Have you ever heard about ‘glycemic pentad?’ If you are suffering from diabetes or if a loved one of yours is struggling with this condition it is better you know what glycemic pentad is. Now, we all know that diabetes is a lifestyle disease. ‘Unlike a heart attack it doesn’t kill you instantly but it weakens all your organs and kills you slowly. This is why it is necessary to manage the condition well to lead a better quality of life and control its perils,’ says Dr Hemant Thacker, consultant physician Bhatia Hospital (Tardeo), Breach Candy Hospital (Breach Candy) Sukh Sagar clinic, Mumbai.

Here Dr Thacker explains how the condition can be managed better with help of glycemic pentad to improve quality of life and reduce chances of organ failure due to high sugar levels. For the uninitiated, diabetic pentad is not a device or a pill but a lifestyle management tool to manage diabetes better and improve quality of life.

What is glycemic pentad?

Dr Thacker: Conventionally, diabetes management involved keeping a tab on the triad – fasting blood sugar level, postprandial glucose and HBA1c – where the fasting blood sugar is the reading taken before meals, postprandial two hours after meals and HBA1c is the haemoglobin A1c test that tells you your average level of blood sugar over the past 2 to 3 months. This has been a standard way of keeping a tab on blood sugar levels which helps to titrate medications make changes in the lifestyle to suit the person. But some studies have pointed out that this documentation of blood sugar level might not be enough. Records say that despite having controlled fasting and postprandial blood sugar levels and HBA1c many diabetics progressively suffered from retinopathy and other complications of diabetes. This is why more aggressive and controlled parameters were needed. So, a forum was formed with 55 experts from all over India who felt the need to develop and introduce glycemic pentad with two more parameters.

The two other parameters that were introduced are glycemic variability and quality of life. So, diabetes management is now like a five-pronged approach where – fasting blood sugar, postprandial blood sugar, HBA1c, glycemic variability and quality of life – all are taken into consideration.

What were the limitations of fasting, postprandial and HBA1c reading? Why we need the extra two parameters? 

Dr Thacker: One needs to understand that blood glucose varies throughout the day and with the slightest change in your diet it can either soar or dip. Remember, your fasting blood glucose can still show a high value even if your HBA1c is in control. Again HBA1c is the average reading taken over two to three months which doesn’t record the high and low point at a specific time. The trouble with relying on postprandial blood sugar reading is that the Indian diet is high on carbohydrates Indian diet constitutes about 65 percent of carbs, which is more than that is recommended for diabetic patients. Carbohydrates have the greatest influence on blood glucose level, and both the amount and type of carbohydrate intake are the important determinants of postprandial glucose. Since Indians consume a diet with high glycemic index and load, postprandial glucose control and overall glycemic control in Indian diabetic population demand a separate attention.

How is the inclusion of glycemic variability and quality of life in glycemic pentad going to help in diabetes management?

Dr Thacker: Glycemic variability (GV) can be simply defined as the degree of daily blood glucose fluctuations (peaks and nadirs) in an individual. It comprises both postprandial glucose spikes as well as the hypoglycemic episodes. Glycemic variations are of two types: Variations measured within a day are called as intraday glycemic variations and the glucose variations measured at the same time on two consecutive days are called as inter day glucose variations. Now, there is some amount of glycemic variation in every individual but with diabetics, the variations just increase. Keeping a tab on glycemic variation throughout the day or after meals will help you manage the condition better. Suppose your sugar levels peaks to 400 after a snack or dips to 80 after dinner you will know what steps need to be taken to bring the levels to normal. This will help to avoid complications of diabetes and avoid near-death situations like hypoglycaemia.

One should also understand that management of diabetes should involve quality of life too, as your sugar levels directly impact your physical health, mental stability and social communication. Yes, sugar in the blood affects the brain and the muscles alike. So, the idea is not to just give medications but to ensure that a diabetic person can live life to the fullest despite the odds.

Precisely how are we going to achieve better control over fluctuating sugar levels with glycemic pentad?

Dr Thacker: Glycemic pentad forum was instituted comprising of 55 experts from different regions of India in the field of diabetology who discussed various evidences related to the topic and shared their experiences and expressed their opinion on the relevance of glycemic pentad in the present diabetes management and whether triple fixed-dose combination of metformin, glimepiride, and voglibose is able to achieve glycemic pentad targets. The forum has come to a consensus that the conglomerate of quintuple elements – FPG, PPG, HbA1c, glycemic variability and quality of life to be termed as glycemic pentad and these milestones to be considered for any antidiabetic therapy. Glycemic pentad deserves a prominent position in the diabetes management in India. The triple fixed-dose combination of metformin, glimepiride, and voglibose.

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Published: May 25, 2018 4:47 pm | Updated:May 25, 2018 4:48 pm



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