Helpful Hints for Taking Care of Your Diabetes. Farahnaz Joarder, MD and Don Kain, MA, RD,CDE Harold Schnitzer Diabetes Health Center

Transcription

1 Helpful Hints for Taking Care of Your Diabetes Farahnaz Joarder, MD and Don Kain, MA, RD,CDE Harold Schnitzer Diabetes Health Center

2 Objectives How big of a problem is diabetes? What is diabetes? How is it diagnosed? What should my blood glucose level be? What are the recommended standards of care? What can I do to prevent and control diabetes?

3 County-level Estimates of Diagnosed Diabetes for Adults aged 20 years: United States 2004

4 County-level Estimates of Diagnosed Diabetes for Adults aged 20 years: United States 2007

5 ESTIMATES OF DIAGNOSED DIABETES

6 How Common is Diabetes in OREGON? PERCENT OF ADULTS DIAGNOSED WITH DIABETES FROM 1994 TO 2008

7 Clinical Impact of Diabetes Diabetes 2- to 6-fold increase in cardiovascular disease Leading cause of new cases of kidney failure Leading cause of new cases of blindness in working-aged adults Leading cause of lower extremity amputations

8 Cost ($ billion) THE COST OF DIABETES $174 billion in Treatment of Diabetes- Related Complications Diabetes Treatment Excess Medical Costs Estimated Direct Medical Costs, 2007 American Diabetes Association. Diabetes Care. 2008;31(3): Diabetes Fact Sheet.

9 THE FACES OF DIABETES

10 COMMON MYTHS ABOUT DIABETES Myth: Diabetes is not that serious of a disease. Myth: Eating too much sugar causes diabetes

11 COMMON MYTHS ABOUT DIABETES Myth: You can catch diabetes from someone else. Myth: If you have type 2 diabetes and your doctor says you need to start using insulin, it means you re failing to take care of your diabetes properly

12 Who should be tested for Type 2 Diabetes? Individuals with risk factors such as: Physically inactivity 1 st degree relative with Type 2 DM High risk ethnic group Asian American, Pacific Islander, African American, Native American, Latino History of gestational diabetes

13 Who should be tested for type 2 diabetes? Individuals with risk factors: High blood pressure ( 140/90) Cholesterol HDL < 35 and/ or Triglycerides > 250 History of cardiovascular disease History of polycystic ovarian syndrome Obesity Blood test suggesting prediabetes

14 Pathogenesis of Type 2 Diabetes Deficient Insulin Secretion DIET AND LIFESTYLE High Blood Sugar Glucose Decreased Glucose Uptake

15 Normal Pancreatic Islet

16 Etiology of Beta-Cell Failure in T2DM -Opportunities For Intervention- Age Incretin Effect Amyloid (IAPP) Deposition Beta-Cell Failure Genetics (TCF7L2) Insulin Resistance Glucose Toxicity Lipotoxicity FFA FFA = free fatty acid; IAPP = islet amyloid polypeptide.

17 -Cell Function (%) Type 2 Diabetes Progressive β-cell Loss Impaired Glucose Tolerance Postprandial Hyperglycemia Type 2 Diabetes Years After Diagnosis IGT = impaired glucose tolerance. Lebovitz H. Clinical Chemistry. 1999;45(8):

18 How Did You Diagnose Diabetes in 2009? Fasting blood glucose of 126 mg/dl or higher. A blood glucose at anytime 200 mg/dl in the presence of typical symptoms of diabetes. A 75 gm glucose tolerance test with a two hour glucose value 200mg/dl.. Diabetes Care 1997; 20:1183

19 JAMA, April 15, 2009.

20 How Do You Diagnose Diabetes in 2010? HgbA1c 6.5% New method to diagnose type 2 diabetes Fasting blood glucose of 126 mg/dl or higher. A 75 gm glucose tolerance test with a two hour glucose value 200mg/dl.. Diabetes Care 2010; Jan 33 (suppl 1)

21 What defines PREDIABETES in 2010? Hemoglobin A1C between 5.7 and 6.4 Impaired Fasting Glucose Glucose > 100 and less than 126 Impaired Glucose Tolerance 75 gram oral glucose drink followed by blood test at 2 hours Glucose > two hours after oral glucose load

22 What does the HbA1c mean? HbA1c (%) eab mg/dl mmol/l x A1c = eag Diabetes Care 2010; 33 (Supp1)

23 A New Look At Glucose Targets Reprinted from JAMA March 26, :1413

24 Intensive Glucose Control in Type 2 DM Important studies reported UKPDS ACCORD Trial ADVANCE Trial VADT Trial See ADA Position Statement Diabetes Care 2009; 32:

25 There are multiple ways to treat Type 2 Diabetes Impaired Insulin Secretion Metformin TZDs GLP-1 agents High blood sugar Sulfonylureas Glinides TZDs (indirectly) GLP-1 agents TZDs Metformin Glucose Production Decreased Glucose Uptake

26 American Diabetes Association Glucose Targets For DiabetesTreatment A1C: < 7.0% BEFORE MEALS: HOURS AFTER A MEAL: < 180

27 EVERY INDIVIDUAL IS DIFFERENT You should discuss with your doctor what the best goal is for you. Goals are affected by: o How long you have had diabetes o Age o Other health problems that you have o Whether or not you have underlying heart disease or complications from diabetes o Problems with low blood sugars

28 How often should I use my glucose monitor to test my blood sugar? Recommendations vary Test at least 3 or more times daily if you are on insulin therapy Targeted testing Testing 2 hours after a meal can give you feedback about your therapy and the effect of the food you ate Testing may help you identify and avoid low blood sugars

29 How often should the A1C be tested? At least two times a year if your diabetes is stable and well controlled Every 3 months if therapy has changed or diabetes is uncontrolled

30 What are some other recommended routine tests? Urine microalbumin A measure of kidney function For screening in diabetes it is recommended at least once/year in type 2 diabetes

31 What else should I do in addition to monitoring my blood sugar? Have an eye exam once yearly Examine your feet daily

32 What else should I monitor in addition to my blood sugar? Monitor your blood pressure Goal blood pressure in the setting of diabetes is < 130/80 Talk to your doctor about your cholesterol levels

33 The Road To Type 2 Diabetes Normal Blood Glucose About 57 million people in the US have prediabetes. Prediabetes An opportunity for intervention Can delay or prevent diabetes with diet and exercise Diabetes About 24 million people in the US

34 DIABETES PREVENTION PROGRAM: CDC STATEMENTS What is the Diabetes Prevention Program? 27-center randomized clinical trial that studied more than 3,200 adults who were 25 years or older and who were at increased risk of developing type 2 diabetes The DPP evaluated intensive lifestyle modification (healthy diet, moderate physical activity of 30 minutes a day 5 days a week) National Center for Chronic Disease Prevention and Health Promotion News & Information CDC Statements on Diabetes Issues

35 DIABETES PREVENTION PROGRAM: CDC STATEMENTS What were the major findings of the DPP? Participants who made lifestyle changes reduced their risk of getting type 2 diabetes by 58 percent. The lifestyle intervention was effective for participants of all ages and all ethnic groups. National Center for Chronic Disease Prevention and Health Promotion News & Information CDC Statements on Diabetes Issues