producing digestive enzymes. It also plays a significant role in metabolism, glucose synthesis and storage. Liver function testing measures the different substances the liver produces and provides valuable information about the liver functional status.

Liver elastography is a specialised ultrasound test that measures the stiffness or fat content of your liver. It is a painless test and provides valuable information about the condition of your liver and also monitors your liver’s response to treatment.

10. Serum Fructosamine

This is a specialised blood test that is also sometimes used to monitor diabetes control. Diabetologist may order a fructosamine test to get an understanding of how well your glucose levels have been managed in the last few weeks. It is an alternative to HBA1c test and used in conditions where an HBA1c test may be inaccurate, or tracking of blood glucose control is required for a shorter period of time.

11. Body Composition Analysis (BCA)

12. Vibration Perception Threshold (VPT) or Biothesiometry testing

Vibration perception testing is a very useful way to detect Diabetic Peripheral Neuropathy (DPN) which is a complication of uncontrolled diabetes. Early detection and management of neuropathy is critical to prevent complications like foot ulcerations and amputations. All diabetic patients are typically recommended by a Diabetologist to do a VPT once every year.

13. Ankle Brachial Index (ABI)

The ankle-brachial index test is done to check for reduced blood flow in arteries of the arms and legs. It can detect peripheral artery disease (PAD) early which can cause leg pain when walking and increase risk of heart attack and stroke. The risk is higher in patients with diabetes, hypertension, high cholesterol, high blood pressure and history of smoking.

14. Insulin Sensitivity Testing

Insulin Sensitivity Testing is very helpful in assessing how the body responds to insulin in obese patients or patients suspected of having insulin resistance. This is very important in understanding conditions such as metabolic syndrome, which usually accompanies diabetes and obesity.

What Are the Treatment Options for Diabetes, Obesity, and Metabolic Disorders at Marengo Asia Hospitals?

At Marengo Asia Hospitals, our approach to the management of diabetes, obesity, and metabolic disorders is holistic. Our treatment options here include symptom management, overall health enhancement, and prevention of complications by lifestyle change, medication, and high-tech interventions.

1. Lifestyle Modifications

• Dietary Guidance: A diet plays a very important role in treating and managing diabetes. Our diabetes educator cum dietician gives personalised dietetic advice for the control of blood sugar, weight loss, and hormonal balance. Patients are counselled to follow:
• Low-Carbohydrate Diets: The intake of minimal sugars with an emphasis placed on more fibre-rich food.
• Avoiding Harmful Foods: Other things that are generally avoided in metabolic management are refined flours, reheated refined oils, palmolein oil, misleading milk supplement drinks, etc.
• Balanced Meals: Incorporate a more balanced consumption of vegetables, lean proteins, and healthy fats, and reduce consumption of processed foods.
• Exercise Programs: Physical exercise is important in dealing with obesity and achieving enhanced insulin sensitivity for diabetic patients. The exercise programs usually involve brisk walking, push-ups, jumping, and many others that help enhance the body's ability to absorb glucose and burn up excess body fats. Healthcare experts at Marengo Asia Hospitals will assist you with personalised fitness plans that help with weight loss, overall metabolic health, and long-term management of both diabetes and obesity.
• Weight Loss Strategies: Weight reduction improves insulin sensitivity and reduces dependence on medication, which is a necessary intervention in early-stage diabetes. Obesity or being overweight can be a risk factor for future diabetes, heart problems, knee pain etc. Obesity management programs for both diabetic and non-diabetic patients provide freedom from obesity in a scientific manner under supervision of a specialised team.

2. Medications

• Insulin Therapy: Insulin is an essential hormone controlling blood glucose. The need for insulin therapy is essentially for type 1 diabetes and, in advanced cases of type 2 diabetes, wherein insulin activity is significantly impaired. Insulin is administered through injections or pumps.
• Oral Hypoglycemic Agents: These are medicines that lower high glucose/sugar levels. Types of oral medicines are as follows:
• Biguanides (for example, Metformin)
• Sulfonylureas
• Gliptins
• SGLT2 Inhibitors
• Alpha glucosidase inhibitors
• Oral GLP1 analogues like Semaglutide

These medicines can be prescribed alone or in combination with injecting insulin to manage the level of blood glucose.

• Hormonal Supplements: If the thyroid or other hormones are out of balance in a patient, they are treated with hormone replacement. It is essential in conditions such as hypothyroidism.

3. Cutting-Edge Innovations

• Continuous Glucose Monitors (CGM): Such devices will measure blood glucose levels in real-time, thereby ensuring continuous data to help the patients as well as professionals in managing diseases, like diabetes, more effectively and in a timely manner.
• Insulin Pumps: Insulin pumps, which are often used in association with CGMs, pump insulin directly into the bloodstream for a far more accurate and consistent delivery of insulin.

Marengo Asia Hospitals is a source for patients to acquire effective treatment for diabetes, obesity, and metabolic diseases through a combination of lifestyle change, medication management, advanced technology, and interdisciplinary care. These innovative techniques help patients manage their illnesses, enhance quality of life, and reduce the risk of complications. Patients can get in touch with Marengo Asia Hospitals by filling up the inquiry form on our website, located at the 'Contact Us' page. You may also contact us through our direct contact number which is located on the same page.