Diabetes Health Status Report ______Site Name_________ Health Outcomes and Care Given to

1. Diabetes Health Status Report ______Site Name_________ Health Outcomes and Care Given to Patients with Diabetes Information from the Annual Indian Health Service Diabetes Audit Makah couple

3. Age is a risk factor for Type 2 Diabetes. Type 2 Diabetes was diagnosed predominately in patients age 40 and older. Today, young adults (30-35) are the fastest growing group of Type 2 Diabetes.

4. Type 1 Diabetes- Immune-mediated form of diabetes. The body produces no insulin at all due to islet cell destruction. Type 2 Diabetes-Caused by a combination of insulin resistance and insulin deficiency. Gestational Diabetes-Diabetes associated with pregnancy. Pre-Diabetes (also called Impaired Glucose Tolerance (IGT)-Pre-diabetic state marked by elevated blood sugar. People with IGT are at high risk for progression to Type 2 Diabetes.

5. Diabetes can be effectively treated and controlled. The duration of diabetes is related to complications such as kidney disease, cardio vascular disease, and amputation. Intensive treatment can reduce the risk of complications of diabetes.

6. Obesity and physical inactivity are associated with the development of Type 2 Diabetes. Adopting habits that control weight and increasing exercise has been shown to significantly reduce the risk of developing diabetes. Minimal weight loss of just 10-20 pounds can improve blood glucose, blood pressure, and cholesterol in patients with Type 2 Diabetes.

7. As a patient's Hemoglobin A1c (A1c) becomes elevated, the risk of complications increases. A1c estimates the average degree of glycemic control over a period of time. A1c should be monitored at 3-4 month intervals for those with elevated levels (HbA1C >7.0%).

8. The target Blood Pressure (BP) for patients with diabetes is < 130/85. High BP increases the risk of heart disease and renal failure in Type 2 Diabetes.

9. Tobacco abuse is the primary preventable risk for cardiovascular disease, which is the leading cause of death in diabetes.

10. Over time, smoking damages the blood vessels. When coupled with excessive glucose in the blood, the effect can be devastating.

12. Aspirin is used as a primary and secondary treatment strategy to prevent cardiovascular events, regardless of disease status. Men and women with diabetes have a 2-4 fold increase at risk of dying from complications of cardiovascular disease.

13. ACE Inhibitors are medications that prevent kidney damage and are prescribed to patients with diabetes. Treatment with ACE Inhibitors have been shown to delay the progression from Microalbuminuria to Proteinuria in patients with diabetes. Ace Inhibitors are commonly prescribed to patients with hypertension as well.

14. Optimal LDL cholesterol levels for adults with diabetes are <100 mg/dl. Pharmacological inter-vention is recommended if dietary and lifestyle changes are ineffective in lowering LDL to <100 mg/dl, or immediately if LDL >160 mg/dl People with diabetes may benefit significantly from statin therapy even if their LDL is below 100mg/dl.

15. Screening for foot problems, vision problems, and dental problems occur more frequently for patients with diabetes. Diabetics patients need these exams at least once a year.

16. Medical nutrition, therapy, and exercise are the primary treatment strategies for Type 2 Diabetes. All patients with diabetes and their families should have diabetes self-management education every year.

17. Diabetic patients should have a flu vaccine and pneumovax every year. Yearly re-vaccination for flu is recommended to provide up-to-date protection. The pneumovax vaccine is necessary at least once and may need a booster, according to physician discretion.

18. Protein appearing in the urine is an indication of kidney disease.

19. People with Type 2 Diabetes who have Microalbuminuria are more likely to have a heart attack or stroke. Treatment with ACE Inhibitors slows the deterioration of kidney function in diabetes.

20. Blood creatinine is a measure of renal function. Patients with diabetes are at risk for renal disease. This test is to be performed annually.

21. Risk factors for Arteriosclerosis include: Total Cholesterol <200 LDL>100 HDL<40 in HDL<45 in women TG>200 A lipid panel should be performed annually (TC, LDL, HDL, TG).

22. All patients with LDL >100 require medical nutrition, therapy, and lifestyle modifications. Pharmacological intervention is recommended if dietary interventions and lifestyle modifications are ineffective in lowering LDL to less than 100.

23. Risk factors for arteriosclerosis include: Total Cholesterol <200 LDL>100 HDL<40 in HDL<45 in women TG>200 A lipid panel should be performed annually (TC, LDL, HDL, TG).

24. Risk factors for Arteriosclerosis include: Total Cholesterol <200 LDL>100 HDL<40 in HDL<45 in women TG>200 A lipid panel should be performed annually (TC, LDL, HDL, TG).

25. A baseline EKG should be obtained after diagnosis of diabetes. This should be repeated every 1-5 years as clinically indicated. For those 40 years of age and above, or with diabetes duration of over 10 years, an EKG every 1-2 years is recommended.

26. Patients with diabetes are at risk for activation of latent Tuberculosis (TB) Infection (LBTI). There is a greater risk of progressing to active TB if not treated. Patients with diabetes should have a PPD if their TB status is unknown.

27. Self Monitoring Blood Glucose (SMBG) determines the pattern of blood glucose throughout the day. This pattern provides information for selection and adjustments in therapy.