DIABETES EDUCATION FOR HEALTH CARE SERIES

Transcription

1 American Association of Diabetes Educators Provider is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. DIABETES EDUCATION FOR HEALTH CARE American Association of Diabetes Educators (AM001) is a Continuing PROFESSIONALS Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). CDR Credentialed Practitioners will receive 5.0 Continuing SERIES Professional Education units (CPEUs) for completion of this activities/materials. CONTINUING EDUCATION The American Association of Diabetes Educators is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program provides 5.0 contact hours (.50 CEU s) of continuing education credit. April April

2 American Association of Diabetes Educators Provider is accredited DISCLOSURES as a provider of continuing TO PARTICIPANTS nursing education by the American Nurses Credentialing Center's Commission on Accreditation. Requirements for Successful Completion: For successful completion, participants are required to be in attendance in the full activity, complete and submit the program evaluation at the conclusion of the educational event. American Association of Diabetes Educators (AM001) is a Continuing Professional Education (CPE) Accredited Provider with the Commission Dian True, RN, on MA, Dietetic CDE, Registration FAADE None (CDR). CDR Credentialed Presenters; Practitioners Dian True, will receive RN, MA, 5.0 CDE, Continuing FAADE None Maureen Molinari, PhD, RDN, LD, CDE None Professional Education units (CPEUs) for completion of this Codi Thompson, BS, RDN, LD None activities/materials. Conflicts of Interest and Financial Relationships Disclosures Planners: Disclosure of Relevant Financial Relationships and Mechanism to Identify and Resolve Conflicts of Interest: No conflicts of interest Sponsorship/Commercial Support: None The American Association of Diabetes Educators is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program provides 5.0 contact hours (.50 CEU s) of continuing education credit. Off-label Use: Participants will be notified by speakers to any product used for a purpose other than that for which it was approved by the Food and Drug Administration Activity-Type: Knowledge-based 2

3 CONTINUING EDUCATION INFORMATION American Association of Diabetes Educators Provider is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. American Association of Diabetes Educators (AM001) is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). CDR Credentialed Practitioners will receive 1.0 Continuing Professional Education units (CPEUs) for completion of this activities/materials. Module 1: L01-P The American Association of Diabetes Educators is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program provides 1.0 contact hours (.10 CEU s) of continuing education credit. ACPE Universal Activity Number: xxx-L01-P; xxx- L01-P; xxx-L01-P; xxx-L01-P; xxx-L01-P Effective Date: April 18, 2017 to April 18,

4 DIABETES & HYPERTENSION A TRAINING FOR HEALTH CARE PROFESSIONALS Presented by: Dian True RN, MA, CDE, FAADE INDEPENDENT CONTRACTOR WORKING WITH THE CHRONIC DISEASE PREVENTION PROGRAM, WYOMING DEPARTMENT OF HEALTH

5 This presentation is brought to you by the Chronic Disease Prevention Program at the Wyoming Department of Health and funded through the State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health Grant (DP ). FOR MORE INFORMATION PLEASE CONTACT, CHRONIC DISEASE PREVENTION PROGRAM MANAGER OR (307)

6 Today s presentation uses evidence-based research to promote evidencebased best practice. Research and data from the following organizations were used in developing this presentation: Centers for Disease Control and Prevention American Diabetes Association American Association of Clinical Endocrinologists American Heart Association 6

7 PRESENTATION OVERVIEW Review: Diabetes (DM) and Hypertension (HTN) Discuss: Guidelines for classifying and managing HTN and DM Identify: Lifestyle and medication for treatment, prevention, and management 7

8 PREVENTING AND MANAGING DIABETES AND HYPERTENSION Stress Medications Nutrition Activity Lifestyle & Balance 8

9 DIABETES IN THE US Total: 30.3 million people have diabetes (9.4% of the US population) Diagnosed: 23.1 million people Undiagnosed: 7.2 million people (23.8% of people with diabetes are undiagnosed) Prediabetes Fast Facts Total: 84.1 million adults aged 18 years or older have prediabetes (33.9% of the adult US population) 65 years or older: 23.1 million adults aged 65 years or older have prediabetes 8/2017 9

