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

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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.”