Preventing Diabetes

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Preventing Diabetes

• Cecilia Sauter MS, RD, CDE
• Diabetes Self-Management Education Program
• University of Michigan

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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
1289(1).
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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
1289(1).
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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
1289(1).
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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
1289(1).
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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
1289(1).
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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
1289(1).
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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
1289(1).
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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
1289(1).
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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
1289(1).
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Diabetes in the US

• Currently 20.8 million have diabetes
• 14.6 million have the diagnosis
• 6.2 million dont know they have diabetes

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Etiology of Diabetes

• Family history
• Ethnicity
• African American
• Native American
• Hispanic
• Asian Americans
• Pacific Islanders
• Age
• Gestational Diabetes or babies over 9 pounds

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Etiology of Diabetes

• Increased weight
• BMI
• overweight 25.0 to 29.9 kg/m2
• obese gt 30.0 kg/m2
• Increased central (i.e., visceral) obesity
• Waist circumference
• Men gt 40 in
• Women gt 35 in
• Decreased activity

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Metabolism without Diabetes
Body
Blood
SI
SI
S
Insulin
SI
Sugar
SI
S
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Metabolism without Diabetes
Blood
Body
S
S
S
S
Insulin
S
S
S
Sugar
S
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Metabolism with Diabetes
Body
Blood
SI
SI
S
S
Insulin
SI
S
Sugar
S
S
S
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Metabolism with Diabetes
Body
Blood
SI
SI
S
S
S
Insulin
SI
S
S
Sugar
S
S
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Progression of Diabetes
10-30 years
Insulin Resistance
Insulin Production
Fasting Blood Glucose
Glucose Intolerance
FBG 80-125
Diagnosis of Diabetes
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Pre-diabetes

• 2000
• 40 of people aged 40-74 years
• 41 million
• 2002
• 54 million

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Prevention of Diabetes

• Diabetes Prevention Program
• Lifestyle changes
• Changes in eating habits
• Increase in physical activity
• 58 reduction in type 2 diabetes

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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

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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

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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

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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

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Prevention of Diabetes

• Physical Activity
• Benefits
• Increases insulin sensitivity
• Decreases weight
• Decreases blood pressure and cholesterol
• Decreases stress
• DECREASES risk of type 2 diabetes

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Prevention of Diabetes

• Physical Activity
• Recommendations
• 30 minutes/day for 5 to 7 days a week
• 10 minutes of activity 3 times/day

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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

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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

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Fad Diets

• Watch for rapid weight loss
• Loss of muscle mass and water vs. fat
• Expensive

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Nutritional Supplements

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

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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

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Diagnostic Criteria for Type 2 Diabetes

• Fasting blood sugar gt 126 mg/dl
• 2 hour glucose tolerance gt 200 mg/dl
• Acute symptoms plus random glucose gt 200 mg/dl

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Impaired Glucose TolerancePre-diabetes

• Impaired Fasting
• Level between gt100 mg/dl and lt126 mg/dl
• Impaired glucose
• During 2 hour glucose tolerance test
• Level between gt140 and lt200 mg/dl

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Thank you

• If you would like a copy of this presentation
  please send an email to diabetes_at_umich.edu
• Questions?