Prevention of type 2 diabetes & retinopathy/blindness from type 1 & type 2

Prevent diabetes..Exercise,Obesity, smoking,healthy diet

detect diabetes..Screen

Patients’ relatives..

Family history

50% type 2..biggest advance

Treatdiabetes & prevent retinopathy

Exercise,Obesity,smoking,HbA1c,BP,cholesterol,ACE/ATII healthy diet

Treatretinopathy..Focal laserGrid, PRP Indirect

?pre-prolif?investigate?triamcinolone

Improve control …retinopathy worse in short term

LIGHT burns

ENOUGH PRP

detect retinopathy..Screen

Background…tight control

Rehabilitate & support

Low Vision servicedepressionOther agencies

Medication & lifestyle

Exercise,Obesity,smoking,HbA1c,BP,cholesterol,ACE/ATII healthy diet

Exercise 30-90 minutes a day

~weight ~50%

Cholesterol

Statin 25% whatever level

Low saturated fats (red meat, dairy products)

Low trans fats (cakes etc)

Fibrates ~TG~25% Olive oil, sunflower oil,

Fish x2 week ~20%

HbA1c 1=38%

Type 2

Dietmetformin2nd druginsulin onceinsulin multiple

Type 1

insulin long acting &rapid acting

Platelet adhesion

Aspirin

Healthy diet

7-9 portions vegetables, fruit/day ~30%

Blood pressure 1mmHg =1.1%

130 (eyes) 115 (kidneys)

ACE/ATII 50% > amlodipine >

Bendrofluazide > B blocker >other

Green…% reduction in retinopathy

Smoking

20 cigarettes/day probably triples retinopathy (EASDec, 2003)

Total quality

• Insulin resistance is not being treated• Roy Taylor in Newcastle has shown an 90% reduction in

blindness• DT1 …70% screening…we need to improve our

screening…good, but needs to be better• I estimate can reduce blindness rate by 90% from current

levels…organisation, without much extra expenditure• Also know that basal bolus insulin reduces retinopathy to

~33%• Laser pre-proliferative..controversial …lighter laser much

earlier, + good control• Intravitreal Triamcinolone…

Intravitreal Triamcinolone

For diffuse macular oedema (laser is not effective)

temporary

Increases eye pressure …small % very high, rarely infection

Rapid control in type 2 (or type 1)

• Danger time…transfering to insulin• Suggesting gradual improvement

in control • (really important never to let

control get poor in the first pace)• Do all diabetes practice nurses

know this?