pamela allweiss ppt hrsa

7/29/2019 Pamela Allweiss PPT HRSA

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Diabetes Update

Pam Allweiss, MD, [email protected]

Centers for Disease Control and Prevention.

Division of Diabetes TranslationThe findings and conclusions of this presentation are those of the presenter and

do not necessarily represent views of the Centers for Disease Control and Prevention
mailto:[email protected]:[email protected]:[email protected]


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An American Epidemic


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Age-adjusted Percentage of U.S. Adults Who Were Obese or Who

Had Diagnosed Diabetes

Obesity (BMI 30 kg/m2)

Diabetes

1994

1994

2000

2000

No Data 26.0%

No Data 9.0%

CDCs Division of Diabetes Translation. National Diabetes Surveillance System available athttp://www.cdc.gov/diabetes/statistics

2009

2009


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26 millionwith Diabetes

79 million

withPre-Diabetes


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Epidemic of Diabetes

Diabetes affects almost 26 million Americans

(8.3%), one quarter of whom dont know they haveit.

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 2010.

www.yourdiabetesinfo.org www.DiabetesAtWork.org


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0

5

10

15

20

25

0

1

2

3

4

5

6

7

8

1958 61 64 67 70 73 76 79 82 85 88 91 94 97 00 03 06 09

N

umberwithDiabet

es(Millions)

Percentagew

ithDiabetes

Year

Percentage with Diabetes

Number with Diabetes

Number and Percentage of U.S. Population with Diagnosed Diabetes,19582010

CDCs Division of Diabetes Translation. National Diabetes Surveillance System

available athttp://www.cdc.gov/diabetes/statistics


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0

10

20

30

40

50

60

Men Women

Percent

Total Non-Hispanic WhiteNon-Hispanic Black Hispanic

Narayan et al, JAMA, 2003

Estimated lifetime risk of developing diabetes for

individuals born in the United States in 2000


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Source: 20052008 National Health and Nutrition Examination Survey.


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The Diabetes Epidemic

Aging of America

Diverse ethnic groups, various incidence andprevalence of diabetes

Earlier diagnosis and reclassification Pre-diabetes: Borderline Diabetes or a touch

of sugar = real condition that needs to betreated

By 2050, 1 in every 3 adult Americans willhave diabetes if current trends continue


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Estimated Cost of

Diabetes in U.S. (ADA 2007)

Total: $174 billion

Indirect costs include increased absenteeism ($2.6billion) 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)


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Diabetes 101: What is Diabetes

Notjust a sugar problem Interaction of food, insulin, other hormones

(glucagon) Physical activity/Obesity

Pancreatic function Genetics

Other commonly associated conditions:hypertension, lipid problems

The complications, not just the diagnosis ofdiabetes, cause the problems

Diabetes is common, serious BUT treatable


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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 yearNIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2010.


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Complications

Eyes

Kidneys

Nerves

Cardiovascular disease and stroke

Randomly controlled studies show that these

complications can be prevented or controlled with

good blood sugar control but this might involvemultiple shots etc

More shots does not mean worse diabetes!


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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

Di i (Di b C 1 2010)


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Diagnosis (Diabetes Care 1-2010)

1) A1C 6.5%. (by lab using a method that is NGSP certified and

standardized to the DCCT assay.* (caveats: anemia, pregnancy)

OR

2) FPG 126 mg/dl (7.0 mmol/l). Fasting is defined as no caloric intake

for at least 8 h.*

OR

3) 2-h plasma glucose 200 mg/dl (11.1 mmol/l) during an OGTT. The

test described by the WHO, using a glucose load containing theequivalent of 75 g anhydrous glucose dissolved in water.*

OR

4. In a patient with classic symptoms of hyperglycemia or hyperglycemic

crisis, a random plasma glucose 200 mg/dl (11.1 mmol/l).

*In the absence of unequivocal hyperglycemia, criteria 13 should beconfirmed by repeat testing


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Types of Diabetes

Type 1: traditionally age 40, multiple problems withinsulin secretion and action, may be any age, about80-90% of people with diabetes, Rx may includeoral agents and/or insulin or newer agents(incretins, GLP1 )

Pre-diabetes

Gestational Diabetes


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Who Is At Risk? Age 45 or older

Overweight

Inactive

Ethnic or minoritypopulation

Family history of

diabetes Excess abdominal fat

High blood pressure

Pre-diabetes

High blood fats

Darkening of the skin

Polycystic ovary

syndrome

History of GestationalDiabetes or large baby


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Could You be at Risk for Diabetes?

