నైరూప్య

Diabetes current perspectives and lessons learnt from the epicenter, the Persian Gulf

Kashif Rizvi

region, it is of utmost importance to realize that no health care system in the world could deal with it just through therapeutic interventions or management of its complications. Given its myriad affects type 2 diabetes has the potential to pass the threshold of sustainable spending in the health care sector of even the wealthiest economies of the world. This talk aims to run through lifestyle habits of a sedentary obesogenic society as the root cause of the epidemic and addresses the current dearth of knowledge amongst health care providers and their ‘glucocentric’ approach which often results in missed diagnosis of warning signs of this syndrome or suboptimal care once diagnosed. In the industrial and automation age there has been a paradigm shift in the metabolic syndrome’s prevalence and unless a holistic, multifaceted and multifactorial approach is adopted we run the risk of not only cutting short the productive years of life but also add to the enormous burden of morbidity and mortality spanning virtually all age groups . Kuwait features amongst the top countries of the world in this regard and has a unique cohort where an indigenous population compares expats in the disease prevalence indicating a strong environmental factor. This talk runs through type 2 diabetes in a holistic manner covering all aspects of it within Kuwaiti society and sets guidelines for the rest of the affluent world.

Type 2 diabetes mellitus (T2DM) is associated with depressive symptoms, and comorbid depression in those with T2DM has been associated with adverse clinical profiles. Recognizing and addressing psychological symptoms remain significant clinical challenges in T2DM. Possible mediators of the reciprocal relationship between T2DM and depression may include physical activity levels, effectiveness of self-management, distress associated with a new T2DM diagnosis, and frailty associated with advanced diabetes duration. The latter considerations contribute to a “J-shaped” trajectory from the time of diagnosis. There remain significant challenges to screening for clinical risks associated with psychological symptoms in T2DM; poorer outcomes may be associated with major depressive episodes, isolated (eg, anhedonic), or subsyndromal depressive symptoms, depressive-like symptoms more specific to T2DM (eg, diabetes-related distress), apathy or fatigue. In this review, we discuss current perspectives on depression in the context of T2DM with implications for screening and management of these highly comorbid conditions.