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

Type 2 DM

Normal

Normal

Diabetes

Diabetes

Borderline

Borderline

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?

PATIENT

Dietitian

Pr. Nurse

Govt.

Sp. Doctor

OrthotistFm. Doctor

Sp. Nurse Podiatrist