Learning Objectives:

• Be able to explain the pathogenesis of microvascular disease in diabetes
• Know the techniques for measuring microalbuminuria, the treatment of chronic kidney disease (CKD) at each stage, and the indications for referral to a nephrologist
• Be able to identify the risk factors for diabetic retinopathy
• Be able to describe the characteristics and mechanisms that differentiate neuropathic from ischaemic foot ulcers
• Be able to assess and manage the diabetic foot
• Have knowledge of the supporting evidence for specific drug therapies that target macrovascular risk factors associated with diabetes

Expert presenter:
Dr Tony Russell
Dr Tony Russell is an endocrinologist and is Director of the Department of Diabetes and Endocrinology, Princess Alexandra Hospital. He is the Team Leader of Placental Biology at the Diamantina Institute for Cancer, Immunology and Metabolic Medicine at The University of Queensland. Dr Russell is on the Steering Committee for the Diabetes Network, Clinical Practice Improvement Centre, Queensland Health and is actively involved in developing the Inala Chronic Disease Centre, assessing a new model of care for the management of type 2 diabetes mellitus.

References for Dr Russell's presentation:
[1] Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1999;22(s01):s5-s19.
[2] Stratton IM, Adler AI, Neil AW, Matthews DR, Manley SE, Cull CA, et al. Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000; 321: 405-412.
[3] National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. Am J Kid Dis 2007;49(2 Suppl 2): S12-154.
[4] Slide care of Dr N Isbel, Nephrologist, Princess Alexandra Hospital, Brisbane.
[5] Yong T. Neglected nephropathy. Aust Fam Phys 2006;35:398-402.
[6] Kidney Health Australia. Chronic kidney disease (CKD) management in general practice. Melbourne 2007.Viewed on 31/01/2008 at: http://www.kidney.org.au/LinkClick.aspx?fileticket=mMpDI15k8AA%3d&tabid=635&mid=1584
[7] The Diabetic Retinopathy Study Research Group. Preliminary reports on the effects of photocoagulation therapy. Am J Ophthalmol 1976;81:383-396.
[8] Ferris FL, Davis MD, Aiello LM. Treatment of Diabetic Retinopathy. NEJM 1999;341:667-678.
[9] International Diabetes Foundation. Diabetes Education Modules. Belgium: International Diabetes Foundation; 2006. Viewed on 15/01/2008, at: http://www.idf.org/home/index.cfm?unode=A513C97A-F08C-4F97-9358-D406CDF4FEC1
[10] Frykberg RG, Armstrong DG, Giurini J, Edwards A, Kravette M, Kravitz S, et al. Diabetic Foot Disorders: a clinical practice guideline. J Foot Ankle Surg. 2000;39(5 Suppl):S1-60.
[11] Smieja M, Hunt DL, Edelman D, Etchells E, Cornuz J, Simel DL. Journal of General Internal Medicine 1999;14:418-424.
[12] Wraight PR, Lawrence SM, Campbell DA, Colman PG. Creation of a multidisciplinary, evidence based, clinical guideline for the assessment, investigation and management of acute diabetes related foot complications. Diabet Med 2005 Feb;22(2):127-36.
[13] Barter P, Best J, Boyden A, Cooper C, Gillam I, Mansfield P, et al. Lipid management guidelines — 2001. MJA 2001 November;175(Suppl):s57-87.
[14] Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. The Lancet 2002 Jul 6;360(9326):7-22.
[15] Keech A, Simes RJ, Barter P, Best J, Scott R, Taskinen MR. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. The Lancet 2005;366:1849-1861.
[16] Patel A, ADVANCE Collaborative Group. Effects of a fixed combination of perindopril and indapamide on macrovascular and microvascular outcomes in patients with type 2 diabetes mellitus (the ADVANCE trial): a randomised controlled trial. The Lancet 2007 Sep 8;370(9590):829-40.
[17] Heart Outcomes Prevention Evaluation (HOPE) Study Investigators. Effects of ramipril on cardiovascular and microvascular outcomes in people with diabetes mellitus: results of the HOPE study and MICRO-HOPE substudy. The Lancet 2000;355:253-59.
[18] Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med 2003 Jan 30; 348(5):383-93.
[19] Diabetes Australia, The Royal Australian College of General Practitioners. Diabetes management in general practice. Guidelines for type 2 diabetes. Diabetes 2007/8;24-28.

Quiz reference:
[20] Russell T. Complications of type 2 diabetes. Lecture. Brisbane: The University of Queensland; 2007.