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Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
Diabetes, Obesity, BMI, what are the limits?
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Diabetes, Obesity, BMI, what are the limits?

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Lecture at maritime convention

Lecture at maritime convention

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  • 1. Diabetes, Obesity, BMI: What are the limits? Iris Thiele Isip Tan MD, FPCP, FPSEM Clinical Associate Professor, UP College of Medicine Section of Endocrinology, Diabetes & Metabolism Department of Medicine, Philippine General Hospital
  • 2. Type 1 diabetes absolute insulin deficiency Type 2 diabetes insulin secretory defect + insulin resistance Gestational diabetes Other specific types http://www.flickr.com/photos/ jill_a_brown/2629206224/ “Diabetes” by Jill A. Brown, 1 Jul 2008. Accessed 30 Oct 2010 http://www.flickr.com/photos/ emagineart/4655345533/ “Pills 3” by eMagine-Art.com, 31 May 2010. Accessed 30 Oct 2010
  • 3. Overweight* or obese with one or more risk factors * BMI >25 kg/m2 Who should be tested for diabetes? American Diabetes Association. Standards of Medical Care in Diabetes - 2010. Diabetes Care 2010;33(1):S11-61
  • 4. Physical inactivity First-degree relative with diabetes 9 lb baby GDM PCOS ♀ History of CVD Hypertension (BP >140/90 or on treatment) HDL <35 mg/dL or Trigly >250 mg/dL A1c >5.7% IGT or IFG on previous tests Insulin resistance (acanthosis nigricans, severe obesity) American Diabetes Association. Standards of Medical Care in Diabetes - 2010. Diabetes Care 2010;33(1):S11-61
  • 5. Overweight* or obese with one or more risk factors * BMI >25 kg/m2 Who should be tested for diabetes? American Diabetes Association. Standards of Medical Care in Diabetes - 2010. Diabetes Care 2010;33(1):S11-61 In those without risk factors, testing should begin at 45 years. FBS is part of PEME “C” for serving seafarers >40 years old To test for diabetes: A1c, FPG or 2-h 75-g OGTT Repeat testing at least q 3 years
  • 6. Criteria for the Diagnosis of Diabetes In the absence of unequivocal hyperglycemia, criteria 1-3 should be confirmed by repeat testing A1c >6.5% NGSP-certified Standardized to DCCT assay FPG >126 mg/dL (7.0 mmol/L) No caloric intake for at least 8 h 2-h glucose >200 mg/dL (11.1 mmol/L) during a 75-g OGTT Random plasma glucose >200 mg/dL (11.1 mmol/L) with classic symptoms of hyperglycemia American Diabetes Association. Standards of Medical Care in Diabetes - 2010. Diabetes Care 2010;33(1):S11-61 1 3 2 4
  • 7. Advantages Fasting not required Greater pre-analytical stability Less perturbations during stress and illness HbA1c Disadvantages Greater cost Limited availability Incomplete correlation with average glucose
  • 8. When HbA1c can be misleading ... Abnormal red cell turnover Anemias from hemolysis and iron deficiency Hemoglobinopathies Sickle cell trait Unique ethnic or geographic distributions American Diabetes Association. Standards of Medical Care in Diabetes - 2010. Diabetes Care 2010;33(1):S11-61 Blood Cells by Andrew Mason, 13 June 2005. http:// www.flickr.com/photos/a_mason/19191446/ Accessed 2 Nov 2010
  • 9. Impaired Fasting Glucose Impaired Glucose Tolerance Prediabetes FPG 100-125 mg/dL (5.6-6.9 mmol/L) 2h OGTT 140-199 mg/dL (7.8-11.0 mmol/L) HbA1c 5.7-6.4% American Diabetes Association. Standards of Medical Care in Diabetes - 2010. Diabetes Care 2010;33(1):S11-61 Toast 2, 3 & 4 by ba1969, 14 Dec 2008. http://www.sxc.hu Accessed 1 Nov 2010
  • 10. 25% 50% 25% Diabetes Persistent IFG/IGT NGT Evolution of Prediabetes to Diabetes With longer observation, majority of individuals develop diabetes Observation period of 3-5 years Nathan et al. Diabetes Care 2007,30(3):753-9
  • 11. <180 mg/dL (10 mmol/L) 70-130 mg/dL (3.9-7.2 mmol/L) Primary target Individualized based on life expectancy and comorbid conditions Peak postprandial capillary plasma glucose Preprandial capillary plasma glucose A1c <7% American Diabetes Association. Standards of Medical Care in Diabetes - 2010. Diabetes Care 2010;33(1):S11-61
  • 12. Insulin secretagogues: 1-2 wk intervals Adjusting Drug Dose toward Glycemic Goal Metformin: 1-2 wk intervals α-glucosidase inhibitors: 2-4 wk intervals TZD: maximum effect at 16-20 wks half the glucose reduction in 4 weeks
  • 13. HbA1c At least twice a year in those with stable glycemic control At least quarterly for those not meeting goals or when therapy is changed American Diabetes Association. Standards of Medical Care in Diabetes - 2010. Diabetes Care 2010;33(1):S11-61
  • 14. Diabetes & Employment Evaluate for Hypoglycemia for those on insulin secretagogues Hyperglycemia can cause long-term complications American Diabetes Association. Diabetes and Employment. Diabetes Care 2010;33(1):S82-86
  • 15. Obesity Body mass index (BMI) measure of fatness Waist circumference measure of visceral fat Full-figured man by Tobyotter, 15 Aug 2009. http:// www.flickr.com/photos/78428166@N00/3872155588/ Accessed 1 Nov 2010
  • 16. Body Mass Index = [weight (kg)/height (m) 2] WHO Classification Asia Pacific Classification Underweight <18.5 <18.5 Normal 18.5-24.9 18.5-22.9 Overweight 25-29.9 23-24.9 Obese Class I 30-34.9 25-29.9 Obese Class II 35-39.9 >30 Morbid obesity >40 = (weight (lb) x 703)/height (in)2 NHLBI, The Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults (2000)
  • 17. Measuring Tape Position for Waist Circumference Horizontal plane around the abdomen at the level of the iliac crest Tape is snug but does not compress the skin; is parallel to the floor Measure at the end of normal expiration NHLBI, The Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults (2000)
  • 18. Waist Circumference Increased risk ♂ >90 cm (35 in) ♀ >80 cm (32 in) High risk ♂ >102 cm (40 in) ♀ >88 cm (35 in) Free Tape Measure Woman by D. Sharon Pruitt, 18 Jan 2009. http://www.flickr.com/photos/pinksherbet/3206805049/ Accessed 1 Nov 2010
  • 19. BMI (kg/m2) Obesity Class Disease Risk* (Relative to Normal Weight and Waist Circumference) Underweight Normal ✝ Overweight Obesity Extreme Obesity ♂<40 in (<102 cm) ♀<35 in (<88 cm) <40 in (<102 cm) <35 in (<88 cm) <18.5 - - 18.5-24.9 - - 25.0-29.9 Increased High 30.0-34.9 I High Very High 35.0-39.9 II Very High Very High >40 III Extremely High Extremely High * Disease risk for type 2 diabetes, hypertension & CVD ✝ Increased waist circumference can also be a marker for increased risk even in persons of normal weight NHLBI, The Practical Guide: Identification, Evaluation and Treatment of Overweight and Obesity in Adults (2000)
  • 20. !ank Y" http://www.endocrine-witch.net

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