1. TYPE 2
DIABETES
Introduction

2. Diabetes in the US
 90-95% of diabetes have type 2 diabetes
 35% of adults 20 are prediabetic
 50% of people over 65 are prediabetic
 26.9% of people over age 65 have diabetes
 The cost of diabetes in 2007 was estimated at
$174 billion
 $116 billion in direct medical costs
 $58 billion in indirect costs
CDC, 2011

3. Diagnosing Diabetes
Fasting Blood
Glucose
Oral Glucose
Tolerance Test
A1C
Normal < 100 < 140 < 5.7%
Pre-
diabetes
≥ 100 but< 126 ≥ 140 but< 200 ≥ 5.7 but< 6.5 %
Diabetes ≥ 126 ≥ 200 ≥ 6.5%
ADA, 2013b

4. Understanding A1C
 The A1C test is a measure
of average blood glucose
control for the past 2 to 3
months.
 It is determined by
measuring the percentage
of glycated hemoglobin, or
HbA1c, in the blood.
 The ADA recommends
testing A1C at least twice
per year.
 A1C can be converted to
an Estimated Average
Glucose (eAG).ADA, 2013a

5. Risk Factor
 Over age 45
 History of gestational diabetes
 Given birth to a baby weighing more than 9
pounds
 Family history of diabetes
 Excess body weight
 Low activity level (exercising less than 3 times a
week)
 High triglycerides (250 mg/dL or more)
 High blood pressure (≥ 140/90 mmHg)
 Metabolic syndrome
 Polycystic ovarian syndromeNIH, 2013

6. Prevalence by Region
Diagnosed Diabetes Among
Adults Aged ≥ 20 Years – 2009
Age-adjusted ranks based on age-adjusted percentage of diabetes
Above median rank
Below median rank
Not above median rank or below median rank
Age-adjusted ranks based on age-adjusted percentage of obesity
Above median rank
Below median rank
Not above median rank or below median rank
CDC, 2013
Obesity Among Adults
Aged ≥ 20 Years -- 2009

7. Symptoms
 Frequent infections
 Wounds that heal
slowly
 Fatigue
 Hunger
 Increased thirst
 Increased urination
 Blurred vision
 Erectile dysfunction
 Pain or numbness in
the feet or hands
 Dry skin

8. Major Health Implications
 Diabetes is the leading cause of:
 Kidney failure
 Nontraumatic lower-limb amputation
 New cases of adult blindness
 Increases the risk of heart disease and stroke
by 2 to 4 times
 Diabetes is the 7th leading cause of death
CDC, 2011

9. Treatment
12 %
14 %
58%
16 %
Insulin
Only
Insulin &
Oral
Medicatio
n
Oral
Medicatio
n Only
 Oral Agents
 Sulfonylureas (glipizide)
 Meglitinides
 Biguanides (metformin)
 Thiazolidinediones
 Alpha-glucosidase
inhibitors
 DPP-4 inhibitors
(Januvia)
 Injectable non-insulin
Agents
 GLP-1 (Victoza)
 Amylinomimetic (Symlin)
 Insulin
Diabetes Treatment
2007-2009
CDC, 2011

10. What Can Be Done?
 Diabetes is a major preventable health
problem in the United States.
 Effective management and treatment of
diabetes can reduce the health complications
associated with diabetes and uncontrolled
blood sugar.
 Diabetes management requires a multi-
disciplinary approach to manage
diet, lifestyle, medications, and promote
preventative care.

11. References
American Diabetes Association (ADA). (2013a). Blood glucose control.
http://www.diabetes.org/living-with-diabetes/treatment-and-care/blood-
glucose-control/
American Diabetes Association (ADA). (2013b). Diagnosing diabetes and
prediabetes. Retrieved from: http://www.diabetes.org/diabetes-
basics/diagnosis/
Centers for Disease Control & Prevention (CDC). (2011). National
diabetes fact sheet, 2011. Retrieved from:
http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf
Centers for Disease Control & Prevention (CDC). (2013). Diabetes
interactive atlases. Retrieved from:
http://www.cdc.gov/diabetes/atlas/countyrank/powerpoints.html
National Institute of Health (NIH). (2013). Type 2diabetes - Risk factors.
Retrieved from:
http://www.nlm.nih.gov/medlineplus/ency/article/002072.htm