Find out if you are at risk for diabetes and what you can do to prevent, diagnose and treat this disease.

1. Diabetes – Ask the Experts!
Debra Margulies, MD – Endocrinologist
Margaret Eckler, RD, Certified Diabetes Educator
Summit Medical Group
Berkeley Heights, NJ
November 18, 2014

2. What is Diabetes Mellitus?
• Blood sugar (glucose) is a main nutrient that
all cells in the body use for fuel
• Insulin is required for cells to get glucose from
the blood
• If there is not enough insulin or the insulin
does not work as well, glucose stays in the
blood resulting in high blood glucose levels
NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2014.

3. Diagnosis of Diabetes

4. Types of Diabetes
• Type 1 Diabetes (no insulin produced)
• Previously termed juvenile/childhood-onset, insulin
dependent
• 5% to 10%
• Type 2 Diabetes (insulin produced doesn’t
work well)
• Previously termed adult-onset, non-insulin dependent
• 90% to 95%
NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2005.

5. Pre-diabetes
• At least 86 million U.S. adults have pre-diabetes
• Increased risk of developing diabetes in
the future and increased risk of
cardiovascular disease
• People with pre-diabetes can prevent or
delay the onset of type 2 diabetes through
lifestyle change and/or medication
NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2014.

6. Risk factors for Diabetes
- Prediabetes
- Over age 45
- Family history of diabetes
- Overweight
- Do not exercise regularly
- Low HDL cholesterol or high triglycerides, high blood pressure
- Certain racial and ethnic groups
- Women who had gestational diabetes, or who have had a baby
weighing 9 pounds or more at birth

7. Obesity Trends* Among U.S. Adults
BRFSS, 1986
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%

8. Obesity Trends* Among U.S. Adults
BRFSS, 1987
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4”
person)
No Data <10% 10%–14%

9. Obesity Trends* Among U.S. Adults
BRFSS, 1988
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%

10. Obesity Trends* Among U.S. Adults
BRFSS, 1989
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%

11. Obesity Trends* Among U.S. Adults
BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14%

12. Obesity Trends* Among U.S. Adults
BRFSS, 1991
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%

13. Obesity Trends* Among U.S. Adults
BRFSS, 1992
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%

14. Obesity Trends* Among U.S. Adults
BRFSS, 1993
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%

15. Obesity Trends* Among U.S. Adults
BRFSS, 1994
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%

16. Obesity Trends* Among U.S. Adults
BRFSS, 1995
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%

17. Obesity Trends* Among U.S. Adults
BRFSS, 1996
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%

18. Obesity Trends* Among U.S. Adults
BRFSS, 1997
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%

19. Obesity Trends* Among U.S. Adults
BRFSS, 1998
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%

20. Obesity Trends* Among U.S. Adults
BRFSS, 1999
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%

21. Obesity Trends* Among U.S. Adults
BRFSS, 2000
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% ≥20%

22. Obesity Trends* Among U.S. Adults
BRFSS, 2001
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

23. Obesity Trends* Among U.S. Adults
BRFSS, 2002
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

24. Obesity Trends* Among U.S. Adults
BRFSS, 2003
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

25. Obesity Trends* Among U.S. Adults
BRFSS, 2004
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

26. Obesity Trends* Among U.S. Adults
BRFSS, 2005
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25-29% ≥30%

27. Obesity Trends* Among U.S. Adults
BRFSS, 2006
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25-29% ≥30%

28. Obesity Trends* Among U.S. Adults
BRFSS, 2007
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25-29% ≥30%

29. Obesity Trends* Among U.S. Adults
BRFSS, 2008
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25-29% ≥30%

30. Obesity Trends* Among U.S. Adults
BRFSS, 2009
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25-29% ≥30%

31. 1999
Obesity Trends* Among U.S. Adults
BRFSS, 1990, 1999, 2009
(*BMI ³30, or about 30 lbs. overweight for 5’4” person)
2009
1990
No Data <10% 10%–14% 15%–19% 20%–24% 25-29% ≥30%

32. Age-Adjusted Percentage of Adults
with Diagnosed Diabetes
1994
No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

33. Age-Adjusted Percentage of Adults
with Diagnosed Diabetes
1995
No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

34. Age-Adjusted Percentage of Adults
with Diagnosed Diabetes
1996
No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

35. Age-Adjusted Percentage of Adults
with Diagnosed Diabetes
1997
No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

36. Age-Adjusted Percentage of Adults
with Diagnosed Diabetes
1998
No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

37. Age-Adjusted Percentage of Adults
with Diagnosed Diabetes
1999
No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

38. Age-Adjusted Percentage of Adults
with Diagnosed Diabetes
2000
No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

39. Age-Adjusted Percentage of Adults
with Diagnosed Diabetes
2001
No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

40. Age-Adjusted Percentage of Adults
with Diagnosed Diabetes
2002
No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

