Diabetes: WhatEveryone Needs toKnow! Hongbiao (Hank) Liu MD PhD     Luna Medical Care
What is Diabetes?    A condition in    which the body    cannot make or    cannot use insulin    properly
Fasting BS                    RandomBS                              Over 200 126 and       Diabetes       With  above     ...
Types of DiabetesMellitus   Type 1   Type 2       Prediabetes                      Impaired Fasting Glucose          ...
Risk Factors Type 2 DM
More Risk Factors                Overweight (Abdominal)                Over 45 years old                 Sedentary Life...
What Happens in Type 2 DM Pancreas can’t make         Stomach empties 50% enough insulin              faster than normal  ...
Signs / Symptoms ofType 2 Diabetes
Additional Symptoms   Frequent Urination                            Skin Infections   Thirst                          ...
Insulin Resistance                     Skin TagsAcanthosis
Polycystic Ovarian    Syndrome   Fertility problems   Acne   Hair loss   Facial Hair   Weight problems   Deadly tria...
Metabolic SyndromeDefinition“A Clustering of    MultipleCardiometabolic Risk Factors”
Criteria        ATP III         WHO                 AACE              IDF                 (AHA/                 NHLB)     ...
90% of T2DM: IR and MSAdapted from International Diabetes Center (IDC), Minneapolis, Minnesota.
Increases in Diabetes
Diabetes in the United States   Estimated prevalence: Nearly 24 million       Nearly 8% of the U.S. population         ...
Diabetes in the United States      NOT an Equal Opportunity Disease!       Among those diagnosed…          16.5% of Nati...
Diabetes+Obesity=Diabesity
Obesity and Diabetes   1:3 Americans are obese   1:5 Americans are morbidly obese   80% of all Type 2 diabetics are    ...
Children and Type 2Diabetes   Mean age: 12-14    years old   Girls > Boys   Overweight   94% are in minority    groups...
Overweight Kids BecomeOverweight Adults   50% of overweight    children become    overweight adults   26-41% overweight ...
What about our children?          In a study done involving 111 children,           57% were obese, 12% were super-      ...
Saturday MorningInfluence     61% of all    commercials   are for FOOD90% are for sugared cereals, candy bars,     fast fo...
INDIANA        Diabetes        Obesity   State ranking for            State ranking for    prevalence (2008)            ...
Diabetes…… wehave pills and insulin tocontrol it, so what is the big             deal?
Costs of Diabetes in theU.S.   $174 billion each year       $116 billion in direct        medical costs       $58 billi...
Type 2 DM is Progressive        350                                              Post-meal glucose        250Glucose      ...
Health Impact of    Diabetes in the United    States                     6th leading cause of deathLeading cause of       ...
Diabetes Increases Death Rate             0.25              0.2Event rate                                              Dia...
Causes of Death in Diabetes                          50                                      40                          4...
Diabetes ManagementReceives      a Failing Report Card…Indicator of Diabetes       Percent of Patients        Mgmt        ...
Now the Good News:Diabetes Can BePrevented   Diabetes Prevention Program       N= 3,234 people with IGT          Ages 2...
Preventing Diabetes        --or Living Healthy with It!   Lifestyle Changes       Healthy Eating       Regular Exercise...
Healthy Eating
Reading Food Labels
Plate Method    Fill ½ of the plate with non-starchy vegetablesFinish with                                    Don’t forget...
The Supersizing P henomenon             Portion Control - I t Does             M t er !              at                   ...
Activity and Exercise       30 minutes of moderate activity        on most days of the weekThis does   NOT Count!
Inactivity and Diabetes      What’s wrong with this picture?
Healthy Weight
Height     Normal     Overweight      Obese       Extreme                                                            Obesi...
Medications   Prevention of Diabetes       Metformin (Glucophage)   Controlling Diabetes       Pills, Insulin, and oth...
