University of Florida, USA
Title: Renal function is an indicator of glycemic control in diabetes
Mandal is a native of India and a naturalized citizen of the United State of America. He is board certified in InternalrnMedicine and Nephrology (not yet recertified in nephrology). Diabetes Mellitus is the most common cause of kidney failurernin the USA and worldwide. This strong association between diabetes and kidney failure has inspired Dr. Mandal to developrnthe framework of Mandal Diabetes Research Foundation to assist diabetic patients in living a good life with medicalrntreatment, and avoiding dialysis. He is a published author/editor of 12 books and more than 100 articles on research inrndiabetes and kidney disease. He is a two-time Fulbright Scholar and a visiting professor of 23 countries which permittedrnlectures on diabetes, high blood pressure and kidney diseases on five continents of the world. His astute knowledge and totalrndedication help patients get better and to live a good life. His convictions are that in the office patients come first, at homernchildren come first. Roses are his love, hence rose gardening is his hobby.
Fasting blood glucose (FBG) > 126 mg/dL (7mmol/L) and /or glycosylated hemoglobin (HbA1c) > 6.5% have traditionallyrnbeen used as a marker for the diagnosis of diabetes and initiation of a treatment plan. Despite the use of these diagnosticrnmarkers and a plethora of oral hypoglycemic agents, diabetic complications namely, cardiovascular disorders, renal failurernand dialysis, and amputations, are on the rise. Therefore a reasonable concern is that either the definition of diabetes or thernprevalent therapy with oral hypoglycemic agents, or both, are faulty. Abundant literature is available regarding thernimportance of using 2-hour postprandial glucose (2hPPG) in glycemic control for the prevention of diabetic complications.rnA robust association has been shown between 1-h or 2-h postprandial hyperglycemia (> 200 mg/dL; 11.1mmol/L) andrncardiovascular disorders and mortality. Notwithstanding the availability of such important information, 2hPPG control is stillrnunder used in clinical practice of diabetes care. Worse than that, popularity of use of FBG and /or HbA1c as a guide forrndiabetes care has permitted an incorrect diagnosis of Type 2 diabetes in numerous hypertensive patients treated with arnthiazide diuretic and having elevated glucose levels followed by mistreatment with oral hypoglycemic agents. The result isrnsubsequent development of overt diabetes in many individuals, some of them are riddled with numerous complications suchrnas foot ulcer, gangrene, kidney failure or heart disease. This article is dedicated to redirecting the attention from using FBGrnand or HbA1c to 2hPPG as a fundamental tool for evaluation of diabetes and to focus on therapy encompassing 2hPPG.rnEvidence has emerged from basic as well as clinical research claiming the importance of control of postprandialrnhyperglycemia in the prevention of diabetic complications. Prevention of diabetic complications is attainable by control ofrnpostprandial hyperglycemia with the prescription of a combination of Glargine insulin twice daily (12 hours apart) andrntreatment of glycemic excursions with fast-acting insulin.
Speaker PPTsDownload PPT