Consensus Guidelines for the Management of
Insulin-Dependent (Type 1) Diabetes Chapter 4

Index of chapters

4.0 KIDNEY, EYE AND NERVE DISEASE, AND FOOT PROBLEMS

4.1 Kidney disease (nephropathy) and hypertension
4.2 Eye disease and retinopathy
4.3 Foot problems
4.4 Nerve damage (neuropathy)


IDDM CONSENSUS GUIDELINES Chapter 4 LATE COMPLICATIONS: Kidney
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4.1 Kidney disease (nephropathy) and hypertension

4.1.1 Screening and diagnosis

Microalbuminuria (urinary albumin excretion 30-300 mg/24-h or 20-200 µg/min) is the earliest detectable manifestation of renal disease, and a predictor of all types of late tissue damage from diabetes.

4.1.2 Management of hypertension/microalbuminuria

By vigorous treatment of hypertension the rate of loss of renal function can be significantly reduced. The target for supine blood pressure should be a strict 140/85 mmHg, or lower in the younger patient.

4.1.3 Other management of renal disease



No patient should be excluded from renal replacement
programmes solely on the basis of having diabetes.

IDDM CONSENSUS GUIDELINES Chapter 4 LATE COMPLICATIONS: Kidney

IDDM CONSENSUS GUIDELINES Chapter 4 LATE COMPLICATIONS: Eye
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4.2 Eye Disease and Retinopathy

4.2.1 Diagnosis and screening

Surveillance is not a complete clinical assessment but a means of identifying patients at risk. Recall and record systems should ensure it occurs regularly.



The primary management of diabetic eye disease
is by careful attention to the metabolic control
targets from the time of diagnosis.

4.2.2 Management of diabetic eye disease

IDDM CONSENSUS GUIDELINES Chapter 4 LATE COMPLICATIONS: Eye

IDDM CONSENSUS GUIDELINES Chapter 4 LATE COMPLICATIONS: Foot
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4.3 Foot Problems of Diabetic Patient



Foot ulceration, and thus amputation,
is nearly always preventable.

The patients with highest risk of serious foot problems are those with:

4.3.1 Foot management guidelines

Diabetes care services should be structured to offer:

4.3.1.1 Surveillance

4.3.1.2 Management

4.3.1.3 Established foot ulceration/infection

A treatment strategy should be available, and be able to rely on the co-ordinated efforts of a foot team consisting of diabetologist, podiatrist (chiropodist), orthotist, microbiologist, investigative radiologist, and vascular and orthopaedic surgeon.

IDDM CONSENSUS GUIDELINES Chapter 4 LATE COMPLICATIONS: Foot

IDDM CONSENSUS GUIDELINES Chapter 4 LATE COMPLICATIONS: Nerves
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4.4 Diabetic Nerve Damage

4.4.1 Diagnosis and screening

4.4.2 Management of diabetic nerve damage

IDDM CONSENSUS GUIDELINES Chapter 4 LATE COMPLICATIONS: Nerves


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