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  • While NIDDK is the lead IC for diabetes research, diabetes research is distributed among many ICs
  • Discuss complications and economic costs associated with diabetes. Note that CVD accounts for 2/3 of deaths in DM and rate of CVD is decreasing in general population but increasing in those with DM.
  • Ominous implications if epidemic of diabetes is not checked.
  • The ABC’s of diabetes campaign is bringing information about interventions for those with diabetes proven successful in clinical trials in preventing diabetes complications to providers and patients.
  • One of our most important earlier findings was the greatly increased risk of diabetes in offspring of diabetic mothers compared with nondiabetic or prediabetic mothers, as shown here. The much greater risk in the offspring of diabetic mothers than prediabetic mothers, both of whom presumably carry diabetes susceptibility genes, suggested a major effect of diabetes In utero on the subsequent risk in the offspring.
  • --The fact that there is an epidemic of type 2 diabetes in the U.S. is certainly no secret. 15 million people have type 2 diabetes. --About 800,000 new cases are diagnosed each year. --Diabetes costs the Nation $100 billion per year in direct and indirect costs of the disease. --In the past 10 years, diabetes has spread throughout the nation. The map on the left from 1990 shows four states with greater than 6 percent prevalence in the darkest blue. By 2000, this prevalence rate had taken over the country. --Increased obesity and sedentary lifestyle contributing to epidemic of type 2.
  • The Diabetes Prevention Program was initiated in 1994 with a planning phase that lasted approximately 18 months. Recruitment was initiated in mid-1996 and completed 3 years later, ahead of schedule. Although the originally planned end of the treatment phase of the study was to be in mid- 2002, we are ending this phase of the DPP now, approximately 1 year ahead of schedule. The decision to terminate the treatment phase of the DPP early was based on the recommendation of the independent Data Monitoring Board that oversaw the performance of the study and examined the study data on a regular basis. They concluded in May of this year that the DPP had answered the major study questions.
  • Describe DPP interventions and results.
  • Describe Small Steps Big Rewards campaign to provide tools proven effective in DPP to providers and those at risk of DM.
  • Handout (.ppt format, 9595.0 kb)

    1. 1. Judith Fradkin, M.D. Director, Division of Diabetes, Endocrinology, and Metabolic Diseases National Institute of Diabetes and Digestive and Kidney Diseases Diabetes and Obesity in Women
    2. 2. Diabetes: Scope of the Problem <ul><li>>17 million Americans </li></ul><ul><li>Leading cause of: </li></ul><ul><ul><li>Kidney failure, adult blindness, amputations </li></ul></ul><ul><li>Cardiovascular disease: main cause of death </li></ul><ul><li>Estimated $132 billion health care costs </li></ul>
    3. 3. Prevalence of Diagnosed Diabetes in the United States Diagnosed (1960-1998) and Projected Diagnosed (2000-2050) Cases Data for 1960-1998 from the National Health Interview Survey, NCHS, CDC. Projected data for 2000-2050 from Boyle JP, et al, Diabetes Care 24:1936-40, 2001. Year 0 5 10 15 20 25 30 People (millions) 1960 1970 1980 1990 2000 2010 2020 2030 2040 2050 Diagnosed cases Projected diagnosed cases
    4. 4. Estimated Growth in Type 2 Diabetes and US Population From 2000-2050 Bagust A, et al. Diabetes 50, Suppl 2 A205, 2001
    5. 5. Prevalence of Diabetes by Race/Ethnicity and Sex
    6. 6. Gender Specific Effects of Diabetes <ul><li>Health risk to woman </li></ul><ul><li>Health risk to offspring </li></ul><ul><li>Prevention is possible </li></ul>
    7. 8. Diabetes and Atherosclerosis <ul><li>DM a CAD Risk Equivalent </li></ul><ul><li>Lose gender protection: equal age adjusted rates MI, stroke claudication </li></ul><ul><li>Claudication increased 3.5-fold men and 8.6-fold women (Framingham) </li></ul><ul><li>Mortality post MI double in diabetes </li></ul><ul><li>Mortality increased 1.4-fold for men and 1.9-fold women (Italy) and 1.6-fold for men and 2.6-fold for women (Finland) </li></ul><ul><li>CAD mortality decreasing in general population, steady in men with DM and increasing in women with DM (NHANES) </li></ul>
    8. 9. Source: National Health and Nutrition Examination Survey (NHANES), CDC, NCHS. Black, not Hispanic Males Females Mexican American White, not Hispanic 2010 Target Aspirin Therapy*: Persons with Diabetes, Age 40 years and Over, 1988-94 Age-adjusted percent Total *Took aspirin at least 15 times in past month. I 95% confidence interval.
