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Diabetes: What Everyone Needs to Know!
Hongbiao (Hank) Liu MD PhD
Luna Medical Care
What is Diabetes?
A condition in which the body cannot make or cannot use insulin properly
Fasting BS Random BS
Under 100
100 - 125
Under 140
Diabetes
Pre - Diabetes
No Diabetes
140 – 200
126 and above
Over 200WithSymptoms
Types of Diabetes Mellitus
Type 1
Type 2 Prediabetes
Impaired Fasting Glucose Impaired Glucose Tolerance
Gestational DM
Other
Risk Factors Type 2 DM
More Risk Factors
Overweight (Abdominal) Over 45 years old Sedentary Lifestyle Non-White Race Family History of DB Family History of High
BP History of High BP (self) High Cholesterol History of Gestational DB Delivered a baby > 9 lbs.
Goals: Women < 35Men < 40
What Happens in Type 2 DM
Liver puts too much sugar into the blood
Muscle cells and other tissues areresistant to insulin
Pancreas can’t make enough insulin
Stomach empties 50%faster than normal
Type 2
Diabetes
Signs / Symptoms of Type 2 Diabetes
Additional Symptoms
Frequent Urination
Thirst Appetite Changes Blurred Vision Tiredness;
Sleepiness Weight Changes Headaches
Skin Infections Slow Healing Yeast Infections Urinary Infections Dry Skin; Itching Numbness; Tingling Feeling / Acting
“Evil” High Blood Pressure Cholesterol Problems
Insulin Resistance
Acanthosis Acanthosis
NigricansNigricans
Skin Tags
Polycystic Ovarian Syndrome
Fertility problems Acne Hair loss Facial Hair Weight problems Deadly triangle
High Blood Pressure
High Cholesterol High Blood Sugar
Metabolic Syndrome Definition
“A Clustering of Multiple
Cardiometabolic Risk Factors”
Criteria ATP III(AHA/ NHLB)
WHO AACE IDF
Abdominal Obesity
M > 102 cmW > 88 cm
BMI > 30 orW : H Ratio M > 0.9 W> 0.85
BMI > 25 *M > 94 cm*W > 80 cmor BMI > 30 + 2 others
Triglycerides > 150 mg/dl
same same Same or on meds
HDL M < 40 W < 50
M < 35W < 39
M < 40W < 50
M < 40 (or on W < 50 meds)
Blood Pressure
> 130/85 or on meds
> 140/90or on meds
> 130/85 > 130/85 or on meds
Fasting Glucose
> 100 mg/dl or on meds
T2 DM, IFG or IGT * +2 others
Btw. 110 – 126 mg/dl
> 100 or T2DM
Other Urinary Albumin Excretion Rate > 20 or alb:creatine ratio > 30
2 hr PP > 140; PCOS; family hx; other
90% of T2DM: IR and MS
Adapted from International Diabetes Center (IDC), Minneapolis, Minnesota.
Increases in Diabetes
Estimated prevalence: Nearly 24 million
Nearly 8% of the U.S. population Almost 25% of persons over age 60 90 - 95% have type 2
25% do not know they have it! 57 million have pre-diabetes 24% have Metabolic Syndrome Projected 44-68% increase in diabetes by
2015 8% per year
Diabetes in the United States
NOT an Equal Opportunity Disease!
Among those diagnosed… 16.5% of Native Americans/Alaskan Natives 11.8% of Black Americans 10.4% of Latinos*
12.6% of Puerto Ricans 11.9% of Mexicans 8.2% of Cubans
7.5% Asian Americans 6.6% Caucasians Lifetime DM risk (born after 2000)
33% men; 39% women; 50% Hispanic women
Diabetes in the United States
Diabetes
+Obesity=Diabesity
Obesity and Diabetes 1:3 Americans are obese 1:5 Americans are morbidly obese 80% of all Type 2 diabetics are
overweight Obesity in children has doubled in 20 years Type 2 diabetes in children has tripled in the last 5 years
Children and Type 2 Diabetes
Mean age: 12-14 years old
Girls > Boys Overweight 94% are in
minority groups 74-100% have a
strong family history
Overweight Kids Become Overweight Adults 50% of overweight
children become overweight adults
26-41% overweight preschool children will become overweight adults
What about our children? In a study done involving 111
children, 57% were obese, 12% were super-obese
In families of children who were obese ~ the caregiver thought the child’s weight was a problem in only 44% of the cases
Young-Hayman, D. et al Obesity Research 2000:8:241-8
Saturday Morning Influence
61% of all commercials
are for FOOD
90% are for sugared cereals, candy
bars, fast food, and chips
INDIANA Diabetes Obesity
State ranking for prevalence (2008)
Adults: Ranked 38th
Diabetes in Indiana is above the national average:
National Average: 8.0% Indiana Average: 8.5%
State ranking for prevalence (2008)
Ranked 31st
Adults in Indiana (2006)
27.5 % obese 35% overweight
Diabetes…
…we have pills and insulin to control it, so what is the big
deal?
Costs of Diabetes in the U.S.
