Transcript Nagpur.DM.1 - Dr Arpan Bhattacharyya

Diabetes: Beyond Sugar
CHAOS

C - Coronary artery disease
 H - Hyper-tension, -glycaemia, -insulinaemia
 A - Atherosclerosis
 O - Obesity
 S - Stroke
Top 5 co-existing conditions
Diabetes in Europe, 2000
60
50
40
Type 1 DM
Type 2 DM
% 30
20
10
0
HBP
LIPID
IHD
MI
CVA
Type 1 - 1531, Type 2 - 7911
Top 5 co-existing conditions
Diab Care Asia, 2000
70
60
50
40
%
Type 2 DM
30
20
10
0
HBP
LIPID
IHD/MI
CVA
Type 2 - 2238
Management of T2DM
Extends Beyond Glucose Control
Issues like
Obesity
High Cholesterol
Hypertension
Smoking
need to be
addressed
Therapeutic Lifestyle change

Healthy Eating,
 Time management,
 Regular exercise
– 30 min daily brisk
walking.
Lipid control

DIFFICULT!
– Target is changing
– What level is safe?
– Multifactorial
(Hyperglycaemia leads to hyperlipidaemia )
Hypertension Complications
End
Stage
Renal
Failure
Peripheral
vascular disease
HT
Coronary
Heart
Disease
43%
Stroke 18%
Congestive
Heart Failure
HypertensionInteresting 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
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.
Treatment -Target Organ
Protection
CNS protection
Renoprotection
Cardioprotection
Antiatherosclerosis
Recommended Treatment Goals
for Hypertension
With Diabetes
Without Diabetes
<130/80 mm Hg
<140/80 mm Hg
SMOKING
How to manage all?
Sp. Doctor
Dietitian
Sp. Nurse
Pr. Nurse
Govt.
PATIENT
Fm. Doctor
Podiatrist
Pharms.