“Diabetes Surgery”   Lab-Band (1 year)       64% of patients showed resolution       26% of patients showed improvement...
Surgical Outcomes:   ComorbiditiesComorbidity      Resolved   Improved or                            ResolvedDiabetes     ...
”The distance is nothing; it is only the first step that is difficult.”
Dr liu diabetes community education
Dr liu diabetes community education
Dr liu diabetes community education
Upcoming SlideShare
Loading in …5
×

Dr liu diabetes community education

441 views

Published on

0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
441
On SlideShare
0
From Embeds
0
Number of Embeds
36
Actions
Shares
0
Downloads
5
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • NGT = Normal Glucose Tolerance IFG/IGT = Impaired Fasting Glucose/Impaired Glucose Tolerance IR = Insulin Resistance MS = Metabolic Syndrome  -Cell failure occurs following an adaptative phase of hypersecretion in response to the development of insulin resistance.
  • Prevalence of Diabetes The Centers for Disease Control and Prevention (CDC) has compiled data on diabetes in the United States obtained from several surveys, including the National Health Interview Survey (NHIS), the Third National Health and Nutrition Examination Survey (NHANES III), the National Hospital Discharge Survey, and surveys conducted through the Behavioral Risk Factor Surveillance System (BRFSS). Based on data from these sources, the CDC estimates that 17 million people, or 6.2% of the population, had diabetes in 2000. A third of these cases were undiagnosed. Almost 9% of people  20 years old and 20.1% of people  65 years old had diabetes. The estimated worldwide prevalence of diabetes in 1997, derived from World Health Organization (WHO) data, was 124 million people, with the majority (97%) having type 2 diabetes. According to the same projections, the number of people with diabetes is expected to increase to 221 million in 2010. Other less conservative projections by King et al used WHO data combined with demographic estimates and projections issued by the United Nations to place the number of people worldwide with diabetes at 135.3 million in 1995 and 300 million in 2025. References: The Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2000. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2002. Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med. 1997;14:S7-S85. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21(9):1414-1431.
  • Prevalence of Diabetes The Centers for Disease Control and Prevention (CDC) has compiled data on diabetes in the United States obtained from several surveys, including the National Health Interview Survey (NHIS), the Third National Health and Nutrition Examination Survey (NHANES III), the National Hospital Discharge Survey, and surveys conducted through the Behavioral Risk Factor Surveillance System (BRFSS). Based on data from these sources, the CDC estimates that 17 million people, or 6.2% of the population, had diabetes in 2000. A third of these cases were undiagnosed. Almost 9% of people  20 years old and 20.1% of people  65 years old had diabetes. The estimated worldwide prevalence of diabetes in 1997, derived from World Health Organization (WHO) data, was 124 million people, with the majority (97%) having type 2 diabetes. According to the same projections, the number of people with diabetes is expected to increase to 221 million in 2010. Other less conservative projections by King et al used WHO data combined with demographic estimates and projections issued by the United Nations to place the number of people worldwide with diabetes at 135.3 million in 1995 and 300 million in 2025. References: The Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2000. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2002. Amos AF, McCarty DJ, Zimmet P. The rising global burden of diabetes and its complications: estimates and projections to the year 2010. Diabet Med. 1997;14:S7-S85. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21(9):1414-1431.
