Conservative Management

There are a number of lifestyle changes which patients are encouraged to make to control blood glucose (DESA)

These are combined with medications to reduce the risk of macrovascular/microvascular complications (LAP)

Lifestyle Changes
  • Diet
    • Specialised diet therapy from a dietician
    • Aim for low fat/sugar/sodium, high starch/fibre
      • Low glycemic index
    • Regular meals are advised
    • Alcohol avoidance
    • Avoid ‘diabetic foods’ as there’s not much benefit
  • Exercise – This works in 2 ways
    • Half an hour five days a week helps to:
      1. Reduce obesity  so indirectly improve metabolism
      2. Increases insulin sensitivity directly
  • Smoking cessation is key
  • Alcohol

 

Medications for complication prevention:
  • Lipids
    • Statins are used for 1º prevention if there is a  QRISK >10% (this is in 2015 guidelines)
      • There is some controversy over statins causing diabetes but this is rare and the benefits far outweigh the risk
  • Anticoagulation
    • Aspirin is used if
      • There are any complications (microvascular/macrovascular) complications
      • Patient has had diabetes >10 years and is >50y/o
    • Clopidogrel is used if aspirin is contraindicated or patient has had a stroke
  • Blood Pressure – maintain 130/80 in all diabetics – this greatly helps against all vascular complications and thus improves life expectancy and quality