41. Age-Adjusted Percentage of Adults
with Diagnosed Diabetes
2003
No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

42. Age-Adjusted Percentage of Adults
with Diagnosed Diabetes
2004
No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

43. Age-Adjusted Percentage of Adults
with Diagnosed Diabetes
2005
No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

44. Age-Adjusted Percentage of Adults
with Diagnosed Diabetes
2006
No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

45. Age-Adjusted Percentage of Adults
with Diagnosed Diabetes
2007
No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

46. Age-Adjusted Percentage of Adults
with Diagnosed Diabetes
2008
No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

47. Age-Adjusted Percentage of Adults
with Diagnosed Diabetes
2009
No Data <4.5 4.5-5.9% 6-7.4% 7.5-8.9% >9%

48. U.S. Diabetes Prevalence
2014
• 29.1 million adults have diabetes
– 8.1 million are not yet diagnosed
• 9.3% of adult population
– 26.9% of all people over age 60
NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2014.

49. Diabetes Complications
• Microvascular – Small blood vessels in:
– Eyes (retinopathy)
– Kidneys (nephropathy)
– Nerves (neuropathy)
• Macrovascular – Large blood vessels in:
– Brain (stroke)
– Heart (heart attack)
– Legs (peripheral artery disease)

50. Diabetes Complications
• 2 in 3 people with diabetes die of heart
disease or stroke
• Diabetes is the #1 cause of adult blindness
• Diabetes is the #1 cause of kidney failure
• Diabetes causes more than 60% of non-traumatic
leg/foot amputations each year
NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2007.

51. Treatment of Diabetes
Prevention!
Prediabetes: 7% weight loss reduces risk of
progressing to diabetes by ~60% (70% if >60 years old)
14 pounds if you weigh 200 pounds
Lifestyle change
– Decreases need for medications (many patients can
control blood sugar with diet/exercise changes
alone)
– Reduces risk for related illnesses, such as heart
attack, stroke, arthritis, etc…
– Improves sense of well-being and overall quality of
life

52. Strive to become more
physically active.
• Start off slowly.
– Add more until you reach at least 30 minutes of moderate intensity
physical activity five days a week.
• Build physical activity into your day.
– Take a brisk walk during lunchtime.
– Take the stairs instead of the elevator.
– Park farther away from the stores or your office.
• Keep at it.
– The longer you keep at it, the better you’ll feel.
– Celebrate small successes.

54. Nutrition Recommendations
• Carbohydrates
– Whole grains, fruits, and vegetables should be
included in a healthy diet
– Total amount of carbohydrate – more
important than source
– Sugars are acceptable, but should be
substituted for other types of carbohydrate
– Fiber (a carbohydrate) is encouraged

55. Nutrition (cont’d)
• Protein
– No evidence to support greater or lesser
intake than for non-diabetics
• Fat
– Less than 7-10% of calories from saturated
fat, and less than 300 mg cholesterol
– Minimize intake of trans fats (hydrogenated
vegetable oils)

56. Nutrition (cont’d)
• Calories
– Should be appropriate to achieve weight loss
if needed
– Individualized
– Exercise, behavior modification, and ongoing
support are usually necessary for permanent
weight control.

57. Nutrition (cont’d)
• Vitamins, minerals, supplements
– No clear evidence of any benefit for diabetes unless a
deficiency is present
– Basic multivitamin/mineral preparation recommended
• Alcohol
– Limit to 1-2 drinks/day consumed with food (caution
if high triglycerides)
• Sodium / Salt
– Less than 2400 mg/day for those with hypertension

58. Diabetes Management Goals
“ABCs of Diabetes”
• A1c (Blood Sugar) <7% (<6.5% if appropriate)
– Pre-meals 90-130mg/dl
– 2 hours after meals <180
• Blood Pressure <130/80
– With ACE-inhibitor or ARB
• Cholesterol
– Important impact on reducing cardiovascular risk (ie, heart
attack, stroke)
– All patients above age 40 should be considered for ‘statin’
therapy regardless of starting cholesterol
• Aspirin therapy

59. Diabetes Management – (cont’d)
• Diabetes/Nutrition education – as needed
• Dilated eye exam – at least yearly
• Kidney blood and urine testing – at least yearly
• Podiatrist (foot doctor) – as needed
• Routine dental care
• Influenza (flu) vaccine – annually
• Pneumonia vaccine – every 5-10 years (once if
over age 65)
• Smoking cessation

60. Summary
• There has been a dramatic rise in the number of people
with diabetes over the past few decades
– parallels the rise in obesity
• Healthy lifestyle choices may delay or prevent diabetes
in those at risk
• If diabetes develops, lifestyle changes can help achieve
management goals
• If diabetes is not controlled by diet/exercise, there are
many treatment options now available
• A team approach is the most effective way to achieve all
the goals of diabetes management
The most important team member is YOU!