For doctors, prevention entails,
•Precise blood glucose control.
•Inspecting the bottom of patient’s feet – something many obese diabetics can’t do for themselves.
•Assessing loss of sensation in feet and lower limbs.
•Monitoring blood pressure.
•Checking blood lipids, blood creatinine and creatinine clearance, and urinary albumin.
•Protecting the kidney with new drugs.
•Making sure patients take oral diabetic agents and insulin correctly.
•Instructing patients on proper diets and having a nutritionist or dietician re-enforce their message.
•Encouraging patients to lose weight and exercise (obesity is considered the main precursor to most adult diabetes).
•Managing complications – blindness (the leading cause of adult blindness), heart disease and stroke (causes 65% of deaths among diabetes), kidney disease (accounts for 44% of case of kidney failure), and amputation (more than 60% of lower-limb amputations occur in diabetics).
Among diabetics and their physician friends, there are few miracles, because old habits are hard to break, and treatment regimens are hard to follow. But there are disruptive innovations on the horizon. Until these disruptions mature and take hold, the physicians’ best bet for controlling the vascular catastrophes associated with diabetes is strict adherence to best practice guidelines and rapt attention to clinical details.