Writes: Dr. Maja Katrandziska Dzonlaga, Family Medicine specialist
- Given the specific conditions under which we work in the past few months, how do you manage to take care of patients who come to family doctors?
We live in a new reality. Our new “normal” is the fight of humanity with SARS CoV2, where all institutions and all resources are directed to Covid 19. However, in our offices, patients suffering from hypertension, diabetes, renal colic, appendicitis , with respiratory infections for other reasons have not disappeared ….. On the contrary, they are here as before, only further burdened by the conditions of the pandemic, with suspicion or confirmation of Covid 19. The work of family doctors is entirely aimed at preventing the spread of infection and control of Covid 19. Family physicians are the first contact, and they also face the challenge of meeting all the challenges …. chronic patients, covids with concomitant diseases and acute conditions. The most important question for us as family physicians is how we can remain good doctors, and not allow ourselves and our staff to get sick, not put our chronic patients who do not have Covid at regular check-ups at risk, and how to manage positive patients with Covid who have a chronic illness and are at risk of developing a more severe clinical picture of Covid.
The Association of General Practitioners and Family Medicine in cooperation with the Center for Family Medicine organized a series of educations, lectures for family doctors and their teams, which dealt with these issues. In that way we managed to get directions on how to reorganize the work in our offices regarding the safety of our patients and accurate protocols for guiding patients with chronic diseases in conditions of pandemics, especially patients with diabetes and hypertension. We have developed new ways of communicating with our patients remotely, usually by telephone or electronic communication, and pre-planning the examinations so that in one act we can complete all the necessary examinations that require physical contact, and then interpret the results, give advice and instructions for treatment through remote methods. We have also developed a tool through which we assess the degree of urgency and necessity for an examination requiring physical contact. A very good trend and to be welcomed is the fact that patients have begun to accept the way of working with an appointment with the family doctor, which I hope will continue to apply in the future.
- On the eve of Diabetes Day, 14.11, we would especially like to focus on patients who are at risk of developing type 2 Diabetes, what is the screening process for these patients?
Of course, the screening process has undergone some modifications. We must never stop screening our patients. But now, we can not do as required by the instructions. We use every moment of patients’ phone calls to ask about the possible existence of risk factors for diabetes. We know our patients best, their lifestyle, their family history and burdens, their habits. We advise thеm on healthy lifestyle habits, a healthy diet, physical activity and smoking cessation. We also perform opportunistic screening of patients who have no risk factors and come to the office for another need. Depending on the results obtained from the measurement of glycemia, we recommend glycemic control within the prescribed time using diagnostic criteria and patient guidance. According to the guidelines, all patients with an BMI> or equal to 25, with one or more risk factors, who have a normal screening result, re-screening is recommended after one year. Also, patients who according to the results are in the prediabetes group, re-screening is done after one year. Patients over 45 years, without risk factors if they get a normal finding during the screening, re-screening is done after 3 years. Those who according to the result are in the group of prediabetes, re-screening is done after 1 year.
A special category is pregnant women. For those who have risk factors, we do screening for diabetes at the first visit. Pregnant women without risk factors are screened at 27-28 gestational weeks. Women with gestational diabetes are screened for life for the risk of девелопинг diabetes mellitus.
- How many patients are present in your office who have certain risk factors for developing Diabetes?
The number of patients with risk factors for developing diabetes is high. Some of these factors can not be modified, they are hereditary factors, the patient’s age over 45 years, or the occurrence of diabetes during pregnancy or the birth of a large baby. However, the other group of risk factors are conditions that can be managed by the joint activities of the doctor and the patient. Such are obesity, especially abdominal obesity, dyslipidemia or high cholesterol, high blood pressure, inadequate diet, lack of physical activity, metabolic syndrome, stress … All these risk factors are present especially in the young population. If we fail to diagnose patients with prediabetes in time with the screening, they can very easily develop a picture of diabetes after a few years. Therefore, the focus of the interest of family doctors is precisely these patients who have prediabetes.
- How much is the metabolic syndrome a threat to the patient’s health?
Metabolic syndrome is caused by the industrialization of society and unhealthy lifestyle. It refers to a group of risk factors for cardiovascular disease, such as stress, physical inactivity, abdominal obesity, and insulin resistance. The sum of these risk factors leads to a higher risk of developing diabetes and cardiovascular disease than if each risk factor were considered individually. Metabolic syndrome is evident from abdominal thickness, which can be determined by measuring waist circumference. Early detection and treatment of metabolic syndrome is aimed at the primary and secondary prevention of type 2 diabetes mellitus, CVD (hypertension, coronary artery disease, stroke, peripheral arterial disease) as well as depression and Alzheimer’s disease.
- What advice do you give to these patients on how to reduce the risk and improve the quality of their health?
-First of all, we give them recommendations for changing the lifestyle and applying a healthy lifestyle. We build an individualized approach to each patient. If the patient is overweight, we give weight loss tips, to start decrease at least 10% of the existing body weight and a tendency to control weight to avoid obesity and BMI> 30, or waist circumference <94 cm, for men and <80 for women. Healthy eating tips for increased consumption of vegetables and fresh fruits, fish, nuts, olive oil, small amounts of red meat and low-fat dairy products. Moderate physical activity of at least 150 minutes per week or individually according to the patient’s needs. We advise smoking cessation with supportive therapy. We educate patients about self-care and self-control.
Some of the patients adhere to our advice, some do less, but we are always available to correct them, to direct them, because it benefits the patient himself, but also us doctors who would have healthier patients and patients in which the disease is under control.