Where do you start?

ADA Risk Test (paper or online)

www.diabetes.org
http://www.diabetes.org/http://www.diabetes.org/


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Categories of increased risk for diabetes

(Pre-diabetes)

Impaired Fasting Glucose: FPG 100 mg/dl(5.6 mmol/l) to 125 mg/dl (6.9 mmol/l)

Impaired Glucose Tolerance: 2-h PG in the75-g OGTT : 140 mg/dl (7.8 mmol/l) - 199 mg/dl(11.0 mmol/l)

A1C 5.76.4%

For all three tests, risk is continuous, extending

below the lower limit of the range and becomingdisproportionately greater at higher ends of therange.


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Why Control Diabetes?

Do Any Interventions Work?

Bottom Line: Does better glucose control translateto better outcomes or better health in theindividual?

Yes! For every 1% drop in A1c the risk of microvascular

complications (eye, kidney, and nerve damage) canbe reduced by up to 40%.

http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.p


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Control the ABCS

A1c: Glucose control

Blood Pressure control

Cholesterol (lipid) control

Smoking cessation


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Glucose

Liver

Peripheral Tissues

(Muscle)

Pancreas

Receptor +

postreceptor defect

Increased glucose

production

Impairedinsulin

secretion

Insulin

resistance

P.23

Causes of Hyperglycemia in

Type 2 Diabetes

1997 PPS

C


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Source: 20072009 National Health Interview Survey.


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Physiologic Serum Insulin Secretion

Profile

Polonsky KS et al, N Engl J Med 1996.

75

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25

0

PlasmaInsu

lin

(U/mL)

Time

4:00 8:00 12:00 16:00 20:00 24:00 28:00 32:00

Breakfast Lunch Dinner


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So what are some resources and

how can we use them?


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Where is the community partner?


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National Diabetes Education

Program CDC and NIH program formed after evidence showed that

better glucose control translated into fewer complications

Public and private partnerships to improve diabetes treatmentand outcomes

Increased public awareness of the seriousness of diabetes, its

risk factors, and strategies for preventing diabetic complications NDEP translates the latest science and spreads the word that

diabetes is serious, common, and costly, yet controllable and,for type 2,preventable

Focus group tested by diverse audiences, multiple languages

NO COPYRGHT : Add your logo! Over 200 public/private partnerships

www.yourdiabetesinfo.orgwww.ndep.nih.gov
http://www.ndep.nih.gov/http://www.ndep.nih.gov/http://www.ndep.nih.gov/http://www.ndep.nih.gov/http://www.ndep.nih.gov/


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NDEP Campaign Materials: Control &Prevention


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Different types of materials

Print Downloads

Podcasts

Videos

Promotion resources

Behavior change resources

PP Presentations such as: Diabetes: the

numbers, and Science of control

i l f


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Materials for Consumers


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Content

Healthy eating/ how to eat out/tasty recipes

Take care of your feet/Be smart about your

heart

Team care

Tips to stay healthy

Know your numbers


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4 Steps to control your diabetes

brochure

Also available in these languages:

Bengali, Cambodian, Chinese, Gujarati, Haitian

Creole (and CD), Hindi, Hmong, Japanese,

Korean, Laotian, Samoan, Spanish, Tagalog,

Thai, Tongan, Urdu, Vietnamese

Materia s or Pro essiona s an Lay
http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=179http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=18http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=21http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=135http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=163http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=163http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=141http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=139http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=136http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=22http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=134http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=25http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=42http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=19http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=20http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=23http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=180http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=24http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=24http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=180http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=23http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=20http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=19http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=42http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=25http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=134http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=22http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=136http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=139http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=141http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=163http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=163http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=135http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=21http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=18http://ndep.nih.gov/publications/PublicationDetail.aspx?PubId=179


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Materia s or Pro essiona s an LayWorkers


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The Road to Health/El Camino

Hacia La Buena SaludCHW Primary

prevention toolkit

The Road to Health (RTH) Toolkit/ El camino hacia la buena salud Toolkit :


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The Road to Health (RTH) Toolkit/ El camino hacia la buena salud Toolkit :

AToolkit on Primary Prevention of Type 2 Diabetes for Community Health

Workers (CHWs)/Promotores

The Road to Health Toolkit was developed based on

the findings from the Diabetes Prevention Program(DPP) study and focus groups with African Americanand Hispanic/Latino Community Health Workers.

