1. Preventing Diabetes Cecilia Sauter MS, RD, CDE Diabetes Self-Management Education Program University of Michigan

2. Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1990 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1). No Data 10%

3. Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1991-92 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1). No Data 10%

4. Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1993-94 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1). No Data 10%

5. Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1995-96 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1). No Data 10%

6. Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1995 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1). No Data 10%

7. Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1997-98 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1). No Data 10%

8. Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 1999 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1). No Data 10%

9. Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 2000 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1). No Data 10%

10. Diabetes and Gestational Diabetes Trends Among Adults in the U.S., BRFSS 2001 Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1). No Data 10%

11. Diabetes in the US Currently 20.8 million have diabetes 14.6 million have the diagnosis 6.2 million don’t know they have diabetes

12. Etiology of Diabetes Family history Ethnicity –African American –Native American –Hispanic –Asian Americans –Pacific Islanders Age Gestational Diabetes or babies over 9 pounds

13. Etiology of Diabetes Increased weight –BMI: overweight = 25.0 to 29.9 kg/m 2 obese > 30.0 kg/m 2 Increased central (i.e., visceral) obesity –Waist circumference: Men > 40 in Women > 35 in Decreased activity

14. Metabolism without Diabetes Insulin Sugar SI S S BodyBlood

15. Metabolism without Diabetes Insulin Sugar S S S S S S S BloodBody S

16. Metabolism with Diabetes Insulin Sugar SI S S S BodyBlood S S S

17. Metabolism with Diabetes Insulin Sugar SI S S S BodyBlood S S S S

18. FBG: 80-125 10-30 years Insulin Resistance Insulin Production Glucose Intolerance Diagnosis of Diabetes Fasting Blood Glucose Progression of Diabetes

19. Pre-diabetes 2000 –40 % of people aged 40-74 years –41 million 2002 –54 million

20. Prevention of Diabetes Diabetes Prevention Program –Lifestyle changes Changes in eating habits Increase in physical activity 58% reduction in type 2 diabetes

21. Prevention of Diabetes Weight loss –5% to 10% weight loss –Weight loss rate of 1 to 2 lb/week –Decrease of 300 to 500 kcal/day = 1/2 to 1 lb weight loss/week Increased physical activity and/or decreased food intake

22. Prevention of Diabetes Healthy Nutrition Recommendations: –Decrease total fat intake smaller amounts of high fat foods broiling/stir fry vs. frying remove skin from chicken substitute with low calorie/low-fat foods

23. Prevention of Diabetes Healthy Nutrition Recommendations: –Increase fruits and vegetables –Whole grains vs. processed –Include dry beans and lentils –Drink water & calorie free drinks –Cut back on high calorie snacks –Watch portion sizes

24. Prevention of Diabetes Healthy Nutrition Recommendations: –Rate your plate ¼ grains or starchy foods ¼ protein ½ non starchy vegetables Add 1 glass milk or small piece of fruit

25. Prevention of Diabetes Physical Activity –Benefits : Increases insulin sensitivity Decreases weight Decreases blood pressure and cholesterol Decreases stress DECREASES risk of type 2 diabetes

26. Prevention of Diabetes Physical Activity –Recommendations: 30 minutes/day for 5 to 7 days a week 10 minutes of activity 3 times/day

27. Prevention of Diabetes Getting started: –What activities can you do –Realistic activities –Start slow: What, when, where, how often, how long Challenging but not overly difficult –Be flexible –Reward yourself

28. Calories Spent in Various Activities Walking, 3.0 miles/hr Walking 5 miles/hr Cycling, 8 miles/hour Mopping, vacuuming Scrubbing floors Gardening Vigorous dancing 275/hr 420/hr 325/hr 240/hr 300/hr 220/hr 320-500/hr

29. Fad Diets Watch for rapid weight loss Loss of muscle mass and water vs. fat Expensive

30. Nutritional Supplements They DO not reduce risk of Type 2 Diabetes Safety is uncertain No scientific evidence to aid in weight loss Expensive

31. Screening for Type 2 Diabetes Positive family history Ethnic group Increased weight and/or central obesity Gestational diabetes or big babies Decreased activity Symptoms of diabetes –Increased thirst, increased urination & weight loss

32. Diagnostic Criteria for Type 2 Diabetes Fasting blood sugar > 126 mg/dl 2 hour glucose tolerance > 200 mg/dl Acute symptoms plus random glucose > 200 mg/dl

33. Impaired Glucose Tolerance “Pre-diabetes” Impaired Fasting: –Level between >100 mg/dl and <126 mg/dl Impaired glucose: –During 2 hour glucose tolerance test –Level between >140 and <200 mg/dl

34. Thank you If you would like a copy of this presentation please send an email to: diabetes@umich.edu Questions?