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Prevention of microvascular and macrovascular complications in diabetes mellitus.

Microvascular and macrovascular complications in relation to diabetes mellitus are responsible for major morbidity and mortality condition. Prevention of these complications should be the aim while managing diabetes. Retinopathy, nephropathy and neuropathy are microvascular complications and macrovascular complication affects heart, brain and foot. In preventing retinopathy, glycaemic and blood pressure control is essential. Laser photocoagulation therapy can prevent loss of vision in non-proliferative or proliferative diabetes mellitus. The aim of preventing nephropathy lies on meticulous glycaemic control, dietary protein limitation and vigorous control of blood pressure. The highest priority at present to prevent diabetic neuropathy is the education of patients and their physicians about the potential for detection and treatment of early neuropathy. Glycaemic control is beneficial in reducing the frequency of progression of neuropathy. Macrovascular complication (cardiovascular, cerebrovascular, peripheral vascular) can be prevented with some intervention strategies eg, discouraging smoking habit, proper diet, regular physical activity, strict glycaemic and blood pressure control, lowering low density lipoprotein cholesterol level and aspirin therapy. Amputation in diabetic foot can be dealt with a number of prevention strategies eg, careful self examination, to use specially fitted shoes, minimisation of trauma, earlier detection and aggressive management by local debridement, provision of special support and early antibiotic therapy.