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ADVICE

ADVICE. Advice. Strongly advise adherence to diet and medication Smoking cessation, exercise, weight reduction Ensure diabetes education and advise Diabetes UK membership Stress role of the whole Diabetes Care Team Regular follow-up with comprehensive Annual Review is essential.

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ADVICE

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  1. ADVICE

  2. Advice • Strongly advise adherence to diet and medication • Smoking cessation, exercise, weight reduction • Ensure diabetes education and advise Diabetes UK membership • Stress role of the whole Diabetes Care Team • Regular follow-up with comprehensive Annual Review is essential. • 20% of patients with early severe complications will be persistent non-attenders • Lifestyle targets: weight reduction >5% if obese, fat intake <30% of energy intake, saturated fat <10% of energy intake, fibre>15g per 1000 calories, exercise for four hours / week.

  3. Obesity Trends Among U.S. Adults1985

  4. Obesity Trends Among U.S. Adults1986

  5. Obesity Trends Among U.S. Adults1987

  6. Obesity Trends Among U.S. Adults1988

  7. Obesity Trends Among U.S. Adults1989

  8. Obesity Trends Among U.S. Adults1990

  9. Obesity Trends Among U.S. Adults1991

  10. Obesity Trends Among U.S. Adults1992

  11. Obesity Trends Among U.S. Adults1993

  12. Obesity Trends Among U.S. Adults1994

  13. Obesity Trends Among U.S. Adults1995

  14. Obesity Trends Among U.S. Adults1996

  15. Obesity Trends Among U.S. Adults1997

  16. Obesity Trends Among U.S. Adults1998

  17. Obesity Trends Among U.S. Adults1999

  18. Obesity Trends Among U.S. Adults2000

  19. Obesity Trends Among U.S. Adults2001

  20. Obesity Trends Among U.S. Adults2002

  21. Obesity Trends Among U.S. Adults2003

  22. Obesity Trends Among U.S. Adults2004

  23. Risk factors for obesity High fat, energydense diet Sedentary lifestyle/ physical inactivity Familyhistory Ethnicity Age Stopping smoking

  24. The health consequences of obesity Cancer Gall-bladder disease Respiratory disease Obesity Hyper-tension Kidney failure Type 2 diabetes Stroke Athero- sclerosis Heart failure

  25. The relationship between BMI and the risk of developing type 2 diabetes 93.2 100 Women 54.0 70 Men 40.3 42.1 40 27.6 21.3 15.8 Risk of type 2 diabetes 11.6 10 8.1 6.7 5.0 4.4 4.3 5 2.9 2.2 1.5 1.0 1.0 1.0 0 <22 <23 23- 24- 25- 27- 29- 31- 33- 35+ 23.9 24.9 26.9 28.9 30.9 32.9 34.9 Body mass index (kg/m2)

  26. Health benefits of 10 kg weight loss in 100 kg subject Death: 20-25% decrease in premature mortality Diabetes: 50% decrease in risk of Type 2 DM 30-50% decrease in blood glucose Lipids: 10% decrease in total cholesterol 30% decrease in triglycerides Blood 10mmHg decrease in systolic pressure: 20mmHg decrease in diastolic

  27. How will you encourage patients to achieve weight loss??

  28. Metabolic syndrome: IDF consensus definition (2005)

  29. Physical activity and risk of strokeBritish Regional Heart Study 4 3 2 Age-adjusted stroke rate 1 0 Vig Mod Light Inact Occas Mod-Vig Wannamethee & Shaper (1992) BMJ; 304: 597-601

  30. Progression of IGT to Diabetes • The Finnish Diabetes Prevention Study and the Diabetes Prevention Program (DPP) both showed that lifestyle changes can reduce progression to diabetes in patients with impaired glucose tolerance (IGT). • The results of the two studies were surprisingly concordant.

  31. Lifestyle changes reducing progression to diabetes mellitus Lifestyle changes reducing progression to diabetes mellitus

  32. Progression of IGT to Diabetes • There was decreased progression from IGT to diabetes of 58% with lifestyle changes in both studies over a three year period. • The metformin limb of the DPP showed that metformin 850mg twice daily reduced progression from IGT to diabetes by 31%.

  33. Why the decline in Coronary Death rates? ? N = 68200 in 2001 versus 1980 BUnal, J Critchley,SCapewell, BMJ. 2005 Sep 17;331(7517):614

  34. BP Other Smoking Statin Low chol Dietary changes smoking 29715 Other 22860 BP 5870 Popn Chol 5770 Statin 2135 Why the decline in Coronary Death rates? N = 68200 BUnal, J Critchley,SCapewell, BMJ. 2005 Sep 17;331(7517):614.

  35. Advice • Strongly advise adherence to diet and medication • Smoking cessation, exercise, weight reduction • Ensure diabetes education and advise Diabetes UK membership • Stress role of the whole Diabetes Care Team • Regular follow-up with comprehensive Annual Review is essential. • 20% of patients with early severe complications will be persistent non-attenders • Lifestyle targets: weight reduction >5% if obese, fat intake <30% of energy intake, saturated fat <10% of energy intake, fibre>15g per 1000 calories, exercise for four hours / week.

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