Clinical Care

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Protecting eyesight, feet, and the nervous system

Classically, diabetes complications are thought of as damaging the heart and blood vessels, eyes, kidneys and nervous system. Blood vessel damage, together with nerve damage, leads to foot problems. Protection of the heart, blood vessels and kidneys is dealt with in an earlier article, as is protection of all of these by control of blood glucose levels. Here we describe how disabling problems which are developing in the eyes, feet, and nervous system despite those measures can be managed optimally.

Cardiovascular risk, blood pressure, and kidney damage

People with type 2 diabetes suffer badly from heart disease, strokes, and damage to the blood supply to their feet. Indeed, these cardiovascular conditions are the major causes of ill-health and death in people with the condition. A significant proportion of that ill-health is preventable, including by attention to the levels of fats and sugar in the blood, the clotting tendency of the blood, and blood pressure. Raised blood pressure is also responsible for worsening of eye damage and kidney damage in people with type 2 diabetes, and is therefore particularly well worth treating.

Use of oral glucose-lowering drugs and insulin

It is important not to think of diabetes as being ‘treated’. And it is important not to think of diabetes management as being about lowering blood glucose levels alone. Other aspects of management are important enough to require separate chapters, both in the Global Guideline and in this Supplement. Nevertheless, the control of blood glucose is central to the management of type 2 diabetes, and nearly all people with the condition will need oral glucose-lowering drugs or insulin to help optimize this important cardiovascular risk factor.

Glucose control: measures, levels and monitoring

Blood glucose control is central to the very nature of diabetes, and the late complications which can develop. Unfortunately, it cannot be sensed by the person with diabetes unless levels are very high or very low. Accordingly, blood glucose control has to be measured reliably, and this needs to be done in the clinic and in normal life. Evidently, the results have then to be related to the risks of developing complications – hence targets and intervention levels.

The IDF 'Global Guideline for Type 2 Diabetes': background and methods

The International Diabetes Federation (IDF) is not in the business of delivering clinical care to people with diabetes; but it is committed to the view that everyone with diabetes should benefit from the best possible care that could be available to them. One foundation of such care is to ensure that it is based on the best possible scientific knowledge. In this Supplement to Diabetes Voice we summarize in non-technical language the evidence base and recommendations of the IDF Global Guideline.

Diabetes management in a primary care setting: the Kenyatta National Hospital

Diabetes is increasingly common worldwide, and Kenya is no exception. The Ministry of Health estimates the prevalence of diabetes to be around 10% (3.5 million people). The cause of much human suffering, diabetes also places a considerable economic burden on individuals and families, and healthcare systems.

Sexual dysfunction in people with diabetes

Diabetes is associated with numerous long-term complications. Many of these, like kidney failure and ischaemic heart disease, are life threatening. Others, such as eye damage and nerve damage, impact heavily on quality of life. But sexual difficulties, which affect both women and men with diabetes, often receive less attention than they deserve, despite the high levels of distress they generate. Mac Robertson looks at the risks for sexual dysfunction in men and women with diabetes and describes the current management options.

Obesity and the metabolic syndrome in young people

As the number of children with obesity continues to grow, the health implications of the condition are becoming increasingly evident: an unprecedented epidemic of type 2 diabetes is emerging in obese and overweight young people. At the time of diagnosis of diabetes, cardiovascular disease may already be present, even in young adults. The close association between type 2 diabetes and cardiovascular disease led to the hypothesis that the two may arise from a common antecedent, the metabolic syndrome – a cluster of metabolic disorders.

Metabolic syndrome, pregnancy and the risk of cardiovascular disease

While a proportion of women with the metabolic syndrome become pregnant, pregnancy itself creates a milieu that is similar to the syndrome, including the development in some women of insulin insensitivity and increased levels of blood

Treating the syndrome today and in the future

We can take advantage of the metabolic syndrome: it can be used as a simple and effective tool to assess health risks in people with type 2 diabetes and those without the condition. We can benefit from the universal availability of the tools needed to make a diagnosis – at no further cost. Given the excessive levels of death and disability suffered by people with type 2 diabetes and its associated conditions, it is of the utmost importance that early and appropriate steps are taken once a diagnosis of the metabolic syndrome is made. Fortunately, there

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