CHAOS • C - Coronary artery disease • H - Hyper-tension, -glycaemia, -insulinaemia • A - Atherosclerosis • O - Obesity • S - Stroke
Top 5 co-existing conditionsDiabetes in Europe, 2000 Type 1 - 1531, Type 2 - 7911
Top 5 co-existing conditionsDiab Care Asia, 2000 Type 2 - 2238
Issues like Obesity High Cholesterol Hypertension Smoking need to be addressed Management of T2DM Extends Beyond Glucose Control
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 Congestive Heart Failure Coronary Heart Disease 43% Stroke 18%
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 CVSevents 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.
Clinical and Experimental Studies Treatment -Target Organ Protection CNS protection Cardioprotection Renoprotection Antiatherosclerosis
How to manage all? Sp. Doctor Dietitian Govt. PATIENT Sp. Nurse Podiatrist Pr. Nurse Pharms. Fm. Doctor