  • OASIS Study Mortality by Diabetes and CVD Status Data from the Organization to Assess Strategies for Ischemic Syndromes (OASIS) registry were analyzed to determine the 2-year prognosis of diabetic and nondiabetic patients who were hospitalized with unstable angina or non–Q-wave myocardial infarction. Outcomes that were studied included total mortality, cardiovascular death, new myocardial infarction, stroke, and new congestive heart failure. A total of 1,718 of the 8,013 registry patients had diabetes (21%). Because patients with diabetes were more likely to have established cardiovascular disease (CVD) at baseline, stratified analyses were performed according to prior CVD and diabetes status. The 2-year mortality rate for diabetic patients was 20.3% for those with prior CVD compared to 13.0% for those without prior CVD. For patients without diabetes, the rate was 12.9% for those with prior CVD compared to 6.9% for those without prior CVD. The P value was <0.001 for a comparison of patients with and without diabetes within the 2 CVD strata. Diabetic patients without prior CVD had the same event rates for total mortality, and all other outcomes, as nondiabetic patients with previous CVD. The CV death rate for diabetic patients with prior CVD was 16.6% compared to 9.3% for those without prior CVD. For patients without diabetes, the rate was 10.5% for those with prior CVD compared to 5.1% for those without prior CVD. The P value was also <0.001 for a comparison of patients with and without diabetes within the 2 CVD strata. Reference: Malmberg K, Yusuf S, Gerstein HC, Brown J, Zhao F, Hunt D, Piegas L, Calvin J, Keltai M, Budaj A. Impact of diabetes on long-term prognosis in patients with unstable angina and non-Q-wave myocardial infarction: results of the OASIS (Organization to Assess Strategies for Ischemic Syndromes) Registry. Circulation. 2000;102(9):1014-1019.
  • Causes of Death in People With Diabetes Based on data collected from 4 cohort studies in the US conducted between 1965 and 1988, it was determined that the leading causes of death listed on the death certificates of persons with diabetes were diseases of the heart (55%), diabetes (13%), malignant neoplasms (13%), and cerebrovascular disease (10%). Despite variation in the way underlying cause of death was classified, the proportion of persons dying from these causes was similar across the 4 studies. Geiss et al also found that the risk of heart disease mortality and ischemic heart disease mortality was 2 to 4 times higher in persons with diabetes than in persons without diabetes. For persons with diabetes, the excess risk of dying from heart disease and ischemic heart disease was higher than the excess risk of mortality for all other causes combined. While the studies may not have distinguished between insulin-dependent diabetes and non-insulin-dependent diabetes (NIDDM), it was assumed that the diabetes deaths were NIDDM deaths because of the older age of the populations and the increased prevalence of NIDDM in older age groups. Reference: Geiss LS, Herman WH, Smith PJ. Mortality in Non-Insulin-Dependent Diabetes. In: National Diabetes Data Group, eds. Diabetes in America. 2nd ed. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 1995.
  • Portion Size Does Matter: Portion control can make a great difference in your blood sugars. Let’s look at what has happened to an order of french fries from 1960 to 1999. In addition: The Average Dinner Plate Size in 1956 was 8”. The Average Dinner Plate Size in 2003 is 10.5”. The Large Drink at McDonald’s in 1961 was 12 oz. The Large Drink at McDonald’s in 2003 is 44 oz. The Average Restaurant Spaghetti Serving in 1969 was 11 oz. The Average Restaurant Spaghetti Serving in 2003 is 21 oz. In 1961 bread, chips or other pre-meal foods were either charged for or given free 13% of the time. In 2003 bread, chips or other pre-meal foods are given free 66% of the time.
  • Review Bullet Points Emphasize that there are many ways to increase physical activity It is important to pick an activity that is enjoyable, otherwise it will be hard to stick with it. Brisk walking is one of the easiest activities to start with. It requires no special equipment, and can be done indoors (shopping malls) and outdoors. Explain role/benefits of increasing physical activity. Ask the participants to give some benefits of increasing their physical activity. Let them have time to answer. If there is no response then give a couple of examples. Improves circulation and respiratory system Lowers blood pressure Increases sensitivity to insulin action Promotes gradual weight loss Helps maintain desired weight Improves energy level (you feel better) Improves your sleeping Improves good cholesterol while lowering bad cholesterol Patients should talk with their physicians to see if there are any health problems that would limit which physical activities they can participate in. Notes ____________________________________________________________________________________________________________________________________________________________________________________________________
  • Prandin is a registered trademark of Novo Nordisk A/S. Starlix is a registered trademark of Novartis Pharmaceuticals Corporation. Glucophage is a registered trademark of Merck Sante S.A.S. and licensed to Bristol-Myers Squibb Company. Precose is a registered trademark of Bayer Pharmaceuticals Corporation. Glycet is a registered trademark of Bayer Pharmaceuticals Corporation, to Pharmacia-Upjohn. Avandia is a registered trademark of GlaxoSmithKline. Actos is a registered trademark of Takeda Chemical Industries, Ltd.
