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ABC’s and…..P of Diabetes

ABC’s and…..P of Diabetes. Eric L. Johnson, M.D. Assistant Professor Department of Family and Community Medicine UNDSMHS Assistant Medical Director Altru Diabetes Center Grand Forks, ND. Definitions. Diabetes is a disorder of abmormal blood sugar levels

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ABC’s and…..P of Diabetes

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  1. ABC’s and…..P of Diabetes Eric L. Johnson, M.D. Assistant Professor Department of Family and Community Medicine UNDSMHS Assistant Medical Director Altru Diabetes Center Grand Forks, ND

  2. Definitions • Diabetes is a disorder of abmormal blood sugar levels • Defect of insulin production or its use by the body • Insulin is a hormone made by pancreas to regulate blood sugar

  3. Definitions • Type 1 diabetes: usually younger, go on insulin day of diagnosis • Type 2 diabetes: usually older, usually treat with pills first • They end up about the same in adulthood

  4. U.S. Prevalence of Diabetes 2010 Diagnosed: 26 million people—8.3% of population (90%+ have Type 2) Undiagnosed:7 million people 79 million people have pre-diabetes CDC 2011

  5. Diabetes In The U.S. 2010 • 8.3% of all Americans • 11.3% of adults age 20 and older • 27% of adults age 65 and older • 1.9 million diagnosed in 2010 • Could be 33% by 2050 • Prediabetes 35% of adults age 20 and older 50% of Americans 65 and older CDC 2011

  6. Estimated Prevalence and Cost of Diabetes in North Dakota • ~6.7% of adults (~40,000 people) • Medical cost of diabetes: $209,700,000 • Indirect Cost: $99,140,000 • Total Cost: $308,800,000

  7. Estimated Prevalence and Cost of Diabetes in Minnesota • ~6% (~300,000 people) • Medical cost of diabetes: $1,750,000,000 • Indirect Cost: $929,000,000 • Total Cost: $2,679,000,000

  8. Individual Diabetes Costs • $8,000-$14,000/year for diabetes • $3200-$3800/year for non-diabetes • This study only looked at 18-65 y/o Curr Med Res Opin. 2010 Aug;26(8):1827-34

  9. Stop Diabetes • Diabetes needs more urgency • Diabetes is fatal • People get cancer, they do everything to get better (and they should) • People get diabetes, don’t always take it seriously • Many cases of type 2 diabetes are preventable

  10. Diagnosing Diabetes Category Fasting blood sugar Normal <100 Impaired Fasting Glucose (IFG) 100 – 125 (prediabetes) Diabetes >126** • OR A1C >6.5 ** On 2 separate occasions American Diabetes Association

  11. Risk Factors for Type 2 Diabetes • Obesity/poor diet • Family History • Sedentary Lifestyle • Gestational Diabetes (diabetes of pregnancy) • Smoking • Increasing Age

  12. Screening for Type 2 Diabetes • 45 year old and older • Risk factors like Family History, Ethnic, High Blood Pressure, Smoking • History of Gestational Diabetes • Any previously documented abnormal blood sugar (i.e., prediabetes)

  13. Diabetes Complications • Eye disease/blindness • Kidney disease • Heart Disease (common) • Stroke (common) • Nerve damage • Liver disease • Amputation • Infection

  14. Scary stuff….. • But….. • Treatments are much better than 10 or 20 years ago • This is not your father’s or mother’s diabetes! • Many cases of type 2 diabetes are preventable

  15. ABC’s….and P of Diabetes • A1C: Test relating to blood sugar • Blood Pressure: Many adults with diabetes have high blood pressure • Cholesterol: Many adults with diabetes have high cholesterol • Prevention: Type 2 diabetes can be avoided/delayed

  16. Avoid Complications of Diabetes • Good blood sugar control • Good blood pressure control • Good cholesterol control

  17. A1C

  18. A1C/Blood Sugar Control • A1C < 7 for most non-pregnant adults • Average daily blood sugar of 154 • Recommend pre-meal blood sugar <130 • Recommend 2 hours after meal blood sugar <180 • Many medications available, meal planning and exercise are important

  19. A1C ~ “Average Glucose” A1C eAG % mg/dL mmol/L 6 126 7.0 6.5 140 7.8 7 154 8.6 7.5 169 9.4 8 183 10.1 8.5 197 10.9 9 212 11.8 9.5 226 12.6 Formula: 28.7 x A1C - 46.7 - eAG American Diabetes Association

