Prevention of Diabetes Mellitus

Report
Prevention of Diabetes, Can we?
EP Joslin, 1921
“…… it is proper at the present time to devote
time not alone to treatment, but still more, as
in the case of typhoid fever, to prevention. The
results may not be quite so striking or as
immediate, but they are sure to come and
important…...”
Onset of Diabetes
Type 1 DM
Normal
Borderline
Diabetes
Type 2 DM
Normal
Borderline
Diabetes
Primary Prevention in Type 1 DM
•
•
•
•
Time available is quite short
Limitation of Inflammation in Islet cells
Prevention of triggering factor/s
Gene therapy?
Answer is not there for Clinical use
today
Primary Prevention in Type 2 DM
• POPULATION
STRATEGY
– Lifestyle change
– Environmental factors
• HIGH RISK
STRATEGY
– Targeting the high risk
group
Prevention of Type 2 DM
• BASIC PROBLEM - Insulin resistance
– Answers
• Exercise
• Maintain body weight
• Healthy eating
REGULAR FOLLOW UP with GTT,
every 2 - 5y
Prevention of chronic complications
-common determinants-1
• EDUCATION
• Regular exercise
• Healthy eating - avoid
COCOCOLANISATION
• Life style modification
Prevention of chronic complications
-common determinants-2
•
•
•
•
Near normal glycaemia
Blood pressure control
Lipid control
Specific treatment
Specific treatment - RETINA
• Aspirin
• ACE inhibitor
• LASER
Photocoagulation
Specific treatment - KIDNEY
• ACE inhibitor
• Protein restriction in
diet
FOOT CARE - whom to provide?
• Everybody?
–
–
–
–
–
–
–
Previous or present ulcer
Poor circulation
Abnormal sensation
Impaired vision
Poor Diabetes control
Deformity
Prosthesis
How to manage all?
Sp. Doctor
Dietitian
Sp. Nurse
Pr. Nurse
Govt.
PATIENT
Fm. Doctor
Podiatrist
Orthotist

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