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ABC’s and…..P of Diabetes Eric L. Johnson, M.D. Assistant Professor Department of Family and Community Medicine UNDSMHS Assistant Medical Director Altru.

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Presentation on theme: "ABC’s and…..P of Diabetes Eric L. Johnson, M.D. Assistant Professor Department of Family and Community Medicine UNDSMHS Assistant Medical Director Altru."— Presentation transcript:

1 ABC’s and…..P of Diabetes Eric L. Johnson, M.D. Assistant Professor Department of Family and Community Medicine UNDSMHS Assistant Medical Director Altru Diabetes Center Grand Forks, ND

2 Definitions Diabetes is a disorder of abmormal blood sugar levels Defect of insulin production or its use by the body Insulin is a hormone made by pancreas to regulate blood sugar

3 Definitions Type 1 diabetes: usually younger, go on insulin day of diagnosis Type 2 diabetes: usually older, usually treat with pills first They end up about the same in adulthood

4 U.S. Prevalence of Diabetes 2010 Diagnosed: 26 million people—8.3% of population (90%+ have Type 2) Undiagnosed: 7 million people 79 million people have pre-diabetes CDC 2011

5 Diabetes In The U.S % of all Americans 11.3% of adults age 20 and older 27% of adults age 65 and older 1.9 million diagnosed in 2010 Could be 33% by 2050 Prediabetes 35% of adults age 20 and older 50% of Americans 65 and older CDC 2011

6 Estimated Prevalence and Cost of Diabetes in North Dakota ~6.7% of adults (~40,000 people) Medical cost of diabetes: $209,700,000 Indirect Cost: $99,140,000 Total Cost: $308,800,000

7 Estimated Prevalence and Cost of Diabetes in Minnesota ~6% (~300,000 people) Medical cost of diabetes: $1,750,000,000 Indirect Cost: $929,000,000 Total Cost: $2,679,000,000

8 Individual Diabetes Costs $8,000-$14,000/year for diabetes $3200-$3800/year for non-diabetes This study only looked at y/o Curr Med Res Opin Aug;26(8):

9 Stop Diabetes Diabetes needs more urgency Diabetes is fatal People get cancer, they do everything to get better (and they should) People get diabetes, don’t always take it seriously Many cases of type 2 diabetes are preventable

10 Diagnosing Diabetes CategoryFasting blood sugar Normal <100 Impaired Fasting Glucose (IFG)100 – 125 (prediabetes) Diabetes >126** OR A1C >6.5 ** On 2 separate occasions American Diabetes Association

11 Risk Factors for Type 2 Diabetes Obesity/poor diet Family History Sedentary Lifestyle Gestational Diabetes (diabetes of pregnancy) Smoking Increasing Age

12 Screening for Type 2 Diabetes 45 year old and older Risk factors like Family History, Ethnic, High Blood Pressure, Smoking History of Gestational Diabetes Any previously documented abnormal blood sugar (i.e., prediabetes)

13 Diabetes Complications Eye disease/blindness Kidney disease Heart Disease (common) Stroke (common) Nerve damage Liver disease Amputation Infection

14 Scary stuff….. But….. Treatments are much better than 10 or 20 years ago This is not your father’s or mother’s diabetes! Many cases of type 2 diabetes are preventable

15 ABC’s….and P of Diabetes A 1C: Test relating to blood sugar B lood Pressure: Many adults with diabetes have high blood pressure C holesterol: Many adults with diabetes have high cholesterol P revention: Type 2 diabetes can be avoided/delayed

16 Avoid Complications of Diabetes Good blood sugar control Good blood pressure control Good cholesterol control

17 A 1C

18 A1C/Blood Sugar Control A1C < 7 for most non-pregnant adults Average daily blood sugar of 154 Recommend pre-meal blood sugar <130 Recommend 2 hours after meal blood sugar <180 Many medications available, meal planning and exercise are important

