Diabetes and Nutrition. Spencer Johnson, O.D., F.A.A.O. Northeastern State University Oklahoma College of Optometry

Transcription

1 Diabetes and Nutrition Spencer Johnson, O.D., F.A.A.O. Northeastern State University Oklahoma College of Optometry

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4 Diabetes Classifications People who self-reported having been told by a doctor or health professional that they had diabetes were classified as having diagnosed diabetes. Those without a history of diabetes but with a fasting plasma glucose greater than or equal to 126 mg/dl or an A1c level greater than or equal to 6.5% were classified as having undiagnosed diabetes.

5 Prediabetes People aged 20 years or older, United States People without diabetes were classified as having prediabetes if: They had fasting plasma glucose values of 100 to 125 mg/dl or A1c values of 5.7% to 6.4%.

6 Prediabetes among U.S. Adults, % 50.0% 40.0% 40.9% 48.3% 30.0% 33.9% 20.0% 23.7% 10.0% 0.0% Total

7 Gestational Diabetes Reported rates of gestational diabetes range from 2% to 10% of pregnancies. Women who have had gestational diabetes have a 35% to 60% chance of developing diabetes in the next years.

8 Percentage with Diabetes Number with Diabetes (Millions) Number and Percentage of U.S. Population with Diagnosed Diabetes, Percentage with Diabetes Number with Diabetes Year CDC s Division of Diabetes Translation. United States Diabetes Surveillance System available at 0

9 Type I vs. Type 2 Prevalence 5% 95% Type I Type 2

10 Prevalence Gender Distribution 48% 52% Men Women

11 Prevalence of Diabetes Among U.S. Adults, 2013

12 PERCENTAGE OF ADULTS WITH DIABETES, 2015

13 Age-Adjusted Prevalence of Diagnosed Diabetes Among US Adults 1994 Missing data <4.5% 4.5% 5.9% 6.0% 7.4% 7.5% 8.9% 9.0% CDC s Division of Diabetes Translation. United States Surveillance System available at

14 Age-Adjusted Prevalence of Diagnosed Diabetes Among US Adults 2015 Missing data <4.5% 4.5% 5.9% 6.0% 7.4% 7.5% 8.9% 9.0% CDC s Division of Diabetes Translation. United States Surveillance System available at

15 Trends in Incidence and Prevalence of Diabetes Among U.S. Adults,

16 Diabetes Prevalence by Race/Ethnicity and Gender Among U.S. Adults,

17 New Cases of Diagnosed Diabetes by Age, U.S Rate per 1,

18 Incidence of Type 1 and Type 2 Diabetes by Race/Ethnicity in Children,

19 Treatment of Diabetes Percentage of adults with diagnosed diabetes receiving treatment with insulin or oral medication, United States,

20 Complications of Diabetes Diabetes is the leading cause of kidney failure, non-traumatic lower-limb amputations, and new cases of blindness among adults in the United States. Diabetes is the seventh leading cause of death in the United States

21 Deaths Among People with Diabetes, United States, 2007 Overall, the risk for death among people with diabetes is about twice that of people of similar age but without diabetes.

22 Estimated Diabetes Costs in the United States, 2012 The total direct and indirect estimated cost of diagnosed diabetes in the United States in 2012 was $245 billion Average medical expenditures for people with diagnosed diabetes were about $13,700 per year. About $7,900 of this amount was attributed to diabetes. After adjusting for age group and sex, average medical expenditures among people with diagnosed diabetes were about 2.3 times higher than expenditures for people without diabetes.

23 Why The Rise?

24 Worldwide aging population Why The Rise?

25 In 1997, the American Diabetes Association (ADA) and the federal government lowered the per se standard for diagnosing diabetes from a fasting blood glucose level of 140 mg/dl to 126 mg/dl.7 Why The Rise?

26 Greater awareness Why The Rise?

27 Why The Rise? Obesity news.harvard.edu

28 bettyjung.net

29 BMI of Adults with Diabetes 100.0% 90.0% 80.0% 87.5% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 26.1% 43.5% 17.8% 0.0% BMI 25+ BMI BMI 40+ Total

30 Age-adjusted Prevalence of Obesity and Diagnosed Diabetes Among US Adults Obesity (BMI 30 kg/m 2 ) No Data <14.0% 14.0% 17.9% 18.0% 21.9% 22.0% 25.9% > 26.0% Diabetes No Data <4.5% 4.5% 5.9% 6.0% 7.4% 7.5% 8.9% >9.0% CDC s Division of Diabetes Translation. United States Surveillance System available at

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32 Relationship Between Obesity and Diabetes a fundamental property of T2DM is its virtual exclusive occurrence in overweight individuals, emphasizing the absolute necessity of understanding the relationship of adiposity to T2DM. Institute for Diabetes, Obesity and Metabolism University of Pennsylvania School of Medicine

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34 Obesity In the U.S.

