The aim of this article was to describe (i) the epidemiology and outcomes of stroke relating to diabetes; (ii) the pathophysiology of diabetes as a risk factor for stroke; (iii) the management of acute stroke in patients with diabetes; (iv) the evidence of primary and secondary prevention of stroke in patients with diabetes; and (v) the risk of new-onset diabetes using older antihypertensive agents. The combination of diabetes and stroke disease is a major cause of morbidity and mortality worldwide. Evidence from large clinical trials performed in patients with diabetes supports the need for aggressive and early intervention to target patients' cardiovascular (CV) risks in order to prevent the onset, recurrence and progression of acute stroke. Identification of at-risk patients with diabetes and metabolic syndrome has also allowed the delivery of early and effective intervention to reduce stroke risks, while active treatment during the acute phase of stroke will reduce long-term neurological and functional deficits. While the ongoing debate on the risk benefits of different antihypertensive, lipid-lowering and antiplatelet agents should not detract clinicians from pursuing aggressive CV risk reduction, the application of evidence-based medicine specifically in patients with diabetes will facilitate the use of appropriate agents to improve clinical outcomes. The overall management of patients with diabetes and acute stroke or at risk of secondary stroke should also include multifactorial intervention that not only targets patient's CV risk but also includes behavioural, lifestyle and, where appropriate, surgical intervention.
Obesity is growing into a global epidemic and alarming trends are seen in Asian countries. Although obesity is defined by body mass index (BMI), waist circumference has emerged as a more specific marker of metabolic risk. BMI and waist circumference thresholds vary between ethnicities and values are lower for Asian populations. Asians are at an increased risk of developing diabetes and early death from cardiovascular complications at lower levels of BMI and waist circumference. Obesity, especially central obesity is strongly associated with development and worsening of type 2 diabetes. The developing countries may find it difficult to face a surge in diabetes with early death and loss of productivity. Therefore, early action to contain an epidemic of obesity should be considered an urgent global priority.
Sri Lanka currently faces a ‘double burden’ of non‐communicable and communicable diseases. Public institutions geared primarily to care for communicable diseases struggled to meet demand for quality care in non‐communicable diseases. The World Health Organization has developed tools for implementing appropriate health care for long‐term problems.We piloted interventions in self‐management support, delivery system design, decision support and clinical information systems at sites in urban and rural Sri Lanka. This undertaking confirmed that interventions through adaptation of Sri Lanka's primary care infrastructure and establishment of innovative partnerships enable the effective implementation of care with existing resources in the short term. We demonstrated that media can be used as a powerful forum for educating the public, promoting new attitudes, providing skills for improving health status and influencing both planners and health care professionals. We also demonstrated that training and education of health care workers and research collaborations can influence policy makers. The collaboration to date has established a model for international collaboration providing both educational and technical support towards capacity building within the country. Collaborations with developing countries will enable the prevention and control of chronic disease in the developing world in keeping with the United Nations resolution regarding diabetes. Copyright © 2009 John Wiley & Sons, Ltd.
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