Put Life Back in Your Patients’ Hands: Winning the fight Against Peripheral Neuropathy in Diabetic Patients
27 Dec 2022
Dear Doctor,
In celebration of World Diabetes Day, P&G Health Philippines, in partnership with the Philippine Association of Family Physicians (PAFP), Philippine Society of Endocrinology, Diabetes and Metabolism (PSEDM), and the Cavite Medical Society (CMS) recently held the “Put Life Back in Your Patients’ Hands: Winning the Fight against Neuropathy in Diabetes” physical-digital event for healthcare professionals, we made sure you don’t miss the updates and innovations in nerve care that were discussed.
Catch the highlights of the “phygital” event here.
In celebration of World Diabetes Day, P&G Health introduced an innovative format for providing continuing medical education for healthcare professionals. The “Put Life Back in Your Patients’ Hands: Winning the Fight Against Neuropathy in Diabetic Patients” was a novel physical-digital or “phygital” event held last 10 Nov 2022 in partnership with the Philippine Academy of Family Physicians (PAFP), Philippine College of Endocrinology, Diabetes and Metabolism (PCEDM) and the Cavite Medical Society (CMS). In-person participants converged for the main forum at The Peninsula Manila hotel in Makati City. The sessions were live-streamed online to satellite venues in North and South Luzon, and Visayas-Mindanao areas and to virtual participants from other countries. The widened reach and exciting new format elicited a much-heightened level of participation from the diverse audience.
P&G Health’s dynamic leadership team and the different partner society’s hands-on support were evident all throughout the event. Mr. Ferdinand Roxas, Senior Director Commercial Leader for P&G Personal Healthcare, and Dr. Ashley Barlow, Senior Director and Head of P&G’s Medical and Technical Affairs, introduced the event concept to the participants. Dr. Karen Estepa – Garcia, PAFP President, Dr. Carolyn Narvacan – Montano, PCEDM President, and Dr. Eileen Feliz Cortes Garcia, CMS President, delivered welcome messages on behalf of the respective organizations. Dr. Digna Almeida, Senior Technical and Medical Affairs of P&G Health Philippines hosted the scientific sessions and introduced the panel of speakers.
Dr. Bien Matawaran, Chairman of the Department of Biochemistry, Molecular Biology & Nutrition, Faculty of Medicine and Surgery, University Santo Tomas, Professor Dr. Rayaz A. Malik, professor of Medicine at Weill Cornell Medicine in Qatar, and Dr. Satish V. Khandilkar, dean of Bombay Hospital comprised the panel of experts.
Prevalence and Burden of Diabetic Complications
Doctor Matawaran profiled the worldwide burden of diabetes and its complications, referring to it as a pandemic that is steadily rising. Peripheral neuropathy (PN) - for which diabetes is the number one cause - is highly prevalent and heterogeneous in its clinical presentation. Doctor Matawaran pointed out that a straightforward diagnosis of PN is an unmet need due to both patient and physician factors. He emphasized that early treatment, hinged on early diagnosis, is key to preventing complications.
Diabetic Neuropathy: Challenging the Dogma
The belief that there is very little diabetic PN around, and hence, it deserves little attention, is a major obstacle in its clinical management. In his lecture, Professor Malik set out to challenge this dogma citing multiple clinical studies that disprove this perception. He echoed the difficulty in identifying diabetic PN, including the limitations of conventional neurodiagnostic procedures. He offered the use of corneal confocal microscopy (CCM) as an alternative, with sensitivity and specificity rates comparable to that of the gold standard, skin biopsy. Professor Malik also talked about promising data from studies on voltage-gated sodium channel antagonists, T-type calcium channel blockers, and botulinum toxin in PN pain management. The role of Vitamin D and neurotropic B vitamins in PN was underscored.
Approach to peripheral neuropathy
In his virtual lecture, Dr Khandilkar talked about the general clinical approach to the different categories of PN, namely: mononeuropathy, mononeuritis multiplex, and polyneuropathy. He gave an overview of the diseases and clinical conditions that give rise to PN and outlined the diagnostic and therapeutic strategies. Also discussed were the genetic component in the development of PN in diabetes, the rising prevalence of PN in Vitamin B12 deficiency among those on vegan diets, and the common differential diagnoses that should be considered in various clinical presentations of PN.
