Your SlideShare is downloading. ×
Primary Prevention of Type 2 Diabetes
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Saving this for later?

Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime - even offline.

Text the download link to your phone

Standard text messaging rates apply

Primary Prevention of Type 2 Diabetes

1,157
views

Published on

Published in: Health & Medicine

1 Comment
0 Likes
Statistics
Notes
  • Celerion is actively recruiting adults living with diabetes (Type 1 or Type 2). Upon qualifying, these individuals would have the opportunity to earn up to $250 per day while contributing to ongoing diabetes research.

    If interested go to the link below and fill up the form
    http://www.studyscavenger.com/Qualification/Default.aspx?sID=10208
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Be the first to like this

No Downloads
Views
Total Views
1,157
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
24
Comments
1
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Primary Prevention of Type 2 Diabetes
  • 2. Lifetime Risk for Diabetes
    • If born in 2000:
      • 32.8% if male (1 in 3)
        • If Hispanic, 45.4%
      • 38.5% if female (2 in 5)
        • If Hispanic, 52.5%
    • Life expectancy:
      • If diagnosed at age 40:
        • Men will lose 11.6 life years
        • Women will lose 14.3 life years
    • JAMA, October 8, 2003 – Vol 290, No. 14, p 1884-1890
  • 3. Copyright restrictions may apply. Narayan, K. M. V. et al. JAMA 2003;290:1884-1890. Cumulative Lifetime Risk for Diagnosis of Diabetes
  • 4. Prevalence of all Glycemic Abnormalities in the United States Undiagnosed diabetes 5.9 million Additional 24.6 million with IGT Diagnosed type 2 diabetes 10 million Diagnosed type 1 diabetes ~1.0 million Centers for Disease Control. Available at: http://www.cdc.gov/diabetes/pubs/estimates.htm; Harris MI. In: National Diabetes Data Group. Diabetes in America . 2nd ed. Bethesda, Md: NIDDK; 1995:15-36; U.S. Census Bureau Statistical Abstract of the U.S.; 2001 US Population: 275 Million in 2000 10
  • 5. Source: Mokdad et al., Diabetes Care 2000;23:1278-83 . Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 1990 <4% 4-6% 6-8%
  • 6. Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 1991-92 Source: Mokdad et al., Diabetes Care 2000;23:1278-83.
  • 7. Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 1993-94
  • 8. Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 1995-96 Source: Mokdad et al., Diabetes Care 2000;23:1278-83.
  • 9. Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 1995 Source: Mokdad et al., Diabetes Care 2000;23:1278-83.
  • 10. Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 1997-98 Source: Mokdad et al., Diabetes Care 2000;23:1278-83.
  • 11. Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 1999 Source: Mokdad et al., Diabetes Care 2001;24:412. 8-10%
  • 12. Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 2000 Source: Mokdad et al., J Am Med Assoc 2001;286:10 .
  • 13. Diabetes Trends* Among Adults in the U.S., (Includes Gestational Diabetes) BRFSS 2001 Source: Mokdad et al., J Am Med Assoc 2001;286:10 . > 10% > 10%
  • 14. 1996 2003 Obesity Trends* Among U.S. Adults BRFSS, 1991, 1996, 2003 (*BMI  30, or about 30 lbs overweight for 5’4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25% 1991
  • 15. Increase in Clinically Severe Obesity (BMI > 40) Sturm,R. Arch Intern Med.  2003;163:2146-2148
  • 16. Diabetes in Children
    • 151,000 people below the age of 20 years have diabetes
    • Prevalence In the 15-to-19-year age group
      • 50.9 per 1000 for Pima Indians from Arizona
      • 4.5 per 1000 for all U.S. American Indian populations (reported cases from the U.S. Indian Health Service outpatient clinics);
      • 2.3 per 1000 for Canadian First Nation people from Manitoba (reported cases from outpatient clinics).
  • 17. Diabetes in Children
    • Cincinnati, Ohio, found an incidence for type 2 diabetes of 7.2 per 100,000 for African Americans and whites aged 10-19 years in 1994.
    • In most of the U.S. case reports, type 2 diabetes accounted for 8% to 46% of all new cases of diabetes (type 1 and type 2) referred to pediatric centers.
  • 18. Diabetes Prevention in Children
    • Obesity prevention
    • Increased physical activity
    • Decreased sedentary behavior
  • 19. Diabetes Prevention in Adults
    • People with Impaired Glucose Tolerance (Pre-Diabetes)
      • Da Qing (1997)
      • Finnish DPS (2001)
      • Reduced fat diet (2001)
      • DPP (2002)
      • STOP-NIDDM (2002)
      • Nateglinide study (2002)
      • SLIM (2004)
      • XENDOS (2004)
