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Diabesity with Sharon Weinstein


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  • 1. ID Wellness December 3, 2010Sharon M. Weinstein, MS, RN, CRNI®, FACW, FAAN
  • 2.  Discuss incidence of Diabesity and pandemic nature State healthcare projections and cost factors associated with disease Identify key dietary and pharmacological factors in managing disease process Describe US and European approaches to management
  • 3. An Epidemic• U.S. newborn today has a 1 in 3 chance of developing diabetes• For Hispanics and African- Americans, the risk is 1 in 2 Centers for Disease Control and Prevention (CDC)
  • 4.  A term coined by former US Surgeon General C. Everett Koop Raises awareness of the health effects of obesity Diabesity® is a registered trademark of Shape Up America! (
  • 5.  Provides interactive information and guidance on weight management, healthy eating, physical activity, childhood obesity and other topics related to the prevention and treatment of obesity
  • 6.  Is the terror within; left unchecked, could have a greater impact than 9/11 Dr. Richard Carmona (former surgeon general) Overweight kids become overweight adults Robert Wood Johnson Foundation – spending at least $500 million over the next 5 years to reduce childhood obesity
  • 7.  Incidence of diabetes: 800,000 cases/year Prevalence of diabetes: 16 million total (includes ~ 8 million undiagnosed) Number will double or triple by 2050 (1 in 3 adults)
  • 8.  $ 44 billion direct medical costs $ 138 billion in direct and indirect costs Medical costs are 3-8x higher for Diabetic vs. non-Diabetic In patient hospital costs are 5 – 9x higher ($7153 vs. $1222) 60 –65% high blood pressure Leading cause of blindness Common cause of ESRD
  • 9.  50% reduction in sick days and no comp cases between 1997 and 2003 Expanded program to asthma and hypertension
  • 10.  Midwest Business Group on Health (Pactiv, City of Naperville, Jewish Federation of Chicago) Rolled out in Milwaukee, Pittsburgh and Los Angeles Payment for medications and consultation Valued at $2000 per year/employee
  • 11.  Usually diagnosed in children and young adults Previously known as juvenile diabetes The body does not produce insulin
  • 12.  Either the body does not produce enough insulin or the cells ignore the insulin When glucose builds up in the blood instead of going into cells… - your cells may be starved for energy - high blood glucose levels affect vital organs
  • 13.  Emergence in children is one of the obesity epidemic’s most eye-opening symptoms
  • 14.  The terms ―overweight‖ and ―obese‖ have precise meanings within medicine - tied to a person’s Body Mass Index score Determined by dividing a person’s weight by the square of his or her height, then multiplying that number by 703. Scores between 25 and 29 are ―overweight,‖ while those with scores 30 and above are ―obese‖
  • 15.  Depends on administrative data  Health risk appraisal (HRA)  Lab  Pharmacy  ClaimsYields only 15% of high risk cohort
  • 16.  Physician engagement Practice level reports Dietary and pharmacological factors Peer comparisons Performance-based incentives Moving toward real-time reporting
  • 17.  Promoting utilization of services Better patient compliance Improved outcomes
  • 18.  A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
  • 19.  Promotes a disease management approach Identifying other co-morbidities present in this same population, such as eye, heart, kidney and clinical depression
  • 20.  Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies Implementation of a screening program expands the population base from the 10% of diabetics that have wounds to 100% of the population who may be candidates for ulcers and other lower extremity complications
  • 21.  Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
  • 22.  Safety related Disease control Health promotion Higher levels of self-care
  • 23. Diabetic Nephropathy40% of new cases of end- stage renal disease (ESRD) are Incidence of ESRD attributed to diabetes Resulting from Primary Diseases (1998)In 2001, 41,312 people with diabetes began ESRD 19% treatmentIn 2001, it cost $22.8 billion in 3% 43% public and private funds to 12% treat patients with kidney failure 23% DiabetesMinorities experience higher Hypertension than average rates of Glomerulonephritis nephropathy and kidney Cystic Kidney disease Other Causes