Reaction
In his reaction, Dr Limuel Anthony B. Abrogena, associate professor at the Ateneo De Manila University School of Medicine and Public Health acknowledged the usefulness of the topics discussed, especially for local primary health and family physicians. The use of B vitamins in PN remains to be an interesting subject of discussion and research, notably on prophylactic use and supplementation in non-deficient PN patients. He stressed the need for a paradigmatic shift at the health system level towards prioritizing patient-valued outcomes as much as clinical markers so that the management of diabetes and its complications will improve.
Panel discussion and Q&A
Doctor Matawaran, Professor Malik, and Dr Abrogena engaged the audience in a very lively panel discussion. Among the questions asked were the effect of exercise and a sedentary lifestyle on the development of peripheral neuropathy. Professor Malik emphasized that a more rapid progression of nerve loss was noted in those with a sedentary lifestyle and encouraged people to be active. Vitamin D was also talked about, and it was stressed that sunlight exposure is insufficient for the amount needed in peripheral neuropathy. It was also noted that alpha lipoic acid is not yet recommended as a treatment for PN due to the paucity of evidence. Professor Malik also made it clear that CCM can diagnose early PN and should be done even before clinical signs and symptoms of PN appear. He advised the use of CCM even in non-PN patients if there is a significant clinical risk, like in metabolic syndrome patients with a strong family history of diabetes. Dr. Li Yan, the Regional Medical Lead, Nerve Care AMA (Asia, Middle East, and Africa) Region of P&G Personal Health Care, was the moderator of the panel discussion.
Conclusion
Diabetes and its complications continue to be a significant global burden. Early treatment following prompt diagnosis may be key to turning around or slowing the progression of PN, but early identification of the condition continues to be a clinical struggle. Neurotropic B vitamins are widely used in PN management, but a lot remains to be known to optimize their use. Promising data from studies in both the diagnostic and therapeutic management of PN heralds what may be a bright future in the treatment of the disease.
In celebration of World Diabetes Day, P&G Health Philippines, in partnership with the Philippine Association of Family Physicians (PAFP), Philippine Society of Endocrinology, Diabetes and Metabolism (PSEDM), and the Cavite Medical Society (CMS) recently held the “Put Life Back in Your Patients’ Hands: Winning the Fight against Neuropathy in Diabetes” physical-digital event for healthcare professionals, we made sure you don’t miss the updates and innovations in nerve care that were discussed.
Catch the highlights of the “phygital” event here.
In celebration of World Diabetes Day, P&G Health introduced an innovative format for providing continuing medical education for healthcare professionals. The “Put Life Back in Your Patients’ Hands: Winning the Fight Against Neuropathy in Diabetic Patients” was a novel physical-digital or “phygital” event held last 10 Nov 2022 in partnership with the Philippine Academy of Family Physicians (PAFP), Philippine College of Endocrinology, Diabetes and Metabolism (PCEDM) and the Cavite Medical Society (CMS). In-person participants converged for the main forum at The Peninsula Manila hotel in Makati City. The sessions were live-streamed online to satellite venues in North and South Luzon, and Visayas-Mindanao areas and to virtual participants from other countries. The widened reach and exciting new format elicited a much-heightened level of participation from the diverse audience.
P&G Health’s dynamic leadership team and the different partner society’s hands-on support were evident all throughout the event. Mr. Ferdinand Roxas, Senior Director Commercial Leader for P&G Personal Healthcare, and Dr. Ashley Barlow, Senior Director and Head of P&G’s Medical and Technical Affairs, introduced the event concept to the participants. Dr. Karen Estepa – Garcia, PAFP President, Dr. Carolyn Narvacan – Montano, PCEDM President, and Dr. Eileen Feliz Cortes Garcia, CMS President, delivered welcome messages on behalf of the respective organizations. Dr. Digna Almeida, Senior Technical and Medical Affairs of P&G Health Philippines hosted the scientific sessions and introduced the panel of speakers.