    9. 10. The ABC’s of Diabetes Know Your Numbers A is for A1C B is for Blood Pressure C is for Cholesterol
    10. 11. Gender Specific Effects on Acute Complications of T1D <ul><li>Adolescent girls had 2-3 fold increased risk DKA compared to boys or younger girls </li></ul><ul><li>Adolescent girls had rates of hypoglycemia like DCCT conventional group while boys were similar to intensive group </li></ul><ul><li>Hypothesis that girls skip insulin for fear of weight gain </li></ul>
    11. 12. Gestational Diabetes <ul><li>14% of pregnancies </li></ul><ul><li>135,000 women in U.S. annually </li></ul><ul><li>GDM has same risk factors as type 2 diabetes </li></ul><ul><li>Fetal macrosomia risk related to postprandial glycemia </li></ul><ul><li>Increased diabetes in offspring </li></ul><ul><li>60-90% risk of recurrence </li></ul><ul><li>risk of type 2 diabetes after pregnancy 30% over 10 years </li></ul>
    12. 13. Mother with Diabetes Woman with Diabetes Infant of Diabetic Mother Diabetes in Pregnancy and Offspring: The Vicious Cycle Pettitt & Knowler, J Obes Wt Reg 1988
    13. 14. Diabetes in Offspring By Maternal Diabetes in Pregnancy Mother
    14. 15. Birth Weight and Risk for Gestational Diabetes <ul><li>U shaped curve with increased risk at low birth weight and high birth weight </li></ul><ul><li>Effect of high birth weight disappears with adjustment for maternal diabetes </li></ul><ul><li>Susceptibility to diabetes and insulin resistance may be programmed in utero </li></ul>
    15. 16. Prevalence of Diabetes in Pima Indians by Infant Feeding Pettitt: Lancet, 1997 Breast Fed Adj. OR = 0.38 (0.16 – 0.89)
    16. 18. Overweight Prevalence by Race/Ethnicity for Adolescent Boys and Girls Percentage SOURCES: National Health and Nutrition Examination Survey, National Center for Health Statistics, CDC NHANES III 1988-1994 NHANES 1999-2000 0 5 15 25 10 20 30 Non-Hispanic White Non-Hispanic Black Boys Aged 12-19 years Mexican American P =<.001 P =<.001 P = .35 Non-Hispanic White Girls Aged 12-19 years Non-Hispanic Black Mexican American P = .10 P = .002 P = .08
    17. 19. Obesity and Women <ul><li>Major determinant of health related quality of life in women throughout the lifespan </li></ul><ul><li>34% of women vs 27.7% of men were obese in NHANES 1999-2000 </li></ul><ul><li>6.3% of women vs 3.1% of men with class 3 obesity </li></ul><ul><li>15% of black women have class 3 obesity– 3-fold increase compared to non-Hispanic white women and Mexican American women </li></ul>
    18. 20. The Toll of Obesity <ul><li>Premature mortality: 280,000 deaths in U.S. annually </li></ul><ul><li>Increased type 2 diabetes, CVD, arthritis, cancer </li></ul><ul><li>Strong correlation with low SES particularly in women </li></ul><ul><li>Strong correlation with sedentary activities (TV watching in women) and inverse correlation with physical activity </li></ul>
    19. 21. The Diabetes Prevention Program A U.S. Randomized Clinical Trial to Prevent Type 2 Diabetes in Persons at High Risk
    20. 22. Mean Weight Change from Baseline 0 6 12 18 24 30 36 42 48 Months Lifestyle Metformin + Placebo
    21. 23. 0 1 2 3 4 0 10 20 30 40 Placebo (n=1082) Metformin (n=1073, p<0.001 vs. Placebo) Lifestyle (n=1079, p<0.001 vs. Met , p<0.001 vs. Placebo ) Percent Developing Diabetes All participants Years from randomization Cumulative incidence (%)
    22. 24. Small Steps. Big Rewards. What’s Your Game Plan?