  • Dr liu diabetes community education

    1. 1. Diabetes: WhatEveryone Needs toKnow! Hongbiao (Hank) Liu MD PhD Luna Medical Care
    2. 2. What is Diabetes? A condition in which the body cannot make or cannot use insulin properly
    3. 3. Fasting BS RandomBS Over 200 126 and Diabetes With above Symptoms 100 - 125 Pre - Diabetes 140 – 200 Under 100 No Diabetes Under 140
    4. 4. Types of DiabetesMellitus Type 1 Type 2  Prediabetes  Impaired Fasting Glucose  Impaired Glucose Tolerance Gestational DM Other
    5. 5. Risk Factors Type 2 DM
    6. 6. More Risk Factors  Overweight (Abdominal)  Over 45 years old  Sedentary Lifestyle  Non-White Race  Family History of DB  Family History of High BP  History of High BP (self)  High Cholesterol  History of Gestational Goals: DBWomen < 35  Delivered a baby > 9 lbs.Men < 40
    7. 7. What Happens in Type 2 DM Pancreas can’t make Stomach empties 50% enough insulin faster than normal Type 2 Diabetes Liver puts too Muscle cells and much sugar other tissues are into the blood resistant to insulin
    8. 8. Signs / Symptoms ofType 2 Diabetes
    9. 9. Additional Symptoms Frequent Urination  Skin Infections Thirst  Slow Healing  Yeast Infections Appetite Changes  Urinary Infections Blurred Vision  Dry Skin; Itching Tiredness;  Numbness; Tingling Sleepiness  Feeling / Acting “Evil” Weight Changes  High Blood Pressure Headaches  Cholesterol Problems
    10. 10. Insulin Resistance Skin TagsAcanthosis
    11. 11. Polycystic Ovarian Syndrome Fertility problems Acne Hair loss Facial Hair Weight problems Deadly triangle  High Blood Pressure  High Cholesterol  High Blood Sugar
    12. 12. Metabolic SyndromeDefinition“A Clustering of MultipleCardiometabolic Risk Factors”
    13. 13. Criteria ATP III WHO AACE IDF (AHA/ NHLB) M > 102 cm BMI > 30 or BMI > 25 *M > 94 cm W > 88 cm W : H Ratio *W > 80 cmAbdominal M > 0.9 or BMI > 30Obesity W> 0.85 + 2 othersTriglycerides > 150 mg/dl same same Same or on medsHDL M < 40 M < 35 M < 40 M < 40 (or on W < 50 W < 39 W < 50 W < 50 meds)Blood Pressure > 130/85 > 140/90 > 130/85 > 130/85 or on or on meds or on meds medsFasting > 100 mg/dl T2 DM, IFG or Btw. 110 – > 100 or T2DMGlucose or on meds IGT * 126 mg/dl +2 othersOther Urinary Albumin 2 hr PP > 140; Excretion Rate > PCOS; family 20 or alb:creatine hx; other ratio > 30
    14. 14. 90% of T2DM: IR and MSAdapted from International Diabetes Center (IDC), Minneapolis, Minnesota.