Dr. Bien Matawaran, Chairman of the Department of Biochemistry, Molecular Biology & Nutrition, Faculty of Medicine and Surgery, University Santo Tomas, Professor Dr. Rayaz A. Malik, professor of Medicine at Weill Cornell Medicine in Qatar, and Dr. Satish V. Khandilkar, dean of Bombay Hospital comprised the panel of experts.
Prevalence and Burden of Diabetic Complications
Doctor Matawaran profiled the worldwide burden of diabetes and its complications, referring to it as a pandemic that is steadily rising. Peripheral neuropathy (PN) - for which diabetes is the number one cause - is highly prevalent and heterogeneous in its clinical presentation. Doctor Matawaran pointed out that a straightforward diagnosis of PN is an unmet need due to both patient and physician factors. He emphasized that early treatment, hinged on early diagnosis, is key to preventing complications.
Diabetic Neuropathy: Challenging the Dogma
The belief that there is very little diabetic PN around, and hence, it deserves little attention, is a major obstacle in its clinical management. In his lecture, Professor Malik set out to challenge this dogma citing multiple clinical studies that disprove this perception. He echoed the difficulty in identifying diabetic PN, including the limitations of conventional neurodiagnostic procedures. He offered the use of corneal confocal microscopy (CCM) as an alternative, with sensitivity and specificity rates comparable to that of the gold standard, skin biopsy. Professor Malik also talked about promising data from studies on voltage-gated sodium channel antagonists, T-type calcium channel blockers, and botulinum toxin in PN pain management. The role of Vitamin D and neurotropic B vitamins in PN was underscored.
Approach to peripheral neuropathy
In his virtual lecture, Dr Khandilkar talked about the general clinical approach to the different categories of PN, namely: mononeuropathy, mononeuritis multiplex, and polyneuropathy. He gave an overview of the diseases and clinical conditions that give rise to PN and outlined the diagnostic and therapeutic strategies. Also discussed were the genetic component in the development of PN in diabetes, the rising prevalence of PN in Vitamin B12 deficiency among those on vegan diets, and the common differential diagnoses that should be considered in various clinical presentations of PN.
Reaction
In his reaction, Dr Limuel Anthony B. Abrogena, associate professor at the Ateneo De Manila University School of Medicine and Public Health acknowledged the usefulness of the topics discussed, especially for local primary health and family physicians. The use of B vitamins in PN remains to be an interesting subject of discussion and research, notably on prophylactic use and supplementation in non-deficient PN patients. He stressed the need for a paradigmatic shift at the health system level towards prioritizing patient-valued outcomes as much as clinical markers so that the management of diabetes and its complications will improve.
Panel discussion and Q&A
Doctor Matawaran, Professor Malik, and Dr Abrogena engaged the audience in a very lively panel discussion. Among the questions asked were the effect of exercise and a sedentary lifestyle on the development of peripheral neuropathy. Professor Malik emphasized that a more rapid progression of nerve loss was noted in those with a sedentary lifestyle and encouraged people to be active. Vitamin D was also talked about, and it was stressed that sunlight exposure is insufficient for the amount needed in peripheral neuropathy. It was also noted that alpha lipoic acid is not yet recommended as a treatment for PN due to the paucity of evidence. Professor Malik also made it clear that CCM can diagnose early PN and should be done even before clinical signs and symptoms of PN appear. He advised the use of CCM even in non-PN patients if there is a significant clinical risk, like in metabolic syndrome patients with a strong family history of diabetes. Dr. Li Yan, the Regional Medical Lead, Nerve Care AMA (Asia, Middle East, and Africa) Region of P&G Personal Health Care, was the moderator of the panel discussion.
Conclusion
Diabetes and its complications continue to be a significant global burden. Early treatment following prompt diagnosis may be key to turning around or slowing the progression of PN, but early identification of the condition continues to be a clinical struggle. Neurotropic B vitamins are widely used in PN management, but a lot remains to be known to optimize their use. Promising data from studies in both the diagnostic and therapeutic management of PN heralds what may be a bright future in the treatment of the disease.