  • 20. Glucose Tolerance Categories American Diabetes Association. Diabetes Care. 2003;26(suppl 1):S5-S20 FPG 2-h PPG (OGTT) 126 110 60 80 100 120 140 160 180 200 Plasma glucose (mg/dL) Normal Diabetes Mellitus 240 220 Diabetes Mellitus Normal IGT IFG 8
  • 21. Finnish DPS study. Mean BMI = 31; all patients had IGT. Intervention included counseling aimed at reducing weight, total intake of fat, and intake of saturated fat and increasing intake of fiber and physical activity. the risk of diabetes was reduced by 58 percent (P<0.001) in the intervention group (Eriksson et al., Diabetologia 1991;34:891-8.
  • 22. 5 year effects of a reduced-fat diet intervention in patients with IGT. Fasting glucose was significantly improved and maintained over 5 years in most compliant experimental group. (Swinburn et al., Diabetes Care201;24:619-24) CD group (– – – –) least compliant RF group (- - - -) most compliant RF group (——–)
  • 23. Diabetes Prevention Program (DPP): Incidence of DM according to group (p<0.001)
  • 24. Diabetes Prevention Program (DPP): Changes in body weight and activity level according to group (p<0.001)
  • 25. STOP-NIDDM trial: Patients assigned to acarbose received a mean daily dose of 194 mg (SD 87). These patients were 25% less likely to develop diabetes than those on placebo. This effect was noted at 1 year and persisted throughout the study. The beneficial effect of acarbose was consistent irrespective of age, sex, and BMI (Chiasson et al., Lancet 2002;359:2072-7)
  • 26. Nateglinide reduced postprandial hyperglycemia in subjects with IGT. Longer-term studies needed to determine whether this agent can delay or prevent the development of type 2 diabetes (Saloranta et al., Diabetes Care 202;25:2141-6)
  • 27. The addition of orlistat (120 mg) or placebo t.i.d. with breakfast, lunch, and dinner to lifestyle changes in XENDOS reduced the incidence of type 2 diabetes in subjects with IGT by 52% when compared with the placebo and lifestyle group. In the IGT population, the results suggest that treating 10 patients with orlistat plus lifestyle (rather than lifestyle alone) for 4 years would prevent the development of one case of diabetes (Diabetes Care 2004;27:155-61)
  • 28. Obese-Normal Glucose Tolerance
    • XENDOS (2004)
    • SOS (1999)
    • Liposuction (2004)
    • Ohio African American-troglitazone (2003)
  • 29. Swedish Obese Subjects (SOS Study
    • 2000 matched patient pairs, one to undergo bariatric surgery, the other provided with conventional obesity treatment, followed for 10 years.
    • Aims are mortality, morbidity and QOL related to weight loss and method
    • After 8 years the surgical group had lost 16.5% while controls maintained-gained weight. Incidence of diabetes was 5-fold lower in surgical group.
  • 30. Liposuction Study: Women with normal glucose tolerance
  • 31. Liposuction Study: Women with Diabetes
  • 32. Ohio African American Troglitazone Study: Placebo Troglitazone
  • 33. Women with previous GDM TRIPOD study Troglitazone reduced the incidence of diabetes in women who returned for follow-up by at least 50%. (Buchanan et al., Diabetes 2002;51:2796-803)
  • 34. Dyslipidemia & Hypertension
      • HOPE (2001)
      • CAPP (1999)
      • LIFE (2002)
      • WOSCOPS (2001)
  • 35. HOPE study: The relative risk for developing diabetes among patients taking ramipril vs placebo is 0.66 (95% confidence interval, 0.51-0.85; P <.001). Ramipril is associated with lower rates of new diagnosis of diabetes in high-risk individuals. Because these results have important clinical and public health implications, this hypothesis requires prospective confirmation.
  • 36. CAPP Study
    • Captopril, titrated to keep supine DBP < 90 mm Hg, was associated with diabetes incidence of 13.3%, compared with 15.2% over 5 years in those treated with diuretics and  -blockers for HTN.
    • Post-hoc analysis of sub-group of patients without diabetes
  • 37. New-onset diabetes mellitus occurred in 242 patients receiving losartan (13.0 per 1000 person-years) and 320 receiving atenolol (17.5 per 1000 person-years); relative risk 0.75 (95% confidence interval 0.63 to 0.88;P < 0.001). Retrospective analysis. Needs prospective confirmation. LIFE Study
  • 38. WOSCOPS: Time to development of diabetes mellitus according to (A) median BMI (<25.65 or >=25.65 kg/m2), (B) median natural log triglyceride (<0.5 or >=0.5 natural log [mmol/L]), (C) median baseline glucose (<4.7 or >=4.7 mmol/L), and (D) treatment assignment (placebo or pravastatin 40 mg/d).
  • 39. Obesity prevention in children
    • Decreased TV watching study (1999)
    • Pathways study (2003)
    • MCG “Fit Kid” program (2005)
    • Parental lifestyle change
    • Dietary interventions
    • Increased physical activity
