T2DM Diabetic Retinopathy Chronic Kidney Disease

Hello, I'm Norman Swan. Welcome to this programour serieson guidelines and type 2 diabetes. Every year there areabout 3.8 million deaths globally attributable to diabetes. In Australia, type 2 diabetes isthe fastestgrowing chronic disease, with the total number of Australianswith diabetes and prediabetes estimated at a whopping 3.2 million, and it's the sixthleadingcause of death.

This program looks at two NHMRCevidencebased guidelines that are new and adess compliionsand comorbiditytype 2 diabetes. They are the evidencebased guidelinesfor diagnosis and management of kidney diseasetype 2 diabetes, and the guidelines for the managementof diabetic retinopathy. For those of youwatching on your computers, you can type your questions directly into the studio. Just click on the LiveTalk tab at thetop of the web page you're looking at.

That also means, of course,that we can ask questions of you. Here's one to get you going: away on that one, and we'llgive you results of thata moment. As usual, there are a numberof useful resources available on the Rural Health EduionFoundation's website: Now let me introduce our panel to you. Stephen Twigg is an endocrinologistat the University of Sydney and Presidentof the Australian Diabetes Society.

Welcome, Stephen. Good evening. Alan Cass is the senior director of the George Institutefor International Health, and director of the PocheIndigenous Health Centre at the University of Sydney. Welcome, Alan. Good evening, Norman. Paul Mitchell isProfessor of Ophthalmology at the University of Sydney,and runs the Blue Mountains Eye Study.

Welcome, Paul. Thanks, Norman. Good to be here. And David Guest is a rural generalpractitionerGoonellabahNSW. Welcome. Thanks, Norman. David, challenging, dealing with comorbiditiesin general practice, I assume. It's a growing area. It's a bigger and bigger problem. It's something that's takingmore and more of GPs' time.

If you get systemsplace, you canprobably cope with the challenge. Talk to me about the trendsthat are going on, Stephen. As you've mentioned already,diabetes is on the rise. We believe that approximately100,000 people per yearAustralia are developing diabetes. It's very similarto the worldwide trend. There are a number of factors thatare probably criticalthe processterms of the development of diabetes.

Treating type II diabetes A practical approach

Let'sbriefly go over a practical approach to treating type II diabetes. The first step is adiabetes eduion program. Now this is a very importantelement of treating type II diabetes as it teachesindividuals about the disease, its potential compliions,and how it can be treated. These programs will workwith individuals to create nutrition and exerciseplans that will help them

to succeedliving a healthy lifestyle. Now, the second stepthetreatment of type II diabetes will vary depending on the severity of the disease at the time of diagnosis. If the condition is mild,meaning the individual has no symptoms or evidence ofcompliions from diabetes, then they can probably just start with lifestyle modifiions alone.

However, if the conditionis moderate or severe, meaning they have symptomsof type II diabetes or evidence of its compliions,then they should be started with lifestylemodifiions as well as metformin, which is the firstlinemediion for type II diabetes. After being started onthese interventions, the individual shouldbe rechecked by their primary care providerin one to two months.

If their hemoglobin A1C has improved and their diabetes is undercontrol, then they can move on to routinefollowup which consists of a primary care visit atleast two times per year as well as a yearly dilatedeye exam by an ophthalmologist. However, if their hemoglobinA1C is not improved and their diabetes is not well controlled, then a secondline mediionshould be added to the regimen

and the type of mediionmay vary by individual, and so this decision should be discussed with one's primary care provider. Then once again, theindividual should have a recheck appointmentin one to two months, and the process thenrepeats itself from hereon. So the fourth step would be to add a second secondline mediion.

Then the fifth and last stepis that if an individual with type II diabetes cannotcontrol their condition with metformin and two additionalsecondline mediions, then insulin should be addedto their treatment regimen, and then the dose should beadjusted accordingly until he or she is able to maintainnormal blood glucose levels. By using this practical approach to treating type II diabetes,healthcare providers can help