he non-insulin dependent Diabetes or NIDDM causes legal blindness, vascular disease, lower limb amputation and renal failure. Non-insulin Diabetes is asymptomaticand may not be diagnosed for many years. The studies revealed that the time taken for the disease initiation in the human body to the onset of its symptoms is nearly seven years.
The diagnostic delay might result in delayed treatment for the Diabetes as well as for the risk factors associated with it. The complications accompanying Diabetes might be observed when NIDDM is diagnosed initially. The research has found that 20 percent of NIDDM patients were suffering from retinopathy and nearly 18 percent from electrocardiographic changes.
Secondary Prevention for Diabetes
Primary prevention of Diabetes includes avoidance of diabetes while secondary prevention is preventing the complications resulted due to Diabetes. The treatment of NIDDM constitutes tertiary prevention. Theoretically, it is estimated that primary prevention of NIDDM can be accomplished by the management of genetic and environmental factors.
According to the research studies, the proliferative diabetic retinopathy can be reduced upto 65 percent when the Diabetes is prevented by the combination of primary and secondary preventive measures in the period of six years. The primary and secondary prevention can diminish the diabetic complications from progressing which will help the patient to go for treatment in the right time thereby decreasing the mortality.
Just making changes in the lifestyle can prevent Diabetes in the case of primary prevention. Secondary prevention involves inhibiting the complications due to Diabetes by avoiding and treating the associated risk factors as well as optimizing the glycemic control.
The secondary preventive measures will show impact when the biochemical changes due to Diabetes have started rather than during the onset of clinical changes. The secondary prevention strategy includes the treatment of microalbuminuria, hypertension, cigarette smoking and dyslipidaemia, which can reduce the complications due to Diabetes.
The reduction of microvascular complications due to Diabetes in people suffering from insulin dependent Diabetes was observed as nearly 50 to 60 percent through optimization of glycemic control. The research studies have found that there is a positive relationship between the glycaemia level and the retinopathy.
Hypertension in patients with NIDDM increases as age progresses and it is considered as the risk factor for the development of atherosclerotic vascular disease. The timely diagnosis and treatment of hypertension is necessary factor in the secondary prevention of Diabetes. High blood pressure in NIDDM patients is associated with obesity and reduced insulin sensitivity.
The insulin sensitivity can be attained by bringing some changes in lifestyle, which is brought up to reduce weight. These changes in lifestyle will also lower the blood pressure. The drug therapy in this matter involves the use of angiotensin converting enzyme inhibitors, calcium antagonists, and alpha blockers which may not have negative impact on insulin sensitivity, glucose tolerance and serum lipid concentration.
If the albumin excretion rate is between 20 ug to 200ug per minute, it is explained as microalbuminuria. The condition of persistent proteinuria is preceded by microalbuminuria in NIDDM and IDDM conditions. The cardiovascular morbidity is preceded by microalbuminuria in NIDDM patients.
The end stage renal disease is preceded by microalbuminuria mostly in IDDM than in NIDDM. This might be due to the surrendering of NIDDM patients to vascular disease prior to the onset of end stage renal disease. The secondary prevention involves reducing the excretion rate of albumin and reducing the progression of renal disease in IDDM patients with microalbuminuria.
This is achieved with improvement in glycemic control and treatment of high blood pressure. The action of certain angiotensin inhibitors on IDDM patients to reduce the albumin excretion is reported but not in the case of NIDDM.
The changes in the circulating levels of very low density lipoprotein and decrease in HDL-C levels are caused by the non-insulin dependent Diabetes. NIDDM leads to increased levels of VLDL, LDL, LDL-C and total triglyceride while the levels of HDL-C are lowered, which might result in peripheral vascular disease and coronary heart disease. The secondary prevention is done by identifying presence of lipid abnormalities in NIDDM patients.
Cessation of smoking
The research reveals that cigarette smoking is connected with the enhanced initiation of vascular disease in the NIDDM cases. It was evaluated that about 65 percent of deaths due to cardiovascular disease was accredited to the diabetes and cigarette smoking.
However, few research studies showed that smoking has no effect on the cardiovascular disease in diabetics compared to the healthy individuals. According to these studies, stopping to smoke may not show much positive impact on NIDDM patients compared to the healthy subjects.