  20. Diabetes Medications • Many new medications on the market in the last 10 years • Three main categories of medication • Oral agents (pills)- many different kinds old and new • Insulin- newer, more modern insulins • Newer, non-insulin injectable medications • Choices allow individualization of treatment plan • Different medications, different indications, different situations

  21. Diabetes Medications-Pills • Sulfonylureas: Glyburide, Glipizide, Glimiperide • Biguanides: Metformin • TZD’s: Actos, Avandia • DPP-IV: Januvia, Onglyza • Others, i.e., Welchol

  22. Diabetes Medications-Injected • Non-insulin: Byetta, Victoza, Symlin • Insulin: -long acting: NPH, Lantus,Levemir -short acting: R, Novolog, Humalog, Apidra

  23. What Medication to Use? • Type 1 always insulin • Type 2 combination of pills, insulin, other injectable Medication selection in type 2 depends on patient and “where they are at”

  24. What Medication to Use? • In type 2, metformin is almost always used in combination with another medication • Nearly all patients with type 2 will eventually need to be on insulin, as the body makes less insulin with age • Insulin!?!?! • No problem, nearly all come in easy to use pen injectors

  25. Blood Pressure

  26. Blood Pressure • Many adults with diabetes have high blood pressure • High blood pressure increases risk for kidney disease, heart attack, and stroke • Target blood pressure in diabetes <130/<80

  27. Blood Pressure Medications • ACE Inhibitors (recommended) Lisinopirl, Enalapril • ARB alternative to ACE (usually) Diovan, Cozaar, others • Beta Blockers Atenolol, Metoprolol

  28. Blood Pressure Medications • Calcium Channel Blockers Diltiazem, Nifedipine, Amolidopine • Diuretics (“water pills”) HCTZ, Furosemide, others

  29. Cholesterol

  30. Cholesterol • Often abnormal in adults with diabetes • Increases risk for heart disease, stroke, amputation

  31. Cholesterol Targets in Diabetes • Total Cholesterol <200 • Triglycerides <150 • HDL (good) • >40 for males • >50 for females • LDL (bad) • <100 • <70 for high risk

  32. Cholesterol Medications • Statins Simivastatin, atorvastatin, rosuvastatin • Fibrates Tricor • Fish Oil (omega-3) • Niacin • Others, i.e., Zetia

  33. Heart Disease and Stroke • Don’t smoke • Treat cholesterol to target • Treat blood pressure to target • Daily aspirin in many patients (>50 y/o) Treating these risk factors effectively can lower risk by up to 40%

  34. Prevention

  35. Pre-Diabetes • Abnormal blood sugar • Not abnormal enough to be classified as diabetes • Normal blood sugar fasting <100 • Pre-diabetes blood sugar 100-125 • Diabetes blood sugar >126 • Usually obese

  36. Pre-Diabetes • Higher risk to develop type 2 diabetes • Best prevention is lifestyle management • May be a role for medication in certain patients or in the future

  37. Pre-Diabetes • Lifestyle management can reduce risk of diabetes by over 50% • Lifestyle management • Meal plan • Activity plan • Stop smoking • Diabetes medications to prevent diabetes not as effective (although this may change with newer meds)

  38. Lifestyle Management/Prevention • 30 minutes of activity 5 days a week • Portion control, “heart healthy” meal plans • 7% body weight reduction is associated with lower risk of diabetes • Can improve blood pressure and cholesterol • Talk with health care provider

  39. Activity/Exercise • Needs to be individualized- for example, if you have arthritis in knees/hips, walking may not be best • Can be simple to start- for example, low weight dumbells while watching TV • Be alert to opportunities to be active

  40. Resources • American Diabetes Association (ADA) www.diabetes.org • American Heart Association (AHA) www.americanheart.org • Centers for Disease Control (CDC) www.cdc.gov • Commercial programs- • Weight Watchers www.weightwatchers.com • Meal planning websites i.e., six o’clock scramble thescramble.com

  41. Summary • Diabetes is common • Diabetes is costly • Diabetes is fatal • Manage diabetes, blood pressure, cholesterol to reduce risk • Type 2 Diabetes can be prevented or delayed • Pre-diabetes should be diagnosed and managed to prevent or delay Type 2 Diabetes and diabetes complications

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