Novel insights into management of type 2 diabetes mellitus

Abstract

Type 2 diabetes mellitus (T2DM) is a significant cause of morbidity and mortality worldwide. It causes a number of macrovascular and microvascular complications, and is a major risk factor for cardiovascular diseases. The management of T2DM involves not only the control of blood glucose level, but also the management of complications that inevitably develop with time. However, there are many unaddressed issues in relation to the management of T2DM. Intensive glycaemic control has been thought to be beneficial but the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study showed that this might be harmful to patients. There has been evidence showing that hypoglycaemia could result in excess cardiovascular events. This puts clinicians into a dilemma. At the same time, practices of complementary and alternative medicine have been welcomed by patients suffering from chronic illnesses, including those with T2DM. The lack of evidence in support or against these alternative treatments has made the life of physicians managing T2DM patients more difficult.

In response to these problems, three clinical studies are presented in this dissertation. The first study, presented in Chapter 3, attempts to explore the relationship between hypoglycaemia and cardiac arrhythmias in real-life situations. Making use of the latest continuous glucose monitoring (CGM) and Holter electrocardiogram (ECG) technology, it has been found that hypoglycaemia was associated with higher incidence of certain forms of ventricular and supraventricular ectopic activity. The second study, presented in Chapter 4, is a randomised controlled trial of Panax ginseng supplement in T2DM patients. This study, involving 100 subjects randomised to receive either Panax ginseng supplement or placebo for 12 weeks, showed that Panax ginseng supplement did not improve haemoglobin A1c (HbA1c) and flow-mediated dilatation (FMD). The third study, presented in Chapter 5, conducted in conjunction with the randomised controlled trial presented in Chapter 4, recruits subjects from the clinical trial to undergo 3 days of parallel CGM and Holter ECG recording to collect data on glycaemic profile and cardiac arrhythmias. Although the three studies were limited by the inadequate number of subjects, they served to illustrate the need for further efforts of research into these unanswered questions.