Pre Diabetes James Figge, MD St. Peter s Health Partners Diabetes: a Global Epidemic 382 million people (8.3 percent of all adults) 46 percent undiagnosed Dramatic increase seen worldwide Trend toward younger people Devastating consequences: half of deaths in individuals under 60 A person somewhere in the world dies from diabetes every six seconds Focus is on Prevention Type II diabetes can be prevented when at risk individuals are identified during the prediabetes state. Type II: the body does not respond to insulin effectively insulin resistance ; can go unnoticed or undiagnosed for years. Pre diabetes occurs before the individual develops full diabetes. Pre diabetes is often reversible, whereas type II diabetes is not. 1
Pre Diabetes Impaired fasting glucose in range of 100 125 Or impaired glucose tolerance high blood sugar after eating HbA1c range 5.7 to 6.4 High risk of developing type II diabetes Healthy diet and exercise can prevent progression to type II diabetes 316 million world wide (6.9 percent of adults) Pre diabetes in the US Affects 86 million American adults 9 out of 10 don t know they have pre diabetes 15 to 30 percent will develop type II diabetes within 5 years CDC Pre diabetes Screening Test: http://www.cdc.gov/diabetes/prevention/pdf /prediabetestest.pdf Complications of Diabetes Cardiovascular: heart attack and stroke, peripheral artery disease, heart failure Kidney: diabetes is a leading cause of chronic kidney disease Eyes: blood vessels in back of eyes (retina) become damaged leading to permanent loss of vision Nerves: damage throughout body; feet most common 2
Diabetes Prevention Program: Finland NEJM: May 3, 2001; 344:1343 1350 daily activity: 30 min walking, jogging, swimming, aerobic ball games, skiing; resistance training. Diet: whole grains, vegetables, fruit, low fat dairy; increase fiber, reduce saturated fats, use monounsaturated vegetable oils (EV olive oil). Aim for at least 5% weight loss. 58 percent reduction in the incidence of type II diabetes documented (p < 0.001). Diabetes Prevention Program: US Multicenter randomized trial. NIH funded. Diverse racial and ethnic groups included. NEJM: February 7, 2002; 346: 393 403. Goals: at least 7 percent weight loss, 150 min moderately intense activity per week, such as brisk walking. Diet: healthy low calorie, low fat. Also a metformin arm. Lifestyle: 58% reduction; metformin 31% Diabetes Prevention Programs Formal CDC approved programs are now available, some at organizations such as the YMCA These feature a structured curriculum with coaching on life style changes, including diet and exercise. Usually have group support and trainers. On line version also available. Prevention or delay of diabetes with lifestyle intervention or metformin can persist for at least 10 years. Lancet Nov 14, 2009: 374; 1677 1686 3
Lifestyle & Wellbeing 4
Mediterranean Diet Adherence to a non calorie restricted Mediterranean diet supplemented with either olive oil (1 liter/week) or mixed nuts (30 g/day) resulted in a 52% decrease in diabetes incidence even without significant changes in body weight or physical activity after a median follow up of 4.0 years. Diabetes Care. January 2011; 34:14 19. PHYSICAL ACTIVITY 30 60 minutes every day 5
Adopt a Dog and Walk to Prevent Diabetes The addition of a canine buddy as a supportive companion is a great enabler that can motivate patients to adopt healthy lifestyle changes. J Phys Act Health. March 2012; 9:414 420. Adopt a shelter (rescue) dog. You will save their life; but they will save yours, too! Motivate Your Patients to be Active 6