Diabetes

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Diabetes
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What Happens When We Eat?
After eating, most food is turned into glucose,
the bodys main source of energy.
American Diabetes Association
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Normal Blood Glucose Control
In people without diabetes, glucose stays in a
healthy range because
Insulin is released at the right times and in the
right amounts
Insulin helps glucose enter cells
American Diabetes Association
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High Blood Glucose (Hyperglycemia)
In diabetes, blood glucose builds up for several
possible reasons
Liver releases too much glucose
Too little insulin is made
Cells cant use insulin well
American Diabetes Association
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Diabetes Types

• Type 1
• Pancreas makes too little or no insulin
• Pre-diabetes
• Gestational Diabetes

• Type 2
• Cells do not use insulin well (insulin resistant)
• Ability for pancreas to make insulin decreases
  over time
• Type 3??

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Number of Americans withDiagnosed Diabetes,
1980-2009
www.cdc.gov
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Diabetes

• Currently affects about 25.8 million Americans of
  all ages.
• About 8 of the population (U.S.)
• Estimated 7 million undiagnosed
• Hispanics/Latinos about 12 diagnosed
• African Americans about 13 diagnosed
• Asian Americans about 8 diagnosed

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Diabetes in Oregon
(Oregon.gov, 2006)
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Symptoms

• Increased thirst
• Increased urination
• Blurry vision
• Fatigue
• Weight loss
• Nausea and vomiting
• More frequent infections

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Diagnosis

• 10 important tests
• A1C
• BP
• Cholesterol
• Eye exam
• Urine test
• Foot exam
• Dental exam
• Weight
• Flu shot
• Pneumonia shot

• Know your numbers
• A1C lt 7
• BP 130/80 or lower
• Cholesterol
• LDL lt100
• HDL gt40 men gt50 women

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Complications

• A leading cause of blindness
• Leading cause of non-accident amputations
• Kidney disease
• Nerve damage (peripheral neuropathy)
• Heart attack / stroke

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Diabetic neuropathy / gangrene
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Diabetic Retinopathy
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Treatment of Diabetes
No medication 16
Insulin only 12
Insulin and oral medication14
Oralmedication only58
National Diabetes Information Clearinghouse.
National Diabetes Statistics, 2011. Available at
http//diabetes.niddk.nih.gov/dm/pubs/statistics/
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Costs

• Estimated to cost more than 174 billion
  annually.
• Direct medical costs 116 billion
• Indirect costs 58 billion
• 1 in every 5 health care dollars spent on
  caring for someone diagnosed with diabetes

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Prevention

• The best time to plant a tree is 20 years ago.
  The second best time is now.
• Chinese Proverb
• Good news with diabetes prevention
• Small steps matter

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Cost-Effectiveness of Lifestyle Modification or
Metformin DPP

• Active interventions (vs placebo) would

Intensive Lifestyle Metformin
Delay onset oftype 2 diabetes by 11.1 years 3.4 years
Reduce incidence oftype 2 diabetes by 20 8
Increase life expectancy by 0.5 years 0.2 years
Cost per QALY 1,124 31,286
QALY Quality Adjusted Life Years
Herman WH, et al for the Diabetes Prevention
Program Research Group.Ann Intern Med.
2005142323-332.