10 ESTIMATED COSTS OF DIABETES IN US, 2014 Total Cost: $245 billion Direct Medical Costs: $176 billion Average medical expenditures among people with diagnosed diabetes were 2.3 times higher than people without diabetes Indirect Costs: $69 billion Disability, work loss, premature deaths American Diabetes Association. (2015): The Cost of Diabetes. Retrieved from: diabetes.html

11 PREVALENCE OF DIABETES IN WYOMING 8.4% 5.9% 10.0% 8.7% 6.2% 12.2% 4.3% 18.1% 6.6% 7.6% 8.5% 5.1% 9.7% 9.5% 13.2% 5.0% 5.1% 9.0% 9.2% 4.6% 7.7% 9.4% 10.6% Source: Wyoming BRFSS, retrieved from % 11

12 DIABETES PREVALENCE BY RACE AND ETHNICITY IN WYOMING Wyoming Diabetes Prevalence by Race and Ethnicity (BRFSS, ) White 7.7% Hispanic 10.4% American Indian 17.8% These data demonstrate a statistically significant difference in diabetes prevalence among White and American Indian populations 2014 Behavioral Risk Factor Surveillance System (BRFSS); 12

13 DIABETES PREVALENCE BY AGE IN WYOMING Ages < >75 Lower Range Upper Range Lower Range Upper Range Lower Range Upper Range Lower Range Upper Range Not Avail. 2.1% 4.6% 8.6% 12.4% 15.2% 20.4% 15.6% 21.1% 2014 Behavioral Risk Factor Surveillance System (BRFSS); CDC: Prevalence by age 13

14 AGE-ADJUSTED PREVALENCE OF OBESITY AND DIAGNOSED DIABETES AMONG US ADULTS Obesity (BMI 30 kg/m 2 ) Diabetes No Data <14.0% 14.0% 17.9% 18.0% 21.9% 22.0% 25.9% > 26.0% No Data <4.5% 4.5% 5.9% 6.0% 7.4% 7.5% 8.9% >9.0% CDC s Division of Diabetes Translation. National Diabetes Surveillance System available at 14

15 WHAT IS DIABETES Metabolic disorder Blood glucose levels are above normal Normal = fasting below 100 mg/dl Most food is digested and converted to glucose (sugar) and used for energy The pancreas makes insulin, a hormone Insulin helps transport glucose from blood to the cells With diabetes: Insufficient insulin Inefficient use of insulin Excess glucose in your blood Standards of Medical Care in Diabetes was originally approved in Most recent review/revision: December

16 TYPES OF DIABETES Type 1 Diabetes Autoimmune destruction of beta cells to make insulin, insulin required Type 2 Diabetes - Insulin resistant Gestational Diabetes Hyperglycemia from the hormonal changes during pregnancy Up to 60% develop diabetes in their lifetime Secondary - Impaired fasting glucose and impaired glucose tolerances. CDC: November 2016; 16

17 PATHOPHYSIOLOGIC CHANGES IN DIABETIC PATIENT Pancreas Beta cell function alpha cell stimulation hepatic glucose production Brain Impaired satiety Dopamine Peripheral Tissue GLUT-4 Kidney Glucose reabsorption GI tract Incretin deficiency and/or resistance Adipose tissue Cytokines (communicators) Inflammatory mediators Free fatty acids Adinopectin Defronzo, R.A. (2009). From the triumvirate to the ominous octet: A new paradign from the treatment of type 2 diabetes mellitus. Diabetes, 58(4), doi: /db