  • 24. • The most common cause of newcases of blindness among adults 20-74 years of age• Between 12,000 to 24,000 peoplelose their sight because of diabetesannually• Nearly all patients with type 1diabetes and over 60% of patientswith type 2 diabetes have retinopathyin first 20 years of disease
  • 25. DiabetesCardiovascular Renal Disease Eye Disease Lower Extremity Depression DiseaseAngina, MI,CABG, Poor Self- Dialysis Blindness Amputation Angioplasty Care
  • 26.  Abdominal obesity (excessive fat tissue in and around the abdomen) Atherogenic dyslipidemia (blood fat disorders — high triglycerides, low HDL cholesterol and high LDL cholesterol — that foster plaque buildups in artery walls) Elevated blood pressure
  • 27.  Insulin resistance or glucose intolerance (the body can’t properly use insulin or blood sugar) Prothrombotic state (e.g., high fibrinogen or plasminogen activator inhibitor–1 in the blood) Proinflammatory state (e.g., elevated C- reactive protein in the blood)
  • 28.  Elevated waist circumference: Men — Equal to or greater than 40 inches (102 cm) Women — Equal to or greater than 35 inches (88 cm) Elevated triglycerides: Equal to or greater than 150 mg/dL
  • 29.  Reduced HDL (―good‖) cholesterol: Men — Less than 40 mg/dL Women — Less than 50 mg/dL Elevated blood pressure: Equal to or greater than 130/85 mm Hg Elevated fasting glucose: Equal to or greater than 100 mg/dL
  • 30.  Weight loss to achieve a desirable weight (BMI less than 25 kg/m2) Increased physical activity, with a goal of at least 30 minutes of moderate-intensity activity on most days of the week Healthy eating habits that include reduced intake of saturated fat, trans fat and cholesterol
  • 31. 17 X more likely to develop for gangrene30 X more likely to require amputation2nd amputation likely to occur within 2 yrs offirstWithin 5 years 50% will die
  • 32.  75% readmitted 5-9% will die while hospitalized 19% require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000/yr Cost = $10 billion /yr or 20% of total diabetes cost
  • 33.  Peripheral Vascular Disease Peripheral Neuropathy
  • 34.  Great American diet Nutritional goals Improving metabolic function
  • 35.  Glucose disposal Current pharmaceuticals Effect on kidney function
  • 36.  Sulphonylureas stimulate insulin secretion Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia Medical management generally improves blood glucose regulation in Type 2 diabetes patients
  • 37.  Evidence base Smoking, drinking, overeating Shape Up America Neurocircuitry of weight control
  • 38.  Common and often disabling complication of diabetes mellitus Impaired sensation or pain in the feet or hands
  • 39.  Conduction is required for nervous system function
  • 40.  Weintraub study - Annals of Rehabilitation Medicine, April 2003
  • 41.  Weintraub study - Objective: to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN) -
  • 42. Design: randomized, placebo-controlled parallel study - Setting: 48 centers in 27 states - Participants: 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months; placebo group wore a similar, unmagnetized device
  • 43.  Intervention: nerve conduction and or quantified sensory testing performed serially Outcome Measures: - Daily visual analog scale scores for numbness or tingling/burning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes, role of placebo and safety issues
  • 44.  Statistically significant reductions, during the 3rd and 4th months in burning (mean change for magnet treatment -12 %; for sham -3%;P < .05) Numbness and tingling (magnet -10%; sham + 1%; P <.05) Exercise-induced foot pain (magnet, -12%; sham -4%; P<.05)
  • 45.  Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations, multiple surgeries, and ultimately amputation
  • 46.  High percentage of population screened Reduction in lower extremity amputations Reduction in hospital admissions Reduction in hospital length of stay
  • 47.  Identifying high-risk patients before the first acute event, then using a primary prevention methodology to prevent the first acute event, results in a significant reduction of human suffering.
  • 48.  A collaborative approach to disease management, using all healthcare disciplines as well as patient and family, results in quality outcomes.
  • 49.  Diabesityknows no borders…that is why we all need to be a part of the solution!
  • 50.