One of the visiting speakers, Dr David Chipps, an endocrinologist at Westmead Hospital, addressed the meeting on the implementation of the NSW Health Department Guidelines for the Clinical Management of Diabetes in Adults. The guidelines have been drawn up from evidence gained from large centre multinational trials, which demonstrate how improved glycaemic control reduces the onset and rate of deterioration of diabetes complications. The essential message is that good clinical management of diabetes leads to a reduced complication rate and that frequently the simple process of measuring the parameters of diabetic control and discussing them with patients induces better control. Poorly controlled MODM patients on maximal oral and dietary therapy frequently gain improved control and feel healthier when insulin is started. Their oral therapy should be continued when insulin is commenced.
Vibration sense is felt to be the most sensitive test for detection of early diabetic neuropathy.
In addition, a nylon filament calibrated to exert 10g of force is very effective for testing for sensory neuropathy. Testing is done on the dorsal and plantar aspects of feet and toes. A diabetic has a one in two risk of a major coronary event over 5 years if their cholesterol is over 5.5. This can be reduced to a one in five risk by correcting their cholesterol with a statin. Weight should be measured together with height and body mass index calculated on initial diagnosis and then 3 monthly.