    15. 15. Increases in Diabetes
    16. 16. Diabetes in the United States Estimated prevalence: Nearly 24 million  Nearly 8% of the U.S. population  Almost 25% of persons over age 60  90 - 95% have type 2  25% do not know they have it!  57 million have pre-diabetes  24% have Metabolic Syndrome  Projected 44-68% increase in diabetes by 2015  8% per year
    17. 17. Diabetes in the United States  NOT an Equal Opportunity Disease! Among those diagnosed…  16.5% of Native Americans/Alaskan Natives  11.8% of Black Americans  10.4% of Latinos*  12.6% of Puerto Ricans  11.9% of Mexicans  8.2% of Cubans  7.5% Asian Americans  6.6% Caucasians  Lifetime DM risk (born after 2000)  33% men; 39% women; 50% Hispanic women
    18. 18. Diabetes+Obesity=Diabesity
    19. 19. Obesity and Diabetes 1:3 Americans are obese 1:5 Americans are morbidly obese 80% of all Type 2 diabetics are overweight Obesity in children has doubled in 20 years Type 2 diabetes in children has tripled in the last 5 years
    20. 20. Children and Type 2Diabetes Mean age: 12-14 years old Girls > Boys Overweight 94% are in minority groups 74-100% have a strong family history
    21. 21. Overweight Kids BecomeOverweight Adults 50% of overweight children become overweight adults 26-41% overweight preschool children will become overweight adults
    22. 22. What about our children?  In a study done involving 111 children, 57% were obese, 12% were super- obese  In families of children who were obese ~ the caregiver thought the child’s weight was a problem in only 44% of the casesYoung-Hayman, D. et al Obesity Research 2000:8:241-8
    23. 23. Saturday MorningInfluence 61% of all commercials are for FOOD90% are for sugared cereals, candy bars, fast food, and chips
    24. 24. INDIANA Diabetes Obesity State ranking for  State ranking for prevalence (2008) prevalence (2008)  Adults: Ranked 38th  Ranked 31st Diabetes in Indiana is  Adults in Indiana above the national (2006) average:  27.5 % obese National Average:  35% overweight 8.0% Indiana Average: 8.5%
    25. 25. Diabetes…… wehave pills and insulin tocontrol it, so what is the big deal?
    26. 26. Costs of Diabetes in theU.S. $174 billion each year  $116 billion in direct medical costs  $58 billion in indirect costs  Missed work  Lost productivity  1 in 10 healthcare dollars spend on diabetes/complications Human costs  leading cause of 7th death
    27. 27. Type 2 DM is Progressive 350 Post-meal glucose 250Glucose Fasting glucose(mg/DL) 150 50 -10 -5 0 5 10 15 20 25 30 300 Insulin resistanceRelative 200function (units) 100 At risk for Normal insulin level diabetes Beta cell failure 0 -10 -5 0 5 10 15 20 25 30 Years of Diabetes Adopted from D. Kendall, R. Bergenstal © International Diabetes Center
    28. 28. Health Impact of Diabetes in the United States 6th leading cause of deathLeading cause of 73% of adults havekidney failure HTN and/or take meds DiabetesLeading cause Heart disease is theof adult blindness leading cause of death Neuropathy in 60-70% of patients contributes to high incidence of lower-limb amputation National Diabetes Fact Sheet, United States, November 2003. Available at http:;;www.cdc.gov/diabetes/pubs/factsheet.htm.
