1. Prevention of diabetes complications The alphabet strategy

2. Remember! With good care all complications can be reduced or even prevented! Serious Eye Disease Reduced Serious Eye Disease Reduced Foot Problems Reduced Foot Problems Reduced Kidney Problems Reduced Kidney Problems Reduced Heart Disease and Stroke Reduced Heart Disease and Stroke 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 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 reductionWeight 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 Weight reductionWeight 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 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 diabetes32% Heart Attacks21% Stroke44% Risk Reduction Death related to diabetes32% Heart Attacks21% Stroke44% 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% ! 1234560 0 20 40 60 80 100 Risk reduction reduction 55% Diabetic,simvastatin Diabetic, placebo Years since randomisation Patients with heart disease (%)

9. Effect of Plant Stanol Ester Spreads (eg Benecol, Flora Pro-active) on “The Good, the Bad and the Ugly” Cholesterol Effect of Plant Stanol Ester Spreads (eg Benecol, Flora Pro-active) on “The Good, the Bad and the Ugly” Cholesterol Effect of Plant Stanol Ester Spreads (eg Benecol, Flora Pro-active) on “The Good, the Bad and the Ugly” Cholesterol 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%: 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. 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. HbA 1c % 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 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 HbA 1c : Any lower is therefore better! 16% Heart failure 43% Amputation / death from leg vessel problems 37% Eye and early kidney disease 12%Stroke 14% Heart Attacks 21% Deaths related to diabetes

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. 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! 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. 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! 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 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. 35 0 5 10 15 20 25 30 Any Vascular event Heart Attacks % -14%-29% Aspirin helps prevent Heart Attacks by up to 29% 2.5 events avoided per 1000 patients treated per year2.5 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. 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:Advice: exercise, diet, not smoking, regular testing & clinicsexercise, diet, not smoking, regular testing & clinics Blood Pressure:Blood Pressure: aim less than 140/80aim less than 140/80 Cholesterol:Cholesterol: less than 5less than 5 Diabetes Control:Diabetes Control: HbA1c% 7% or less (amount of glucose sticking to your blood over the last 2 months)HbA1c% 7% or less (amount of glucose sticking to your blood over the last 2 months) Eyes:Eyes: check yearly at leastcheck yearly at least Feet:Feet: check yearly at leastcheck yearly at least Guardian Drugs:Guardian Drugs: Aspirin 75mg protects against heart disease, ACE inhibitorsAspirin 75mg protects against heart disease, ACE inhibitors Risk of Diabetes Complications