    • Drug therapy
    • Environmental policy
  • 40. Pathways: The three-year intervention included components related to physical activity, school food service, classroom curriculum, and family support. Began with 3rd grade children and lasted through 5 th   -- -- -- -- NL - - - - - - - Intervention --------------- Control The aims were not met. No significant difference between groups.
  • 41. MCG “Fit Kid” Program Bernard Gutin, et al., Medical College of Georgia
  • 42. Obesity in Adults
    • Easier to prevent than to cure
    • Clinically severe obesity (>100 lbs overweight) is increasing much faster than obesity. Prevalence of BMI >50 has increased over 400% since 1986.
    • Popular diets all have low adherance and one offers little lasting benefit over another (JAMA, 2005)
  • 43. Obesity Prevention in Adults
    • Decreasing sedentary behaviors
    • Increasing physical activity
  • 44. Copyright restrictions may apply. Hu, F. B. et al. JAMA 2003;289:1785-1791. Percentage Changes in Risk of Developing Obesity Among Nonobese Women and in Risk of Developing Type 2 Diabetes Among Nondiabetic Women Associated With Television (TV) Watching, Other Sedentary Behaviors, and Walking
  • 45. Weight Loss in Adults
    • Diet comparison study (2005)
    • National Weight Control Registry
    • Portion-controlled servings
    • Meal replacement
  • 46. Table 1. Lifestyle modification for obesity, 1974 to 2002 1974 1985 to 1987 1991 to 1995 1996 to 2002 * Number of studies 15 13 5 9 Sample size 53.1 71.6 30.2 28.0 Initial weight (kg) 73.4 87.2 94.9 92.2 Length of treatment (weeks) 8.4 15.6 22.2 31.4 Weight loss (kg) 3.8 8.4 8.5 10.7 Loss per week (kg) 0.5 0.5 0.4 0.4 Attrition 11.4 13.8 18.5 21.2 Length of follow-up (weeks) 15.1 48.3 47.7 41.8 Loss at follow-up (kg) 4.0 5.3 5.9 7.2
  • 47. Group treatment induced a significantly greater weight loss than individual care after 6 mos of treatment, even in patients who preferred individual treatment (Renjilian et al., J Consult Clin Psychol. 2001;69:717-21)
  • 48. Long-term behavioral treatment appears only to delay rather than to prevent weight re-gain (Perri et al. J Consult Clin Psychol. 2001;69:722-6)
  • 49. Benefits of low vs. high levels of physical activity in a randomized controlled trial. High = 2500 kcal/wk, Low = 1000 kcal/wk. No difference in weight loss after 6 mos; high level maintained significantly better (Jeffery et al., Am J Clin Nutr. 2003;78:684-9)
  • 50. National Weight Control Registry
    • 18 years and older, who have successfully maintained a 30 pound weight loss for a minimum of 1 year. Currently, the registry includes approximately 4,500 individuals.
    • Successful weight losers report making substantial changes in eating and exercise habits to lose weight and maintain their losses.
    • The average registrant has lost approximately 60 pounds and has maintained that loss for roughly 5 years.
    • Two-thirds of these successful weight losers were overweight as children and 60% report a family history of obesity.
    • Approximately 50% of participants lost weight on their own without any type of formal program or help.
    • Walking is the most frequently cited physical activity performed by NWCR members.
  • 51. Table 3. Eating habits of National Weight Control Registry members Women ( n = 629) Men ( n = 155) Maximum weight (kg) 94.6 121.0 Maximum BMI (kg/m 2 ) 34.6 37.2 Current weight (kg) 66.0 85.6 Current BMI (kg/m 2 ) 24.1 26.4 Energy intake (kcal/d) 1296 1724 Energy from fat (%) 24 23 Energy from protein (%) 19 18 Energy from carbohydrate (%) 55 56 Number of meals or snacks per day 5.0 4.5 Number of meals at fast food restaurants per week 0.7 0.8 Number of meals at non-fast food restaurants per week 2.4 2.9
  • 52. During first 3 mos Group A patients ate 1200 – 1500 kcal/d diet of conventional foods. Group B patients had same calorie goal but replaced two meals and two snacks with shakes and bars. After 3 mos, both groups replaced 1 meal/snack daily. (Flechtner-Mors et al., Obes Res. 2000;8:399-402)
  • 53. Copyright restrictions may apply. Dansinger, M. L. et al. JAMA 2005;293:43-53. One-Year Changes in Body Weight as a Function of Diet Group and Dietary Adherence Level for All Study Participants
  • 54. Evidence-Based Recommendations
    • Primary prevention of Type 2 Diabetes:
      • Level 1: 7% weight loss and 150 minutes of moderate physical activity/week
      • Level 2: Bariatric surgery
    • Primary prevention of obesity
      • Children: No evidence
      • Adults: Avoidance of sedentary behaviors
    • Obesity Treatment
      • No evidence supports one method over another
      • Group support/meal replacements provide strongest evidence