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 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.

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

Relative Risk of Diabetes for race/ethnicity population as compared to non-Hispanic whites among people age 20 years or older in the United States, 2005

Non-Hispanic white 1.0

American Indians and Alaska Native 2.2

African Americans 1.9

Mexican Americans 1.7

Asians, native Hawaiians and Pacific Islanders in Hawaii 2.0

California Asians 1.5

CDC Diabetes, National Diabetes Fact Sheet: United States, 2005. Accessed March 2007 at http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2005.pdf

Complications

• Macrovascular complications – coronary artery disease – stroke – peripheral vascular disease

• Microvascular complications – retinopathy – nephropathy – neuropathy

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/

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

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.

Public Health Approach

• Life style changes

• Community program

• Team care

• Family involvement