1/3 go on to develop Type II diabetes. Cardiovascular disease, all cause mortality Half of all newly diagnosed diabetes could. be reversed …
Preventing Diabetes
Edward Cazzola, MD
Employee Services Disease Management
Employee Services 3331-2 Disease Management 505-844-HBES 4237 hbe@sandiagov
Overview
What is diabetes? What is prediabetes? What is the natural history of diabetes? Who is at risk? Metabolic syndrome, fat distribution missing link Lifestyle changes Conclusion
Employee Services 3331-2 Disease Management 505-844-HBES 4237 hbe@sandiagov
Pathophysiology of Diabetes
Glucose gas Insulin carburetor Muscle cells engine Muscle Cell Receptor Fat Cells
Adiponectin other hormones
Genetic expression with time
Employee Services 3331-2 Disease Management 505-844-HBES 4237 hbe@sandiagov
Diabetes is a Vascular Disease
Damage is Macrovascular Microvascular
Eyes Kidneys Carotids Heart Inflammation
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Types of Diabetes
Type I, Juvenile, Insulin Dependant Diabetes
Autoimmune Destruction of beta cells
Type II
FBG 126 mg/dl 2 hour pp 200mg/dl
Employee Services 3331-2 Disease Management 505-844-HBES 4237 hbe@sandiagov
Types of Diabetes
continued
Prediabetes
Impaired fasting glucose IFG impaired glucose tolerance IGT FBG 100
to 125mg/dl, normal GTT 1/3 go on to develop Type II diabetes Cardiovascular disease, all cause mortality
New concern
2 hours post prandial hyperglycemia
Employee Services 3331-2 Disease Management 505-844-HBES 4237 hbe@sandiagov
Stages in Natural History of Diabetes
Euglycemia Euglycemia Normal Blood Sugar Normal Blood Sugar
Cardiovascular Risk Cardiovascular Risk Prediabetes Prediabetes
Primary Prevention
Hyperglycemia Hyperglycemia micro macrovascular damage micro macrovascular damage Diabetes Diabetes
Disability and Early Death Disability and Early Death
Employee Services 3331-2 Disease Management 505-844-HBES 4237 hbe@sandiagov
Who is at Risk?
Under weight or overweight at birth Family history Age
middle age-greatest risk
High BMI
Abdomen fat Insulin resistance Liposuction
Latino, Hispanic, Native American, African American females
Employee Services 3331-2 Disease Management 505-844-HBES 4237 hbe@sandiagov
Metabolic Syndrome
Waist Circumference 35 Female 40 Male Triglycerides 150 HDL
50 for Female 40 for Male
Blood Pressure
135/85
FPG
100mg/dl
Employee Services 3331-2 Disease Management 505-844-HBES 4237 hbe@sandiagov
Missing Links
Fat
Cells
Complex highly active endocrine glands
Secretes:
Restin Leptin Tumor Necrosis Factor Free Fatty Acids dampens insulin effects Adiponectin Many Others
Employee Services 3331-2 Disease Management 505-844-HBES 4237 hbe@sandiagov
Effects of Missing Links
All impair glucose utilization in skeletal muscle Increase glucose prod 
uction from liver Decrease insulin secretion from beta cells Adiponectin Increases inflammation
Employee Services 3331-2 Disease Management 505-844-HBES 4237 hbe@sandiagov
The Research
4 Randomized Controlled Trials Half of all newly diagnosed diabetes could be reversed Diabetes can be prevented through lifestyle changes
Employee Services 3331-2 Disease Management 505-844-HBES 4237 hbe@sandiagov
Diabetes Prevention Program DPP
3234 overweight patients 3 groups 3 years follow-up
Intensive Lifestyle Modification reduced risk by 71 7-10 reduction in body weight Metformin reduced risk by 75 Standard lifestyle recommendations developed diabetes
Employee Services 3331-2 Disease Management 505-844-HBES 4237 hbe@sandiagov
Study to Prevent Non-Insulin-Dependent Diabetes Mellitus STOP-NIDDM
1429 patients with abnormal IGT follow up at 33 years Acarbose
25
risk reduction 53 reduction in cardiovascular events
Employee Services 3331-2 Disease Management 505-844-HBES 4237 hbe@sandiagov
Placebo
Finnish Diabetes Prevention Study
522 middle aged obese patients with abnormal IGT 32 year follow-up Intensive lifestyle modification no lifestyle changes 58 risk reduction
1-5 weight loss
Reduced fat intake 30 of calories Reduced saturated fat - 10 of calories Increased fiber intake - 15 gm/1000 kcal Exercise 150 minutes per week
Employee Services 3331-2 Disease Management 505-844-HBES 4237 hbe@sandiagov
Troglitazone in Prevention of Diabetes TRIPOD
255 Hispanic women who had previous gestational diabetes 30 month follow up TDZ Increased insulin sensitivity
56 risk reduction
Placebo
121 progressed to diabetes
Employee Services 3331-2 Disease Management 505-844-HBES 4237 hbe@sandiagov
Take Home Message
Diabetes is a BAD disease Preventable not Inevitable Lifestyle Modification Walk 5 times a week Lower calorie intake
Employee Services 3331-2 Disease Management 505-844-HBES 4237 hbe@sandiagov
What you can do about it
Gradually increase physical activity 10-20 minutes a day more than 150 minutes per week
Cut 500 calories a day with
portion controlled foods and/or meal replacements
Keep records of your food intake and activity
Employee Services 3331-2 Disease Management 505-844-HBES 4237 hbe@sandiagov
Thank You
Let us know how were doing Complete and return the evaluation form Feel free to contact us 505-844-HBES 4237
hbe@sandiagov
For up-to-date information on contemporary health topics, preventive, screening and health education opportunities for retirees, employees and their families visit the HBE Weekly UPDATE @ wwwsandiagov/health/update
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Source:anemia.org