$174 billion each year
$116 billion in direct medical costs
$58 billion in indirect costs
Missed work Lost productivity 1 in 10 healthcare
dollars spend on diabetes/complications
Human costs 7th leading cause of
death
Type 2 DM is ProgressiveType 2 DM is Progressive
Relative function(units)
0
100
200
300
-10 -5 0 5 10 15 20 25 30
Years of Diabetes
Insulin resistance
Normal insulin levelBeta cell failure
At risk for diabetes
Adopted from D. Kendall, R. Bergenstal © International Diabetes Center
Glucose(mg/DL)
50
150
250
350
Fasting glucose
Post-meal glucose
-10 -5 0 5 10 15 20 25 30
Health Impact of Diabetes in the United States
Diabetes
National Diabetes Fact Sheet, United States, November 2003.Available at http:;;www.cdc.gov/diabetes/pubs/factsheet.htm.
6th leading cause of death
73% of adults have HTN and/or take meds
Heart disease is theleading cause of death
Leading cause ofkidney failure
Leading causeof adult blindness
Neuropathy in 60-70% of patients contributes to high incidence of lower-limb amputation
0
0.05
0.1
0.15
0.2
0.25
Even
t ra
te
Months6 9 153 18 2112 24
Diabetes/CVD
Diabetes Increases Death Rate
www.hypertensiononline.orgMalmberg K, et al. Circulation. 2000;102:1014-1019.
Organization to Assess Strategies for Ischemic Syndromes
No Diabetes/CVD
Diabetes/No CVD
No Diabetes/No CVD
40
15 13 1310
4 5
0
10
20
30
40
50
Perc
en
t of
death
s
Geiss LS, et al. In: Diabetes in America. National Institutes of Health;1995.
Causes of Death in Diabetes
Isch
emic
heart
disea
se
Oth
er h
eart
dise
ase
Diabe
tes
Canc
er
Stro
ke
Pneu
mon
ia/
influe
nza
All
other
www.hypertensiononline.org
Diabetes Management Receives a Failing Report Card…
Beaton, S.et al. Diabetes Care 27: 694-698, 2004
Indicator of Diabetes Mgmt
Percent of Patients at Goal
A1C 37%NHANES III 1988-1994 7.8%NHANES 1999-2000 8.1%
LDL Cholesterol 23%
Systolic BP 41%
Now the Good News: Diabetes Can Be Prevented Diabetes Prevention Program
N= 3,234 people with IGT Ages 25-85 (mean 51) Average BMI 34 45% minorities
Goals Achieve/maintain weight loss of 7% Maintain moderate physical activity at
least 150 minutes/week
Preventing Diabetes--or Living Healthy with
It!
Lifestyle Changes Healthy Eating Regular Exercise Healthy Weight
Weight Loss (7% of weight)
Medications Weight Loss Surgery
Healthy Eating
Reading Food Labels
Plate MethodFill ½ of the plate with non-starchy vegetables
Add a servingof a protein food
Choose a carbserving
Don’t forget the dairy!
Finish with a fruit
210
320
450
610
0
100
200
300
400
500
600
700
1960 1978 1995 1999
Year
Ca
lori
es
The Supersizing PhenomenonPortion Control - It Does Matter!
77G
68G
57G
26 Grams Carbs
10G Fat
22G
26G 29G
Activity and Exercise
30 minutes of moderate activity on most days of the week
This does NOT
Count!
Inactivity and DiabetesInactivity and Diabetes
What’s wrong with this picture?
Healthy Weight
Height Normal
BMI=<25
Overweight
BMI=25-29
Obese
BMI=30-39
Extreme Obesity BMI=>40
5 ft 0 in Up to 127 Up to 152 Up to 203 Over 203 5 ft 1 in Up to 131 Up to 157 Up to 210 Over 210
5 ft 2 in Up to 135 Up to 163 Up to 217 Over 217 5 ft 3 in Up to 140 Up to 168 Up to 224 Over 224
5 ft 4 in Up to 144 Up to 173 Up to 231 Over 231
5 ft 5 in Up to 149 Up to 179 Up to 239 Over 239
5 ft 6 in Up to 154 Up to 185 Up to 246 Over 246 5 ft 7 in Up to 158 Up to 190 Up to 254 Over 254
5 ft 8 in Up to 163 Up to 196 Up to 261 Over 261
5 ft 9 in Up to 168 Up to 202 Up to 269 Over 269
5 ft 10 in Up to 173 Up to 208 Up to 277 Over 277 5 ft 11 in Up to 178 Up to 214 Up to 285 Over 285
6 ft 0 in Up to 183 Up to 220 Up to 293 Over 293
6 ft 1 in Up to 188 Up to 226 Up to 301 Over 301
6 ft 2 in Up to 193 Up to 232 Up to 310 Over 310 6 ft 3 in Up to 199 Up to 239 Up to 318 Over 318
6 ft 4 in Up to 204 Up to 245 Up to 327 Over 327
Medications Prevention of Diabetes
Metformin (Glucophage) Controlling Diabetes
Pills, Insulin, and other Injectables Weight Loss
Orlistat (Alli- OTC) Meridia Others
“Diabetes Surgery” Lab-Band (1 year)
64% of patients showed resolution 26% of patients showed
improvement
Roux-en-Y Gastric Bypass 76.8% of patients showed
resolution - other studies showed 83% - 98%
Surgical Outcomes:Comorbidities
Comorbidity Resolved Improved or Resolved
Diabetes 76.8% 86.0%
Hyperlipidemia
70%
Hypertension 61.7% 78.5%
Sleep Apnea 85.7%
”The distance is nothing; it is only the first step that is difficult.”