Prevention of diabetes complications The alphabet strategy

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Prevention of diabetes complicationsThe alphabet
strategy
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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
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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

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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

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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

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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!
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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.

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Cholesterol lowering reduces Heart Disease in
Patients with Diabetes by up to 55 !
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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

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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.

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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
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Risk Reduction With a 1 Reduction in HbA1c
Any lower is therefore better!
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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.

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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!

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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.

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Any Foot Problems Seek help!
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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

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Aspirin helps prevent Heart Attacks by up to 29
35
30
25
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10
5
0
Any Vascular event
Heart Attacks

• 2.5 events avoided per 1000 patients treated per
  year

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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.

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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