Prevention and Control of Diabetes Mellitus

HED204 PG 136 – 137:

1. Primary Prevention

Two strategies for primary prevention have been suggested:

a. Population strategy and;

b. High-risk strategy

a. Population Strategy: The scope of primary prevention of type 1 diabetes is limited

on the basis of current knowledge and is probably not appropriate. However, the
development of prevention programmes for type 2 diabetes based on elimination of
environmental risk factors is possible.

There is pressing need for primordial prevention – that is, prevention of the emergence
of risk factors in countries in which they have not yet appeared. The preventive
measure comprises maintenance of normal body weight through adoption of healthy
nutritional habits and physical exercise. The nutritional habits include an adequate
protein intake, a high intake of dietary fibre and avoidance of sweet foods. Elimination
of other less well defined factors such as protein deficiency and food toxins may be
considered in some populations. These measures should be fully integrated into other
community-based programmes for the prevention of non-communicable diseases e.g
coronary heart disease.

b. High-Risk Strategy: There is a special high-risk strategy for type 1 diabetes. At

present, there is no practical justification for genetic counselling as a method of
prevention. Since NIDDM appears to be linked with sedentary lifestyle, over nutrition
and obesity, correction of these may reduce the risk of diabetes and its complications.
Since alcohol can indirectly increase the risk of diabetes, it should be avoided. Subjects
at risk should avoid diabetogenic drugs like oral contraceptives. It is a wise to reduce
factors that promote atherosclerosis, e.g smoking, high blood pressure, elevated
cholesterol and high triglyceride levels. These programmes may most effectively be
directed at target population groups (WHO, 2012).

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2. Secondary Prevention

When diabetes is detected, it must be adequately treated. The aims of treatment are:

a. To maintain blood glucose levels as close within the normal limits as practicable and;

b. To maintain ideal body weight.

Treatment is based on:

a. Diet alone – small balanced meals more frequently.

b. Diet and oral anti-diabetic drugs or;

c. Diet and insulin.

Good control of blood glucose protects against the development of complications.

Proper management of the diabetics is most important to prevent complications.

Routine checking of blood sugar, of urine for protein and ketones, of blood pressure,
visual acuity and weight should be done periodically. The feet should be examined for
any defective blood circulation (Doppler ultrasound probes are advised), loss of
sensation and the health of the skin. Primary health care is of great importance to
diabetic patients since most care is obtained at this level.

Self-Care: A crucial element in secondary prevention is self-care. That is, the diabetic
should take a major responsibility for his own care with medical guidance – e.g
adherence to diet and drugs regiments, examination of his own urine and where
possible blood glucose monitoring; self-administration of insulin, abstinence from
alcohol, maintenance of optimum weight, attending periodic check-ups, recognition of
symptoms associated with glycosuria and hyperglycemia etc.

The patient should carry an identification card showing his name, address, telephone
number (if any), and the details of treatment he is receiving. In short, he must have a
working knowledge of diabetes. All these mean education of patients and their families
to optimize the effectiveness of primary health care services.

3. Tertiary Prevention

Diabetes is major cause of disability through its complications e.g blindness, kidney
failure, coronary thrombosis, gangrene of the lower extremities, etc. The main objective
at the tertiary level is to organise specialised clinics (Diabetic clinics) and units capable
of providing diagnostic and management skills of a high disorder. There is great need to
establish such clinics in large towns and cities. The tertiary level should also be involved

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in basic, clinical and epidemiological research. It has also been recommended the local
and national registries for diabetics should be established.