Objectives 10/11/2013. Diabetes- The Real Cost of Sugar. Diabetes 101: What is Diabetes. By Ruth Nekonchuk RD CDE LMNT

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1 Diabetes- The Real Cost of Sugar By Ruth Nekonchuk RD CDE LMNT Objectives To explain diabetes To explain the risks of diabetes To enumerate the cost of diabetes to our country To enumerate the cost of diabetes to a person Diabetes 101: What is Diabetes Not just a sugar problem Interaction of food, insulin, other hormones (glucagon and incretin hormones) Physical activity/obesity Pancreatic function Genetics Other commonly associated conditions: hypertension, lipid problems The complications, not just the diagnosis of diabetes, cause the problems Diabetes is common, serious BUT treatable 1

2 Causes of Hyperglycemia in Diabetes Peripheral Tissues (Muscle) Receptor + post-receptor defect Glucose C Insulin resistance Liver Increased glucose production Pancreas Impaired or no insulin secretion Blood sugar (glucose) comes from: 1. what we eat through the digestive tract 2. storage in the body- liver and muscles Types of Diabetes Type 1: Usually age <20 Make no insulin- must be given About 10% of people with diabetes Type 2: Traditionally over 40, but any age now May have problems of insulin secretion and resistance About 90% of people with diabetes Medications may include pills, insulin and incretin hormones Pre-diabetes Gestational Diabetes 2

3 Symptoms Frequent urination Excessive thirst Extreme hunger or constant eating Unexplained weight loss Presence of glucose in the urine Tiredness or fatigue Changes in vision Numbness or tingling in the extremities Slow-healing wounds or sores Abnormally high frequency of infection Many people have no symptoms Diagnosis 1) A1C 6.5%. 2) FPG 126 mg/dl (Fasting is defined as no caloric intake for at least 8 h.) 3) With classic symptoms of high blood sugar and random plasma glucose 200 mg/dl (11.1 mmol/l). *Criteria 1 and 2 should be confirmed by repeat testing Age 45 or older Overweight Inactive Ethnic or minority population Family history of diabetes Excess abdominal fat Who Is At Risk? High blood pressure Pre-diabetes High blood fats Darkening of the skin Polycystic ovary syndrome History of Gestational Diabetes or large baby 3

4 Where does glucose go? Everywhere blood flowsthe whole body! Complications Eyes Kidneys Nerves Cardiovascular disease and stroke Studies show that these complications can be prevented or controlled with good blood sugar control Taking insulin does not mean worse diabetes! Diabetes means: 2 x the risk of high blood pressure 2 to 4 x the risk of heart disease 2 to 4 x the risk of stroke #1 cause of adult blindness #1 cause of kidney failure Causes more than 60% of non-traumatic lower-limb amputations each year NIDDK, National Diabetes Statistics fact sheet. HHS, NIH,

5 Could You be at Risk for Diabetes? Where do you start? ADA Risk Test (paper or online) Pre-diabetes Fasting glucose of: 100 mg/dl-125 mg/dl Random glucose of: 140 mg/dl-199 mg/dl after eating A1C: % For all three tests, risk is continuous, extending below the lower limit of the range and becoming disproportionately greater at higher ends of the range. Age adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes Obesity (BMI 30 kg/m 2 ) No Data <14.0% % % % >26.0% Diabetes No Data <4.5% % % % >9.0% CDC s Division of Diabetes Translation. National Diabetes Surveillance System available at 5

6 26 million with Diabetes 79 million with Pre Diabetes Epidemic of Diabetes Diabetes affects almost 26 million Americans (8.3%), one quarter of whom don t know they have it. Another 79 million Americans have pre-diabetes, which raises their risk of developing type 2 diabetes, heart disease, and stroke. About 1.9 million new cases of diabetes were diagnosed in people aged 20 or older in Number and Percentage of U.S. Population with Diagnosed Diabetes, Percentage with Diabetes Percentage with Diabetes Number with Diabetes Number with Diabetes (Millions) Year 0 CDC s Division of Diabetes Translation. National Diabetes Surveillance System available at 6

7 Estimated lifetime risk of developing diabetes for individuals born in the United States in 2000 Percent Total Non-Hispanic Black Men Non-Hispanic White Hispanic Women Narayan et al, JAMA, 2003 Source: National Health and Nutrition Examination Survey. The Diabetes Epidemic Aging of America Certain ethnic groups have higher incidence of diabetes Earlier diagnosis Pre-diabetes- no longer borderline or touch of sugar- needs treatment! By 2050, 1 in every 3 adult Americans will have diabetes if current trends continue Sedentary Lifestyles 7

8 Estimated Cost of Diabetes in U.S. (ADA 2007) Total: $174 billion Indirect costs include increased absenteeism ($2.6 billion) and reduced productivity while at work ($20.0 billion) for the employed population Reduced productivity for those not in the labor force ($0.8 billion) Unemployment from disease-related disability ($7.9 billion) Lost productive capacity due to early mortality ($26.9 billion) Why Control Diabetes? Do Any Interventions Work? Bottom Line: Better glucose control translates to better outcomes and better health in the individuals. For every 1% drop in A1c the risk of microvascular complications (eye, kidney, and nerve damage) can be reduced by up to 40%. Self Management Test glucose with home meter (1-4 times per day) Physical Activity (30 min most days of the week) Healthy eating (moderate carbohydrate and low fat intakes) Weight loss if overweight or obese (10% loss has shown improvement in glucose, lipids and blood pressure) Take medications as directed 8

9 Source: National Health Interview Survey. Physiologic Serum Insulin Secretion Profile 75 Breakfast Lunch Dinner Plasma Insulin ( U/mL) :00 8:00 12:00 16:00 20:00 24:00 28:00 32:00 Time Polonsky KS et al, N Engl J Med

10 The Diabetes Prevention Program (DPP): Goal: To prevent or delay the development of type 2 diabetes in persons with impaired glucose tolerance (IGT) High-risk individuals with IGT and elevated FPG (N=3234) randomized to Control Group Intensive lifestyle intervention group; at least monthly contact with case managers Metformin group (Medication) Reduction at 10 years compared to the control group 49% in the intensive lifestyle intervention group 18% in the metformin group Control the ABCS A1c: Glucose control Blood Pressure control Cholesterol (lipid) control Smoking cessation 10

11 Barriers to Control of Diabetes Cost Time Access to Medical Care Misinformation Fear Lack of Support Attitudes of patient and/or health care provider Mary s Story 11