Volume 1 number 1 Summer 2003
Special issue for the abstracts of the 7th Pan Arab Conference on Diabetes
PACD7 , 25 – 28 March 2003 Cairo

Abstract Number : 34
Treating the Patient with Multiple Co-Morbidities

Christopher D. Saudek, M.D.

The treatment of diabetes does not end with the control of blood glucose, and in fact glycemic control may not even be the most important feature of a given patient’s care. This is particularly true when multiple co-morbidities, when other illnesses, diabetes-related or not, significantly affect the person’s prognosis.

Diabetes-related co-morbidities include such conditions as coronary artery disease, hypertension, dyslipidemia and renal disease. Each is seen very commonly in association with diabetes; and each seriously affects outcome. Multiple risk factor intervention is a necessity, often-requiring individual assessment and treatment of the co-morbid conditions. Management of hypertension, for example, was found by the UKPDS to have a more significant impact in mortality than intensive glucose control. But each of the diabetes-related co-morbidities must be assessed and even treated preventively in order to reduce mortality.

Patients also frequently have co-morbidities that are largely unrelated to diabetes, especially elderly people with type 2 diabetes. Co-morbidities such as cancer, dementias, frailty, addictions, depression or congestive heart failure have such a major impact on life expectancy or the ability of a person to follow a diabetic regimen, that they require scaling back glycemic control goals. Given that well controlled blood glucose is most effective in preventing long-term microvascular complications (retinopathy, nephropathy, neuropathy), there are clinical situations in which tight control of blood glucose can reasonably be sacrificed in favor of simply avoiding severe hyperglycemia

The management of diabetes requires clinical judgment as well as fixed guidelines.

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