“For every one person living with diabetes, there’s another walking around that hasn’t been diagnosed. So, your first role is offering screening services for clients. We would advise you do a fasting blood glucose level as this enables you to diagnose either prediabetes or diabetes. You can do a fingerprint test in your pharmacies, anything from 6 to 6.9. Is considered prediabetes.

“The window of opportunity between insulin resistance, which is the cause of type 2 diabetes, and prediabetes is around 15-20 years. If the insulin resistance state is ignored, the person then moves on to prediabetes. From prediabetes to diabetes can take anything from 1-5 years.

WHY IT’S IMPORTANT TO IDENTIFY PREDIABETES

“If you institute lifestyle changes where your client goes towards a lifestyle where they're getting at least 10 000 steps a day and they start restricting high GI carbohydrates, then there's a chance you can prevent or delay it,” explained Dr Bhana. “Metformin can be used in the treatment of prediabetes, to delay it or even prevent it.”

DIAGNOSING DIABETES

A fasting blood glucose level above 7 has diabetes and needs to be referred to their GP or the closest clinic. “Here, the earlier you intervene the better,” said Dr Bhana. “The reason you’re so important is that over 50% of people that present with type 2 diabetes to their doctors, already have complications. That means they’ve been walking around with diabetes for a long period of time. We don't have good screening services in SA, and you can play a pivotal role in this. If you pick people up early, especially in the prediabetic stage, this is where you can make a significant difference to their life.”

Dr Bhana explained that in the past a step wise approach was followed to manage type 2 diabetes: “You were diagnosed and they said lifestyle modification and if that didn't work and the sugar was up, they'll start you off on one tablet like metformin and 3-6 months later, if the HPMC is still above seven, then you go to your second agent, and if that wasn't enough, you'd then move on to basal insulin and basal plus.

“However, things have changed because we realised the pathogenesis of type 2 diabetes that developed and now look at the different pathways involved.”

To learn about the 11 interlocking pathways which contribute to hyperglycaemia and how to target them, common barriers to achieving glycaemic control, and the mechanism of action and pros and cons for different treatment options, watch the full webinar HERE.

To download Dr Bhana’s presentation, click here.

To request your certificate of attendance from watching the replay, email john.woodford@newmedia.co.za