1. Prevention of Diabetes, Can we?

2. EP Joslin, 1921 “…… it is proper at the present time to devote time not alone to treatment, but still more, as in the case of typhoid fever, to prevention. The results may not be quite so striking or as immediate, but they are sure to come and important…...”

3. Onset of Diabetes Type 1 DM Type 2 DM Normal Diabetes Borderline

4. Primary Prevention in Type 1 DM Time available is quite short Limitation of Inflammation in Islet cells Prevention of triggering factor/s Gene therapy? Answer is not there for Clinical use today

5. Primary Prevention in Type 2 DM POPULATION STRATEGY –Lifestyle change –Environmental factors HIGH RISK STRATEGY –Targeting the high risk group

6. Prevention of Type 2 DM BASIC PROBLEM - Insulin resistance –Answers Exercise Maintain body weight Healthy eating REGULAR FOLLOW UP with GTT, every 2 - 5y

7. Prevention of chronic complications -common determinants-1 EDUCATION Regular exercise Healthy eating - avoid COCOCOLANISATION Life style modification

8. Prevention of chronic complications -common determinants-2 Near normal glycaemia Blood pressure control Lipid control Specific treatment

9. Specific treatment - RETINA Aspirin ACE inhibitor LASER Photocoagulation

10. Specific treatment - KIDNEY ACE inhibitor Protein restriction in diet

11. FOOT CARE - whom to provide? Everybody? –Previous or present ulcer –Poor circulation –Abnormal sensation –Impaired vision –Poor Diabetes control –Deformity –Prosthesis

12. How to manage all? PATIENT Dietitian Pr. Nurse Govt. Sp. Doctor Orthotist Fm. Doctor Sp. NursePodiatrist