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Chapter 36 Diabetes: A Public Health Pandemic

Chapter 36 Diabetes: A Public Health Pandemic. Amazing Facts. EVERY 24 HOURS New Cases - 4,100 Deaths - 810 Amputations - 230 Kidney Failure - 120 Blindness – 55

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Chapter 36 Diabetes: A Public Health Pandemic

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  1. Chapter 36Diabetes: A Public Health Pandemic

  2. Amazing Facts EVERY 24 HOURS • New Cases - 4,100 • Deaths - 810 • Amputations - 230 • Kidney Failure - 120 • Blindness – 55 National Institute of Diabetes and Digestive and Kidney Diseases. National Diabetes Statistics fact sheet: general information and national estimates on diabetes in the United States, 2005. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, 2005.

  3. Epidemiology • Prevalence of diabetes has doubled since 1991 • 7.0 million to 14.6 million (2005) • 6.2 million people are unaware they have diabetes • Almost 10 percent of the population aged 20 years or older has diabetes • 1.5 million new cases were diagnosed in 2005. • Projected prevalence will exceed 29 million in the year 2050

  4. Complications • Macrovascular complications • coronary artery disease • stroke • peripheral vascular disease • Microvascular complications • retinopathy • nephropathy • neuropathy

  5. BMI Categories • Underweight = <18.5 • Normal weight = 18.5-24.9 • Overweight = 25-29.9 • Obesity = BMI of 30 or greater National Health Lung and Blood Institute Website March 25, 2007 http://www.nhlbisupport.com/bmi/

  6. Criteria for testing for diabetes in asymptomatic adult individuals Testing for diabetes should be considered in all individuals at age 45 years and above, particularly in those with a BMI 25 kg/m2*, and, if normal, should be repeated at 3-year intervals. Testing should be considered at a younger age or be carried out more frequently in individuals who are overweight (BMI 25 kg/m2*) and have additional risk factors: • are habitually physically inactive • have a first-degree relative with diabetes • are members of a high-risk ethnic population (e.g., African American, Latino, Native American, Asian American, Pacific Islander) • have delivered a baby weighing >9 lb or have been diagnosed with GDM • are hypertensive (140/90 mmHg) • have an HDL cholesterol level <35 mg/dl (0.90 mmol/l) and/or a triglyceride level >250 mg/dl (2.82 mmol/l) • have polycystic ovary syndrome (PCOS) • on previous testing, had IGT or IFG • have other clinical conditions associated with insulin resistance (e.g., PCOS or acanthosis nigricans) • have a history of vascular disease • * May not be correct for all ethnic groups. PCOS, polycystic ovary syndrome

  7. Managing Diabetes • Understanding of the disease and its co-morbidities • Glycemic control • Patient education, lifestyle modification and appropriate medical therapy. • Secondary prevention • maintaining a healthy weight, following a balanced diet, being physically active, taking medication as prescribed and managing stress.

  8. Public Health Approach • Life style changes • Community program • Team care • Family involvement

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