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Figure 5.1 Life expectancy is reduced in diabetes, particularly for the young type 1 patients diagnosed in childhood. This Figure is based on a mortality study reported in the 1970s (Goodkin G. Journal of Occupational Medicine 1975;17(11):716-21). Modern proactive prevention programmes with tight risk factor control and early intervention for emerging complications are changing this pattern.

Figure 5.1 Life expectancy is reduced in diabetes, particularly for the young type 1 patients diagnosed in childhood. This Figure is based on a mortality study reported in the 1970s (Goodkin G. Journal of Occupational Medicine 1975;17(11):716-21). Modern proactive prevention programmes with tight risk factor control and early intervention for emerging complications are changing this pattern.

Figure 5.2 How 10 obese men and 10 lean men fare on the journey through life (Joslin, 1941).

drugs are safe for the majority. Controlling blood pressure using two or more different agents is more likely to be successful than using higher doses of single drugs, and less likely to give the side effects that are often associated with the higher rather than middle range doses. The same principle applies to other areas, including glycaemic control, where for instance metformin may be increased from a moderate dose to the maximum licensed dose with little improvement in blood glucose levels but significantly greater risk of abdominal side effects. For hypertension, effective control may be achieved if more than one pathway is blocked, preventing the system from escaping the effects of a single pathway approach. Explaining these principles to the patient may begin to put the concept of polypharmacy in a more positive light.

Blood glucose control

Blood glucose control is particularly important for the prevention of microvascular complications, including retinopathy, nephropathy, and peripheral and autonomic neuropathies. Table 5.1 shows the impact found in a number of studies.

Glycaemic control has a less substantial but still important impact on macrovascular disease (Figure 5.4). The intensive

Table 5.1 Impact of reducing HbAlc on diabetes complications in a number of studies.

Study name

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