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Prevention of diabetes complications The alphabet strategy

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Prevention of diabetes complications The alphabet strategy Remember! With good care all complications can be reduced or even prevented! Serious Eye Disease Reduced ... – PowerPoint PPT presentation

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Title: Prevention of diabetes complications The alphabet strategy


1
Prevention of diabetes complicationsThe alphabet
strategy
2
Remember!With good care all complications can be
reduced or even prevented!
Heart Disease and Stroke Reduced
  • Foot Problems
  • Reduced
  • Serious Eye
  • Disease
  • Reduced

Kidney Problems Reduced
3
ADVICE
  • Stop smoking
  • Close attention to diet
  • Weight reduction and exercise
  • Ensure diabetes education and regular follow-up
    with your diabetes care team
  • Comply with recommended treatment

4
How to Prevent Diabetes or improve Diabetes
control
  • Weight reduction
  • Total fat intake to less than 30 of calories
  • Intake of saturated fat to less than one-third of
    the total fat
  • Increase in fruit and vegetable, at least 4-5
    portions a day
  • Moderate exercise for at least 30 minutes per day
    or 4 hours a week includes walking, gardening,
    anything!
  • Overall frequent ingestion of whole grain
    products, vegetables, fruits, low fat milk, lean
    meat products, soft margarines, vegetable oils
    rich in mono-unsaturates

5
BLOOD PRESSURE
  • Know your blood pressure
  • In most cases the ideal aim is less than 140/80
  • If kidney disease is present then the aim is
    lower

6
UKPDS Results A Blood Pressure of 154/87 versus
144/82
Risk
Reduction Death related to diabetes 32
Heart Attacks 21 Stroke 44
Aim BP 140/80 or less in most people!
7
CHOLESTEROL
  •  Aim total cholesterol levels less than 5.0
    mmol/l or bad to good cholesterol ratio of
    less than 3. This is the LDL-cholesterol divided
    by the HDL-cholesterol.

8
Cholesterol lowering reduces Heart Disease in
Patients with Diabetes by up to 55 !
9
Effect of Plant Stanol Ester Spreads (eg
Benecol, Flora Pro-active) on The Good, the
Bad and the Ugly Cholesterol
  • The Good HDL cholesterol increased by 10.7
  • The Bad Total cholesterol reduced by 5.8
  • The Ugly LDL cholesterol reduced by 9.3

10
DIABETES CONTROL
  • The usual aim is for a HbA1c less than or equal
    to 7.0.
  • The HbA1c is the amount of glucose that sticks
    to your blood over the last 2 months
  • Your home blood glucose target is 4-7mmol/l.

11
HbA1c 7.0 versus 7.9
Reduction in risk by 25 for eye disease and
early kidney disease 16 for Heart
Attacks 24 for cataract surgery
12
Risk Reduction With a 1 Reduction in HbA1c
Any lower is therefore better!
13
EYE Examination
  • Make sure that your eyes are looked at carefully
    at least yearly after special eye drops have been
    put in.
  • This should be done by a health care professional
    trained in diabetic eye examination
  • Ideally, a retinal camera should be used.
  • You should be referred to an Eye Specialist if
    needed.

14
Diabetic Eye Disease
  • Commonest cause of blindness
  • Can be prevented
  • Eye Examination at least yearly
  • Risk factors smoking, Blood Pressure, poor
    diabetes control
  • Treatment with laser may be possible but does not
    always work
  • Prevention better than cure!

15
FEET Examination
  • You should check your own feet regularly and seek
    advice if needed.
  • Make sure that your feet are looked at carefully
    at least yearly by a health care professional
    trained in diabetic feet examination
  •  Ideally a podiatrist should do the examination
    if problems are identified.

16
Any Foot Problems Seek help!
17
GUARDIAN DRUGS
  • Aspirin 75mg once daily
  • Diabetes UK now advises aspirin treatment
    to protect against heart disease in all patients
    with diabetes over the age of 30 years with any
    of the following previous heart attack, angina,
    high blood pressure (once the pressure is less
    than 150/90), diabetic eye disease, blood vessel
    disease of the legs, early kidney disease,
    cholesterol problem, family history of heart
    disease, weight problem, Indo-Asian and smokers.
    Side effects should be discussed

18
Aspirin helps prevent Heart Attacks by up to 29
35
30
25
20

15
10
5
0
Any Vascular event
Heart Attacks
  • 2.5 events avoided per 1000 patients treated per
    year

19
GUARDIAN DRUGS
  • ACE-inhibitors
  • Have a special role in preventing diabetic
    complications in most patients with diabetes.
    Please discuss this with your diabetes care team.

20
Diabetes Care Strategy
  • Advice
  • exercise, diet, not smoking, regular testing
    clinics
  • Blood Pressure
  • aim less than 140/80
  • Cholesterol
  • less than 5
  • Diabetes Control
  • HbA1c 7 or less (amount of glucose sticking to
    your blood over the last 2 months)
  • Eyes
  • check yearly at least
  • Feet
  • check yearly at least
  • Guardian Drugs
  • Aspirin 75mg protects against heart disease, ACE
    inhibitors

Risk of Diabetes Complications
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