Long Term Management

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Type II diabetes is not an isolated disease, but rather, a complex metabolic abnormality often involving hypertension, obesity, dyslipidemia, renal function, and a spectrum of cardiovascular diseases. Appropriate management of diabetes requires multiple strategies aimed to improve the patient's glycaemic control, and minimize the risk of complications, based on individual preferences, comorbidities, and the overall prognosis. The key element for a successful outcome, however, is cooperation from the patient. Adequate information about the risks of diabetes and potential benefits of good self-management should be discussed with the patient. Basic guidelines for long-term management include diet and exercise therapies; blood glucose, blood pressure, and lipids management as described in Sect. 3.5.

Diabetes is a risk factor for micro- and macrovascular complications. Characteristic of diabetes, microvascular complications affect small blood vessels throughout the body, with particular danger in three sites: retina (diabetic retinopathy), renal glomerulus (diabetic kidney), and nerve sheaths (diabetic neuropathy). Macrovascular complications affect diabetics and nondiabetics alike. However, there is an excess risk to diabetics compared with the general population. For example, diabetics are twice as likely to suffer a stroke, myocardial infarction is 3-5 times more likely to occur to diabetics, and amputation of a foot due to gangrene is 50 times more likely. Diabetes-related risks for cardiovascular complications are additive to other risk factors, e.g., smoking, overweight, or Hyperlipidemia. We will further address these issues as part of surveillance strategies for the long-term management of diabetes.

Infections, trauma, myocardial infarction, surgery, and other common illnesses produce increased insulin resistance and worsen glycaemic control in diabetics. Hence, diabetic patients with intercurrent illnesses may require more frequent monitoring of blood glucose.

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