1. Diabetes: Beyond Sugar

2. CHAOS C - Coronary artery disease H - Hyper-tension, -glycaemia, -insulinaemia A - Atherosclerosis O - Obesity S - Stroke

3. Top 5 co-existing conditions Diabetes in Europe, 2000 Type 1 - 1531, Type 2 - 7911

4. Top 5 co-existing conditions Diab Care Asia, 2000 Type 2 - 2238

5. T 2 DM Management of T 2 DM Extends Beyond Glucose Control T 2 DM Management of T 2 DM Extends Beyond Glucose Control need to be addressed Issues like Obesity High Cholesterol Hypertension Smoking

6. Therapeutic Lifestyle change Healthy Eating, Time management, Regular exercise – 30 min daily brisk walking.

7. Lipid control DIFFICULT! – Target is changing – What level is safe? – Multifactorial (Hyperglycaemia leads to hyperlipidaemia )

8. HT Peripheral vascular disease Coronary Heart Disease 43% End Stage Renal Failure Stroke 18% Congestive Heart Failure Hypertension Complications

9. Hypertension- Hypertension- Interesting Facts  5-6 mm reduction in DBP lowers stroke risk by 33% and CHD risk by 15%  Hypertension Optimal Study (HOT) Study- DBP  85 mm Hg associated with lower risk of CVS events than reduction to  90 mm Hg

10. Hypertension in India CODI Study – BP was measured in 54.5% of patients with DM, – In 40% BP was found to be high, – 10% were on treatment BUD Study – 24% of people with high BP were currently checking.

11. Clinical and Experimental Studies Treatment -Target Organ Protection Antiatherosclerosis CNS protection Cardioprotection Renoprotection

12. Recommended Treatment Goals for Hypertension With DiabetesWithout Diabetes <130/80 mm Hg<140/80 mm Hg

13. SMOKING

14. How to manage all? PATIENT Dietitian Pr. Nurse Govt. Sp. Doctor Pharms. Fm. Doctor Sp. NursePodiatrist