Prevention of Diabetes, Can we?

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Prevention of Diabetes, Can we?
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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...
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Onset of Diabetes
Type 1 DM
Normal
Diabetes
Borderline
Type 2 DM
Borderline
Normal
Diabetes
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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

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Primary Prevention in Type 2 DM

• POPULATION STRATEGY
• Lifestyle change
• Environmental factors

• HIGH RISK STRATEGY
• Targeting the high risk group

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Prevention of Type 2 DM

• BASIC PROBLEM - Insulin resistance
• Answers
• Exercise
• Maintain body weight
• Healthy eating
• REGULAR FOLLOW UP with GTT, every 2 - 5y

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Prevention of chronic complications-common
determinants-1

• EDUCATION
• Regular exercise
• Healthy eating - avoid COCOCOLANISATION
• Life style modification

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Prevention of chronic complications-common
determinants-2

• Near normal glycaemia
• Blood pressure control
• Lipid control
• Specific treatment

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Specific treatment - RETINA

• Aspirin
• ACE inhibitor
• LASER Photocoagulation

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Specific treatment - KIDNEY

• ACE inhibitor
• Protein restriction in diet

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FOOT CARE - whom to provide?

• Everybody?
• Previous or present ulcer
• Poor circulation
• Abnormal sensation
• Impaired vision
• Poor Diabetes control
• Deformity
• Prosthesis

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How to manage all?
Sp. Doctor
Dietitian
Govt.
PATIENT
Sp. Nurse
Podiatrist
Pr. Nurse
Orthotist
Fm. Doctor