1. What does it mean to our patients? Presenter: CF Otieno Affiliation: Department of Clinical Medicine and Therapeutics,UoN & KNH-Medicine

2. TYPE 2 DIABETES Progressive disease Well characterized... But-poorly controlled Broad treatment goals:- glycaemia,BP,LDL,Weight,Knowledge,Self management,HRQoL etc

3. RISK FACTORS OF COMPLICATIONS Microvascular Hyperglycaemia Genetics (Hypertension) Macrovascular Lipids Hypertension Genetics Age

4. COMPLICATION PROFILES AT KNH Microvascular Eye Neuropathy Nephropathy Microalbuminuria Macroalbuminuria ESRD

5. MACROVASCULAR COMPLICATIONS Cerebrovascular disease (Mwazo) Myocardial infarction (Nguchu) (STEMI/NSTEMI) Erectile dysfunction (Ngalyuka)

6. COMPOSITE COMPLICATIONS Renal disease Diabetic foot ulcer, 7.8%: (Diabetes) – Risk factors (The patient) – Knowledge, Attitude, Practice (The health unit) – Policy Foot-at-risk>33% (Mugambi E, et al)

7. RISK FACTOR PROFILE AT KNH Glycaemic control: <40% good control BP control – only 50% known HTN, out of these only 25% well controlled. Lipids - high LDL Adherence to treatment – POOR

8. REASONS FOR POOR CONTROL Provider factors: Knowledge, Attitude, Practices, etc System factors Policies, Medication access, Insulin access Patient factors Knowledge, Attitude, Practices, Socio-Economic Status Heterogeneous disease

9. CONSEQUENCES OF POOR CONTROL Enhanced complications ( at early age) Renal Cardiac Stroke Attenuated HRQoL Health resource consumption-hospitalization; dependance.

10. CAN WE STEM THE TIDE? Access to care: Policies Physical Quality of care and evaluation Clinical end-points Administrative end-points Risk stratification of patients? Address fatigue of care providers?

11. AREAS TO ADDRESS Health system adjustment: patient-focused decision- making Generate evidence:-longitudinal studies for outcomes; RCTs etc. Cost-related studies-effectiveness and benefit analysis MORTALITY reviews

12. In conclusion,.. We need to ask ourselves: Can we tell whether our patients are better off NOW than thirty years ago ? OR What ails our patients? What does the care we give mean to them ?

13. THANK YOU