As part of the celebration of the 10th anniversary of the opening of the Diabetes Consultation at HPA Alvor, Ricardo Louro reveals that it has been “a decade of hard work and growth”, marked by the desire to continue innovating and committing to the well-being of his patients.

The Portugal News (TPN): What is diabetes?

Ricardo Louro (RL): Diabetes is currently a major non-infectious epidemic, with numbers expected to rise over the coming decades. It is a chronic metabolic disease characterised by abnormally high blood sugar (glucose) levels. It is a multifactorial disease in its aetiology and treatment but is characterised by insufficient production of insulin by the pancreas and/or our body's inability to use it effectively. Insulin is an essential hormone in the utilisation of glucose as a source of energy and without it glucose doesn't pass into the cells, increasing its levels in the blood. This increase is responsible for the signs and symptoms associated with Diabetes as well as its many associated complications.


TPN: What are the differences between type 1 and type 2 diabetes?

RL: I think the classification of diabetes is likely to change over the next few years and the development of genetic science could have a big impact on this.

Type 1 Diabetes is considered to be an autoimmune disease in which the immune system destroys the cells in the pancreas responsible for producing insulin. It mostly appears in childhood or younger, and its treatment includes insulin almost from the moment of diagnosis.

Type 2 diabetes is more common in adults (despite increasing numbers at younger ages) and is usually associated with risk factors such as being overweight or obese, a sedentary lifestyle and genetic inheritance. In most cases, insulin is still produced in these patients, but it acts inefficiently for the body's needs. Treatment should be carried out by promoting healthy lifestyles, oral and/or injectable antidiabetics and/or insulin.


TPN: Is there any way to prevent either type of diabetes? If so, how?

RL: Type 1 Diabetes, as described in the previous question, despite having genetic and autoimmune factors at its root, cannot be prevented, but its onset can be delayed, particularly with new therapies that have recently emerged.

Type 2 Diabetes can often be prevented or its onset delayed through behavioural aspects: promoting healthy lifestyles, maintaining an adequate weight, exercising regularly, eating a balanced diet and controlling other factors that are often associated with it, such as hypertension (increased blood pressure) and dyslipidaemia (increased cholesterol, LDL and triglycerides). Prevention is therefore one of the pillars of the intervention carried out with patients.

TPN: How is diabetes diagnosed?

RL: Diabetes is usually diagnosed using blood tests, which assess various parameters that can confirm the suspected diagnosis.


TPN: What treatment is prescribed for people with diabetes? Whether type I or type II

RL: Treatment should always be individualised and patient-centred, and no two patients are the same, so no two treatments are the same.

In Type 1 Diabetes, the use of insulin is common almost from the moment it is diagnosed, and it can be administered through several injections, although recently there has been a great development and greater accessibility to insulin pumps.

In Type 2 Diabetes, in addition to lifestyle changes, we have oral antidiabetics and/or injectable antidiabetics and/or insulin.

In both forms of diabetes, regular glycaemic control, ongoing patient education and regular monitoring in multidisciplinary consultations are essential pillars for achieving good metabolic control and reducing the likelihood of complications associated with the disease.


TPN: What is done during the diabetes consultation at the HPA?

RL: The diabetes consultation consists of a preliminary assessment by the nursing team where blood glucose levels, blood pressure, weight, body mass index, abdominal circumference and diabetic foot assessment are assessed and analysed. This assessment also reinforces teaching on a wide range of topics related to diabetes and reinforces monitoring of the disease's complications.

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This is followed by the Medical Consultation which, taking all this information together, reassesses the patient and draws up a future plan for them. The Consultation is also supported by a multidisciplinary patient referral team that is essential for the patient's therapeutic success: nutritionists, podiatrists, psychologists, exercise technicians, ophthalmologists, neurologists, nephrologists, gastroenterologists, general surgeons and vascular surgeons, allowing for both holistic and individualised monitoring. The aim is to provide our patients with a treatment plan tailored to their reality and needs.


TPN: What kind of follow-up is given to patients with diabetes?

RL: The follow-up is individualised patient by patient. There is great proximity between the patient and their follow-up team, both in terms of access to the Diabetes Consultation and access to the Diabetes Day Hospital.

Generally speaking, consultations are held every 3 to 6 months and include, in addition to the above, regular monitoring through blood and urine tests as well as other complementary diagnostic tests and consultations with other specialities in order to optimise each patient's diagnostic and therapeutic progress.

This regular monitoring is essential in order to identify any changes at an early stage, reinforce the diabetes patient's education and adapt the ongoing treatment if necessary. All of this leads to better metabolic control and protection of the various organs of the diabetes patient, allowing them to live longer and with a better quality of life.


TPN: In people who have been diagnosed, what complications can the disease cause?

RL: Diabetes, through its toxic levels of sugar (glycaemia) in the blood, can cause damage to all the body's organs, causing the well-known complications. The most commonly referred to are Diabetic Retinopathy (changes in vision that can result in blindness), Diabetic Nephropathy (changes in the function of the kidney that can result in haemodialysis), Diabetic Neuropathy (changes in the function of the peripheral nerves causing loss of sensation, more common in the lower limbs), Cardiovascular Disease (increased cardiovascular risk with increased incidence of heart disease - Acute Myocardial Infarction - and brain disease - Stroke) and Healing Alterations (prolonged wound treatment time with increased predisposition to infections and even amputations in some cases).


TPN: How can these diseases be prevented?

RL: Complications are essentially prevented in two ways: strict metabolic control with the application of drugs that protect the various target organs, which has emerged in recent years, and regular, periodic monitoring with a focus on surveillance for complications and teaching how to avoid and detect them.

Prevention is essential if diabetes patients are to have a better quality of life. As mentioned above, this involves promoting healthy lifestyles (diet, physical exercise, compliance with medication, avoiding tobacco and alcohol). At HPA, we pay special attention to therapeutic education, helping patients to understand their disease and better manage their daily lives.


For more information, please contact Grupo HPA Saude on (+351) 282 420 400.