18 ROLE OF THE PANCREAS Role of the Pancreas Anabolic hormone Helps store glucose as glycogen in muscle and liver Secreted in response to elevated glucose Halts breakdown of glycogen in liver Increases protein synthesis, fat storage Powerful hypoglycemic An Overview of the Pancreas - Understanding Insulin and Diabetes Beta Cells Amylin Secreted in 1:1 ratio with insulin Satiety Lowers post-prandial glucagon response Slows gastric emptying Type 1 = make non Type 2 make less than usual amount 18

19 ROLE OF THE PANCREAS Alpha Cells Synthesize glucagon b Stimulated in response to low blood sugar Stimulates liver to convert glucagon to glucose Inhibits liver uptake of glucose May cause hyperglycemia An Overview of the Pancreas - Understanding Insulin and Diabetes 19

20 PATHOPHYSIOLOGIC CHANGES IN DIABETIC PATIENT Leading to: Inflammation Insulin resistance Increase in BP Dyslidemia Impaired thrombolysis Increase in body weight Defronzo, R.A. (2009). From the triumvirate to the ominous octet: A new paradign from the treatment of type 2 diabetes mellitus. Diabetes, 20 58(4), doi: /db

21 International Diabetes Center: 21

22 PRE-DIABETES Increased risk for diabetes Standards of Medical Care in Diabetes was originally approved in Most recent review/revision: December

23 Symptoms of Diabetes Sudden weight loss Frequent Urination Blurry vision Wounds that won t heal Always hungry Always tired Sexual problems Vaginal infections Numb/tingling hands or feet Always Thirsty 23

24 TYPE 1 DIABETES Autoimmune disease Progressive destruction of beta cells Autoimmune diseases, such as t1d may be passed down through families Onset is usually rapid Extreme thirst, weight loss, extreme fatigue, and elevated glucose levels Commonly diagnosed in childhood May occur at any age Standards of Medical Care in Diabetes was originally approved in Most recent review/revision: December

25 TYPE 1 & 2 DIABETES Standards of Medical Care in Diabetes was originally approved in Most recent review/revision: December

26 SELF-MONITORING BLOOD GLUCOSE Before meals mg/dl 2 hours after eating <180 mg/dl Hemoglobin A1c <7% American Diabetes Association.(2016). Standards of medical care in diabetes. Diabetes Care, 8(S1):S4. doi: /dc15-S003 26

27 VISION Comprehensive Diabetes Eye Exam At Least Annually Measure pressures Look at retina Look at vessel Standards of Medical Care in Diabetes was originally approved in Most recent review/revision: December

28 ANNUAL FLU SHOT 28

29 PNEUMONIA SHOT One before age 65 One after age 65 Separated by 5-7 years New Prevnar 13 booster now available 29

30 FOOT EXAMS Teach and Encourage Daily Self Foot Exam Identify Redness Swellings Cuts Nails Callouses Microvascular Disease Patients with microvascular disease should have the feet seen every visit. Standards of Medical Care in Diabetes was originally approved in Most recent review/revision: December

31 KIDNEY- URINE TEST Microalbumin, measured annually Goal : 30 or less Medication may be indicated ACE ARBS Important to control A1c/BS Important to control BP Standards of Medical Care in Diabetes was originally approved in Most recent review/revision: December

32 Heart Disease Kidney failure Stroke Loss of limb Blindness Nerve damage 32

33 HEMOGLOBIN A1C The American Diabetes Association suggests: A1C of 7% or less eag 154 mg/dl. More or less stringent based on each individual goals. 33

34 Abridged version of the American Diabetes Association Position Statement: Standards of Medical Care in Diabetes Diabetes Care ;38(Suppl. 1): S1 S94, content/33/2/97/suppl/dc1. doi: /diaclin

35 ADDITIONAL RESOURCES Diabetes Self-Management Programs Diabetes Prevention Programs Lions Club Eye Care Medication Assistance Programs Senior Services Churches Community Volunteer Clinic, Casper, Cody & Powell, Riverton, Rocksprings & others Wellness Centers 35

36 Thank you for participating! 36