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36 Metabolic Syndrome You don t die of obesity; you die of the diseases that travel with it. It s these metabolic decompositions that make obesity the scourge that it is. Diabetes, hypertension, heart disease, cancer, and dementia the things that kill you are collectively packaged under the concept of metabolic syndrome. synapse.ucsf.edu

37 What has changed in the U.S. Diet over the past 100 years? The American Diet. Stephen Guyenet. Youtube. TEDxHarvardLaw, 12 Feb

38 Longbottomline.com

39 Huffingtonpost.com

40 The American Diet. Stephen Guyenet. Youtube. TEDxHarvardLaw, 12 Feb

41 U.S. Food Subsidies pcrm.org

42 Diet

43 What has changed in the U.S. diet over the past century? Sugar, Sugar Processed Food Livestock feeding patterns

44 The American Diet. Stephen Guyenet. Youtube. TEDxHarvardLaw, 12 Feb

45 Changes in the U.S. Food Supply Wikipedia.org 1. The Cuban Revolution of 1959, assumption of power by Fidel Castro, and subsequent Bay of Pigs incident in 1961 cut off our standard sugar supply.

46 Changes in the U.S. Food Supply President Richard Nixon astutely noted that fluctuating food prices cause political unrest. He directed his secretary of agriculture, Earl (Rusty) Butz, to find a way to make food cheap. Among other things, this led to corn subsidies as part of the Farm Bill. Wikipedia.org

47 Changes in the U.S. Food Supply High-fructose corn syrup was introduced in the U.S. in the early 1970s.

48 Changes in the U.S. Food Supply Hurrican Allen in 1980 wiped out the entire Caribbean sugar crop. Sugar futures soared. Coca-Cola switched to HFCS and the rest of the food industry soon followed. washingtonpost.com

49 The American Diet. Stephen Guyenet. Youtube. TEDxHarvardLaw, 12 Feb

50 U.S. Per Capita Consumption of Caloric Sweeteners U.S. Department of Agriculture, Economic Research Survey, 2012

51 Changes in the U.S. Food Supply Senator George McGovern s Select Committee on Nutrition and Human Needs led to a directed policy on the part of the U.S. Department of Agriculture in the late 1970 s to reduce our consumption of dietary fat.

52 120 cal glucose 60 cal glucose/ 60 cal fructose 96 cal glucose 48 cal glucose

53 Whole Food Food that has been processed or refined as little as possible and is free from additives or other artificial substances

54 Fiber gal4.piclab.us

55 The American Diet. Stephen Guyenet. Youtube. TEDxHarvardLaw, 12 Feb

56 Consumer Information

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59 There is no such thing as a special diet for cancer and a different, equally special diet for heart disease. The evidence now amassed from researchers around the world shows that the same diet that is good for the prevention of cancer is also good for the prevention of heart disease, as well as obesity, diabetes, cataracts, macular degeneration, Alzheimer s, cognitive dysfunction, multiple sclerosis, osteoporosis and other diseases. -T. Colin Campbell, Ph.D. Cornell University

60 Atkins Diet meat, vegetables Diets Vegetarian/Vegan diet fruits, vegetables, whole grains Traditional Japanese Diet rice, fish, vegetables Mediterranean Diet olive oil, legumes, fruits, vegetable, whole grains, dairy, eggs, fish, wine Paleolithic Diet meat, fish, nuts, non-cultivated fruits and vegetables

61 Diet Sugar Fiber

62 BMI Calculators Child BMI Calculator Adult BMI Calculator nglish_bmi_calculator/bmi_calculator.html

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64 Counseling Patients We define a healthy weight according to body mass index, or BMI, which is based on your height and weight. A healthy BMI is less than 25, overweight is between 25 and 30, and severely overweight is defined as a BMI greater than 30. Based on your height and weight your BMI is X. This can affect the health of your eyes by increasing your risk for diabetic retinopathy and age-related macular degeneration. Review of Optometry, March 2015, p. 49

65 Practice Take-home Suggestions 1) Measure BMI 2) Discuss with patients 3) Refer when necessary