Focus groups with CHWs from urban and ruralAfrican American and Hispanic/Latino

communities: Diabetes testing, management, and prevention

strategies Barriers, opportunities, perceptions Focus on primary prevention Tools needed Training video

NDEP Websites


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NDEP Websites


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www.diabetesatwork.org Content

General Diabetes Education :

Nutrition, Weight Control, and Physical Activity

Lunch and Learn topics

Lesson Plans (English and Spanish)

Fact Sheets (English and Spanish)

Guide to choosing a health plan, developed with AAHP

Supervisors guide

NO COPYRIGHT!


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Fotonovela: Do it for them! But for you too.

(Hazlo por ellos! Pero por ti tambin.)

This fotonovela is a bilingual (Spn/Eng)fotonovela featuring dramatic stories of Latinas

talking to Latinas about preventing or delaying

type 2 diabetes and being healthy for their

children and themselves.

The stories use three womens challenges in

maintaining a healthy lifestyle to convey an

important message:

Increasing physical activity,

making healthy food choices and

losing weight (if you are overweight)

decreases or delays your risk of developing

type 2 diabetes.


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Tasty Recipes for People with Diabetes and Their Families

(Ricas recetas para personas con diabetes y sus familiares)

A bilingual booklet, Tasty Recipes is

filled with recipes specifically

designed for Latin Americans.

Recipes are accompanied by their

nutritional facts table. The bookletalso includes diabetes health

information and resources.

This effective, yet practical,

educational promotional tool is a

terrific addition to any kitchen.
http://www.ndep.nih.gov/publications/PublicationDetail.aspx?PubId=143http://ndep.nih.gov/media/diabetes-recipe-spanish-omelet.pdfhttp://www.ndep.nih.gov/publications/PublicationDetail.aspx?PubId=131


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Words of Wisdom

Cant transform everything at once

Use the web sites to print out forms and

recipes

Dont re-invent the wheel

Learn from others


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The Diabetes Prevention Program (DPP): The New

Frontier: Lifestyle Modifications or Medication

Goal: To prevent or delay the development of type 2 diabetes in personswith impaired glucose tolerance (IGT)

High-risk individuals with IGT and elevated FPG (N=3234) randomized to

Placebo

Intensive lifestyle intervention; at least monthly contact with case

managers

Metformin titrated to 850 mg bid

Reduction at 2.8 years

58% in the intensive lifestyle intervention group 31% in the metformin group

The Diabetes Prevention Program Research Group. Diabetes Care. 1999;22:623.

NIDDK. http://www.niddk.nih.gov/welcome/releases/8_8_01.htm.


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National Diabetes Prevention Program

Goal:

Systematically scale the translated model of theDiabetes Prevention Program (DPP) for high riskpersons in collaboration with community-basedorganizations that have necessary infrastructure,health payers, health care professionals, publichealth, academia, and others to reduce theincidence of type 2 diabetes in the United States.


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National Diabetes Prevention Program

Training = CDC contracted with Emory University to

establish the Diabetes Training and Technical

Assistance Center (DTTAC) and developed Master

Trainer curriculum and unified Lifestyle Coachcurriculumwww.dttac.org.

Recognition Program = CDC and partners developed

the standards for program recognition

For more information:http://www.cdc.gov/diabetes/prevention/
http://www.dttac.org/http://www.dttac.org/


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www.cdc.gov/diabetes/prevention


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How do I get NDEP materials?

All NDEP materials are

copyright-free.Download from

www.yourdiabetesinfo.org

Visit all of the NDEP Websites:

www.ndep.nih.gov

www.betterdiabetescare.nih.gov

www.cdc.gov/diabetes/ndep

www.diabetesatwork.org
http://www.yourdiabetesinfo.org/http://www.ndep.nih.gov/http://www.betterdiabetescare.nih.gov/http://www.cdc.gov/diabetes/ndephttp://www.diabetesatwork.org/http://www.diabetesatwork.org/http://www.cdc.gov/diabetes/ndephttp://www.betterdiabetescare.nih.gov/http://www.ndep.nih.gov/http://www.yourdiabetesinfo.org/

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