    29. 29. Diabetes Increases Death Rate 0.25 0.2Event rate Diabetes/CVD 0.15 Diabetes/No CVD No Diabetes/CVD 0.1 No Diabetes/No CVD 0.05 3 6 9 12 15 18 21 24 Months 0 Organization to Assess Strategies for Ischemic Syndromes Malmberg K, et al. Circulation. 2000;102:1014-1019. www.hypertensiononline.org
    30. 30. Causes of Death in Diabetes 50 40 40 30 20 15 13 13 10 10 4 5s h ae d f o t necr e P 0 er ic e s r en ia/ as rt te ce za th m s se a e he sea be an ke flu n di he lo in mo c ia ro C Is di er Al D St eu t th ar Pn O heGeiss LS, et al. In: Diabetes in America. tNational Institutes of Health;1995. www.hypertensiononline.org
    31. 31. Diabetes ManagementReceives a Failing Report Card…Indicator of Diabetes Percent of Patients Mgmt at GoalA1C 37% NHANES III  1988-1994 7.8% NHANES  1999-2000 8.1%LDL Cholesterol 23%Systolic BP 41% Beaton, S.et al. Diabetes Care 27: 694-698, 2004
    32. 32. Now the Good News:Diabetes Can BePrevented Diabetes Prevention Program  N= 3,234 people with IGT  Ages 25-85 (mean 51)  Average BMI 34  45% minorities Goals  Achieve/maintain weight loss of 7%  Maintain moderate physical activity at least 150 minutes/week
    33. 33. Preventing Diabetes --or Living Healthy with It! Lifestyle Changes  Healthy Eating  Regular Exercise  Healthy Weight  Weight Loss (7% of weight) Medications Weight Loss Surgery
    34. 34. Healthy Eating
    35. 35. Reading Food Labels
    36. 36. Plate Method Fill ½ of the plate with non-starchy vegetablesFinish with Don’t forget a fruit the dairy!Choose a carb serving Add a serving of a protein food
    37. 37. The Supersizing P henomenon Portion Control - I t Does M t er ! at 29G 26G 700 77G 610 22G 68G 600 500 10G Fat 57G 450Calories 400 320 26 Grams Carbs 300 210 200 100 0 1960 1978 1995 1999 Year
    38. 38. Activity and Exercise  30 minutes of moderate activity on most days of the weekThis does NOT Count!
    39. 39. Inactivity and Diabetes What’s wrong with this picture?
    40. 40. Healthy Weight
    41. 41. Height Normal Overweight Obese Extreme Obesity BMI=<25 BMI=25-29 BMI=30-39 BMI=>405 ft 0 in Up to 127 Up to 152 Up to 203 Over 2035 ft 1 in Up to 131 Up to 157 Up to 210 Over 2105 ft 2 in Up to 135 Up to 163 Up to 217 Over 2175 ft 3 in Up to 140 Up to 168 Up to 224 Over 2245 ft 4 in Up to 144 Up to 173 Up to 231 Over 2315 ft 5 in Up to 149 Up to 179 Up to 239 Over 2395 ft 6 in Up to 154 Up to 185 Up to 246 Over 2465 ft 7 in Up to 158 Up to 190 Up to 254 Over 2545 ft 8 in Up to 163 Up to 196 Up to 261 Over 2615 ft 9 in Up to 168 Up to 202 Up to 269 Over 2695 ft 10 in Up to 173 Up to 208 Up to 277 Over 2775 ft 11 in Up to 178 Up to 214 Up to 285 Over 2856 ft 0 in Up to 183 Up to 220 Up to 293 Over 2936 ft 1 in Up to 188 Up to 226 Up to 301 Over 3016 ft 2 in Up to 193 Up to 232 Up to 310 Over 3106 ft 3 in Up to 199 Up to 239 Up to 318 Over 3186 ft 4 in Up to 204 Up to 245 Up to 327 Over 327
    42. 42. Medications Prevention of Diabetes  Metformin (Glucophage) Controlling Diabetes  Pills, Insulin, and other Injectables Weight Loss  Orlistat (Alli- OTC)  Meridia  Others
    43. 43. “Diabetes Surgery” Lab-Band (1 year)  64% of patients showed resolution  26% of patients showed improvement Roux-en-Y Gastric Bypass  76.8% of patients showed resolution - other studies showed 83% - 98%
    44. 44. Surgical Outcomes: ComorbiditiesComorbidity Resolved Improved or ResolvedDiabetes 76.8% 86.0%Hyperlipidemia 70%Hypertension 61.7% 78.5%Sleep Apnea 85.7%
    45. 45. ”The distance is nothing; it is only the first step that is difficult.”

    ×