DIABETES ESSENTIALS

Richard Arakaki, M.D.

Phoenix Area Diabetes Consultant

Indian Health Service

September 23, 2016

DEFINITION

Diabetes mellitus is a chronic disorder of abnormal fuel metabolism that results in high blood glucose levels

After eating, most food is turned into glucose,

the body’s main source of energy.

What Happens When We Eat?

How Food is Digested

2. Stomach acids break down food

3. Pancreas releases digestive

enzymes

4. Carbohydrates converted to

glucose 5. Glucose enters bloodstream

6. Pancreas releases insulin

1. Food digestion starts with chewing

Carbs, Fats, Protein

Glucose

Insulin

Normal Blood Glucose ControlNo Diabetes

Glucose stays in a healthy range

Insulin from the pancreas is released at the right times and in the right amounts

Insulin helps glucose in the blood enter cells

High Blood Glucose (Hyperglycemia)Diabetes

Blood glucose builds up

for several possible reasons…

Too little insulin is made

Cells can’t use insulin well

Liver releases too much glucose

Symptoms of Hyperglycemia

•Increased urination

•Increased thirst

•Blurry vision

•Feeling tired

•Weight loss

•Slow healing of cuts or wounds

•More frequent infections

•Many times; no symptoms at all

Hyperglycemia Can Cause Serious Long-Term Problems

•Blindness

•Kidney disease

•Nerve damage

•Amputation

•Heart attack

•Stroke

Chronic complications of diabetes

Criteria for the Diagnosis of Diabetes

A1C ≥6.5%

OR

Fasting plasma glucose (FPG)

≥126 mg/dL (7.0 mmol/L)

OR

2-h plasma glucose ≥200 mg/dL

(11.1 mmol/L) during an OGTT

OR

A random plasma glucose ≥200 mg/dL (11.1

mmol/L)ADA. 2. Classification and Diagnosis. Diabetes Care 2015;38(suppl

1):S9; Table 2.1

An Important Test: A1c level or Average Blood Glucose Concentration (eAG)

<5.7%>6.5%

<7.0%

DiagnosticCriteria

TreatmentGoal

Two Main Types of Diabetes

Pancreas makes too little or no insulin

Most people are under age 20 when diagnosed

Insulin is always needed for treatment

Type 1 diabetes

Type 2 diabetes

Cells do not use insulin well (insulin resistance); ability for pancreas to make insulin decreases over time

Most people are over age 40 when diagnosed, but type 2 is becoming more common in younger adults, children and teensType 2 is more likely in people who: Are overweight; Are non-Caucasian; Have a family history

Diabetes Facts in the United States

•29.1 million people in the U.S. have diabetes

•8.1 million people with diabetes are undiagnosed

•9.3 % of the U.S. population

•1.9 million Americans aged 20 years or older were newly diagnosed with diabetes in 2010

Source: National Diabetes Fact Sheet, 2014

Burden of Diabetes in the United States

•The leading cause of:

•new blindness among adults

•kidney failure

•non-traumatic lower-limb amputations

•Increases the risk of heart attack and stroke by 2-4 fold

•7th leading cause of death

•Mortality rates 2-4 times greater than non-diabetic people of the same age

•Total direct and indirect cost of diagnosed diabetes is $245 billion a year

•1 in 5 health care dollars is spent caring for someone with diagnosed diabetes

•1 in 10 health care dollars is attributed directly to diabetes

Source: Centers for Disease Control and Prevention

Is There Any Good News?

•Yes, we can reduce the chances of developing type 2 diabetes in high-risk people (weight loss, exercise, medications)

•Yes, we can reduce the chances of developing diabetes complications through:

•Blood glucose control (diet, monitoring, medication)

•Blood pressure control

•Cholesterol control

•Regular visits to healthcare providers

•Early detection and treatment of complications

Steps to Lower Your Risk of Diabetes Complications

•A1C < 7•Blood pressure < 140/80•Cholesterol (LDL) < 100, statin therapy for high risk•Get help to quit smoking•Be active•Make healthy food choices•Take care of your feet•Get recommended screenings and early treatment for complications

Treatment for Type 2 Diabetes May Change Over a Lifetime

Always Includes:

•Education

•Healthy eating

•Blood glucose monitoring

•Physical Activity

May Include:

•Medications, including insulin

Diet and Exercise is the cornerstone of

diabetes treatment

Treating High Blood Glucose (Hyperglycemia)

Too little insulin is made

Cells can’t use insulin well

Liver releases too much glucose

Other ways to lower BS levels

Stimulate the pancreas; or use insulin

Reduce insulin resistance

Metformin; GLP-1 agonist

Reduce kidney glucose reabsorption

What is Prediabetes?

•Blood glucose levels are higher than normal but not

yet diabetes

•Most people with prediabetes don’t know they have it

•An important risk factor for future diabetes and CV

disease

•Interventions can reduce the rate of progression from

prediabetes to diabetes

•Healthy diet

•Physical activity

•Weight loss

FPG 100–125 mg/dL (5.6–6.9 mmol/L): IFG

OR

2-h plasma glucose in the 75-g OGTT

140–199 mg/dL (7.8–11.0 mmol/L): IGT

OR

A1C 5.7–6.4%

*For all three tests, risk is continuous, extending below the lower limit of a

range and becoming disproportionately greater at higher ends of the range.

ADA. 2. Classification and Diagnosis. Diabetes Care 2015;38(suppl 1):S10; Table

2.3

Categories of Increased Risk for Diabetes (Prediabetes)*

A Call to Action: Diabetes Prevention

• Reduce the risk by 60% with Lifestyle Intervention in Diabetes Prevention Program (DPP): >7% weight loss; 150 min/wk moderate activity

• Reduce risk by 30-60% with different medications

• Many Lifestyle Intervention Programs

• Many medications; metformin, TZDs, alpha-glucosidase inhibitors

• Many different ethnic groups• US and European Studies

• Asian studies; India, China, Japan

Diabetes Prevention: Translation

• Primarily Lifestyle Intervention programs

modeling the DPP (16 week sessions)

• DEPLOY study: DPP delivered at the YMCA

• Pilot Project: United Health Group to pay for

Delivery of DPP program at YMCAs

• Special Diabetes Prevention Initiative: Tribes

across nation

Preventive Efforts Are Key

•Most of the diabetes costs are due to end-stage complications

•Investment of resources into early diagnosis, patient education, prevention and treatments pays off in:

•Longer lives

•Increased productivity

•Reduced costs over the long term

DIABETES ESSENTIALS

Thank you very much!

Any questions?