19 A1C ~ “Average Glucose” American Diabetes Association A1C eAG % mg/dL mmol/L Formula: 28.7 x A1C eAG

20 Diabetes Medications Many new medications on the market in the last 10 years Three main categories of medication –Oral agents (pills)- many different kinds old and new –Insulin- newer, more modern insulins –Newer, non-insulin injectable medications Choices allow individualization of treatment plan Different medications, different indications, different situations

21 Diabetes Medications-Pills Sulfonylureas: Glyburide, Glipizide, Glimiperide Biguanides: Metformin TZD’s: Actos, Avandia DPP-IV: Januvia, Onglyza Others, i.e., Welchol

22 Diabetes Medications-Injected Non-insulin: Byetta, Victoza, Symlin Insulin: -long acting: NPH, Lantus,Levemir -short acting: R, Novolog, Humalog, Apidra

23 What Medication to Use? Type 1 always insulin Type 2 combination of pills, insulin, other injectable Medication selection in type 2 depends on patient and “where they are at”

24 What Medication to Use? In type 2, metformin is almost always used in combination with another medication Nearly all patients with type 2 will eventually need to be on insulin, as the body makes less insulin with age Insulin!?!?! No problem, nearly all come in easy to use pen injectors

25 B lood Pressure

26 Many adults with diabetes have high blood pressure High blood pressure increases risk for kidney disease, heart attack, and stroke Target blood pressure in diabetes <130/<80

27 Blood Pressure Medications ACE Inhibitors (recommended) Lisinopirl, Enalapril ARB alternative to ACE (usually) Diovan, Cozaar, others Beta Blockers Atenolol, Metoprolol

28 Blood Pressure Medications Calcium Channel Blockers Diltiazem, Nifedipine, Amolidopine Diuretics (“water pills”) HCTZ, Furosemide, others

29 C holesterol

30 Often abnormal in adults with diabetes Increases risk for heart disease, stroke, amputation

31 Cholesterol Targets in Diabetes Total Cholesterol <200 Triglycerides <150 HDL (good) –>40 for males –>50 for females LDL (bad) –<100 –<70 for high risk

32 Cholesterol Medications Statins Simivastatin, atorvastatin, rosuvastatin Fibrates Tricor Fish Oil (omega-3) Niacin Others, i.e., Zetia

33 Heart Disease and Stroke Don’t smoke Treat cholesterol to target Treat blood pressure to target Daily aspirin in many patients (>50 y/o) Treating these risk factors effectively can lower risk by up to 40%

34 P revention

35 Pre-Diabetes Abnormal blood sugar Not abnormal enough to be classified as diabetes –Normal blood sugar fasting <100 –Pre-diabetes blood sugar –Diabetes blood sugar >126 –Usually obese

36 Pre-Diabetes Higher risk to develop type 2 diabetes Best prevention is lifestyle management May be a role for medication in certain patients or in the future

37 Pre-Diabetes Lifestyle management can reduce risk of diabetes by over 50% Lifestyle management –Meal plan –Activity plan –Stop smoking Diabetes medications to prevent diabetes not as effective (although this may change with newer meds)

38 Lifestyle Management/Prevention 30 minutes of activity 5 days a week Portion control, “heart healthy” meal plans 7% body weight reduction is associated with lower risk of diabetes Can improve blood pressure and cholesterol Talk with health care provider

39 Activity/Exercise Needs to be individualized- for example, if you have arthritis in knees/hips, walking may not be best Can be simple to start- for example, low weight dumbells while watching TV Be alert to opportunities to be active

40 Resources American Diabetes Association (ADA) American Heart Association (AHA) Centers for Disease Control (CDC) Commercial programs- Weight Watchers Meal planning websites i.e., six o’clock scramble thescramble.com

41 Summary Diabetes is common Diabetes is costly Diabetes is fatal Manage diabetes, blood pressure, cholesterol to reduce risk Type 2 Diabetes can be prevented or delayed Pre-diabetes should be diagnosed and managed to prevent or delay Type 2 Diabetes and diabetes complications


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