Segment 1 Opening titles include scenes of crowded London streets, traffic, pollution, fatty food frying, callipers measuring skin fat and a blood pressure gauge. Professor Harry Keen introduces the subject of vascular disease in the diabetic. He invites Professor Neville Woolf to talk about the nature of the arterial lesion in the diabetic. Woolf describes how difficult it is to assess levels of atherosclerosis in patients. He refers to diagrams taken from a study made by the International Atherosclerosis Project at New Orleans Medical School which compares the levels of arterial wall disease in diabetics and non-diabetics. Time start: 00:00:00:00 Time end: 00:05:34:15 Length: 00:05:34:15
Segment 2 Woolf concludes that it is impossible to tell the difference between arterial wall disease in a diabetic patient and a non-diabetic patient when looking at post mortem results. He invites Dr John Jarrett to talk about arterial wall disease in life. Jarrett refers to a study in Framingham, Massachusetts, in which an entire population has been studied for 20 years; he compares the death rate from arterial disease in diabetics and non-diabetics. Time start: 00:05:34:15 Time end: 00:09:26:00 Length: 00:03:51:10
Segment 3 A short film is shown of Keen and Mr Christopher Catterall in the diabetic clinic of King's College Hospital. They discuss a patient, Mr Peterson, and inspect his right leg for signs of ischaemia. A close-up of the leg is shown while Catterall describes the signs of ischaemia. Catterall and Keen discuss treatment plans and the option of surgical amputation. Back in the studio, Jarrett returns to the Framington study and reiterates the fact that atherosclerosis is more common in the diabetic. He then goes on to compare the percentage of deaths from coronary heart disease in the US and Japan, which are 53% and 6.5% respectively. A short film is shown in which Keen speaks to Dr Eishi Miki about the high levels of atherosclerosis in the Western world when compared with Japan. Miki thinks this is largely due to the difference in diet. Film ends. Time start: 00:09:26:00 Time end: 00:16:13:00 Length: 00:06:47:00
Segment 4 Keen shows diagrams relating to the dietary factors alluded to by Miki, comparing the diets of Japanese and Western diabetics. It is clear that there is more carbohydrate and less fat in the Japanese diet. Keen describes how diet can cause atherosclerosis, referring to a diagram showing the components which go to make up the lipoproteins which carry triglyceride and cholesterol in the circulation. However, in the diabetic the situation is more complicated as insulin affects lipoprotein levels. Time start: 00:16:13:00 Time end: 00:20:38:00 Length: 00:04:25:00
Segment 5 Keen continues to discuss lipoproteins - he refers to a diagram which compares lipoprotein levels in the blood of diabetics and non-diabetics. Woolf then talks about how the circulating blood can cause the development of lesions in the arterial wall. He believes the blood constitution of the diabetic is altered because of their inability to metabolise carbohydrates in the same way as the non-diabetic. Time start: 00:20:38:00 Time end: 00:26:01:12 Length: 00:05:23:12
Segment 6 Jarrett talks about population studies. He outlines a number of risk factors for diabetics to develop atherosclerosis and focuses on three: blood pressure, smoking and obesity. Keen concludes by saying he believes that arterial disease in the diabetic is a preventable phenomenon in the same way as it is preventable in the general population. Blood pressure should be monitored and kept low, smoking should cease, physical exercise should be encouraged and obesity avoided. Time start: 00:26:01:12 Time end: 00:33:53:08 Length: 00:07:51:21