026 - The diabetes model: chronic disease between theworlds of numbers and man
Autor(s): C.A. Lovagnini-Scher
Issue: RIMeL - IJLaM, Vol. 6, N. 3-S1, 2010 (MAF Servizi srl ed.)
Page(s): 26-30
In order to fully understand determined aspects related to diabetes is necessary to consider the scenario of this illness that is composite and still evolving today. The epidemiology of diabetic pandemia are well known and the numbers we are facing today are bigger and bigger. The new hypotheses, which propose glycated hemoglobin as a marker of diagnosis, despite there still isn’t a unanimous consensus, certainly help to increase the incidence of the disease. Moreover, being diabetes a chronic disease, it is essential to consider the peculiar characteristics that differentiate it from acute illness. The chronic diseases differ profoundly from acute events and the relationship, as it develops between doctor and patient, shows many different features. The model of care in chronic diseases requires a knowledge which goes beyond pure biomedical science, and involves elements linked to psychological and social aspects. However, increasing importance is given to the diagnostic and prognostic information derived from both laboratory and self blood glucose monitoring which are often an essential element in the process of care of a diabetic patient. The transition to a new unit of measurement in glycated hemoglobin determination, represents a sea change and involve a process of cultural evolution for both the physician and patient. On one hand, what the clinical environment is expecting from this passage, which at first glance may appear merely formal, is linked to the standardization of the method that will allow the comparability of data between different laboratories, permitting therefore an even greater value of this parameter in research. The study of daily and above the range variations in blood sugar becomes a parameter that cannot be neglected. On the other hand, daily variations in glucose monitoring, are regarded as always more interesting parameters and prognosis seems to be more and more strictly linked to variation coefficients which therefore become markers that cannot be neglected any longer. The diabetes involves not only alterations in glucose control but it involves, more extensively, the whole metabolism, as it happens lipid profile or renal function; the major hub function of laboratory reports in the process of care delivery must be stressed and the attention that is paid by the patient to the laboratory report calls for close attention in formal appearance and a commitment to cultural spreading.