Anil K. Mandal
University of Florida, USA
Mandal is a native of India and a naturalized citizen of the United State of America. He is board certified in Internal\r\nMedicine and Nephrology (not yet recertified in nephrology). Diabetes Mellitus is the most common cause of kidney failure\r\nin the USA and worldwide. This strong association between diabetes and kidney failure has inspired Dr. Mandal to develop\r\nthe framework of Mandal Diabetes Research Foundation to assist diabetic patients in living a good life with medical\r\ntreatment, and avoiding dialysis. He is a published author/editor of 12 books and more than 100 articles on research in\r\ndiabetes and kidney disease. He is a two-time Fulbright Scholar and a visiting professor of 23 countries which permitted\r\nlectures on diabetes, high blood pressure and kidney diseases on five continents of the world. His astute knowledge and total\r\ndedication help patients get better and to live a good life. His convictions are that in the office patients come first, at home\r\nchildren 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 traditionally\r\nbeen used as a marker for the diagnosis of diabetes and initiation of a treatment plan. Despite the use of these diagnostic\r\nmarkers and a plethora of oral hypoglycemic agents, diabetic complications namely, cardiovascular disorders, renal failure\r\nand dialysis, and amputations, are on the rise. Therefore a reasonable concern is that either the definition of diabetes or the\r\nprevalent therapy with oral hypoglycemic agents, or both, are faulty. Abundant literature is available regarding the\r\nimportance of using 2-hour postprandial glucose (2hPPG) in glycemic control for the prevention of diabetic complications.\r\nA robust association has been shown between 1-h or 2-h postprandial hyperglycemia (> 200 mg/dL; 11.1mmol/L) and\r\ncardiovascular disorders and mortality. Notwithstanding the availability of such important information, 2hPPG control is still\r\nunder used in clinical practice of diabetes care. Worse than that, popularity of use of FBG and /or HbA1c as a guide for\r\ndiabetes care has permitted an incorrect diagnosis of Type 2 diabetes in numerous hypertensive patients treated with a\r\nthiazide diuretic and having elevated glucose levels followed by mistreatment with oral hypoglycemic agents. The result is\r\nsubsequent development of overt diabetes in many individuals, some of them are riddled with numerous complications such\r\nas foot ulcer, gangrene, kidney failure or heart disease. This article is dedicated to redirecting the attention from using FBG\r\nand or HbA1c to 2hPPG as a fundamental tool for evaluation of diabetes and to focus on therapy encompassing 2hPPG.\r\nEvidence has emerged from basic as well as clinical research claiming the importance of control of postprandial\r\nhyperglycemia in the prevention of diabetic complications. Prevention of diabetic complications is attainable by control of\r\npostprandial hyperglycemia with the prescription of a combination of Glargine insulin twice daily (12 hours apart) and\r\ntreatment of glycemic excursions with fast-acting insulin.
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