Diabetes Mellitus

PRESENTED BY:Folasade Adesina

Michael ItidiareNicole LafortuneSophia LaguerLauren Young

Ali Zaidi

SPECIAL THANKS TO:Dr. Aliya Brown

Diabetes mellitusDiabetes mellitus is a disease is a disease characterized by persistent characterized by persistent hyperglycemia (high blood sugar hyperglycemia (high blood sugar levels). It is a metabolic disease that levels). It is a metabolic disease that requires medical diagnosis, requires medical diagnosis, treatment and lifestyle changes. treatment and lifestyle changes.

ProblemProblem Although many Although many

resources and resources and programs have programs have been established been established to decrease the to decrease the prevalence of prevalence of diabetes, diabetes diabetes, diabetes is still increasing is still increasing in the African in the African American American communitycommunity

QuestionQuestion

Is the prevalence of diabetes within Is the prevalence of diabetes within the African American community the African American community

more linked to their socioeconomic more linked to their socioeconomic status or genetics?status or genetics?

What Are the Two What Are the Two Types of DiabetesTypes of Diabetes

Type I Diabetes Type I Diabetes Type II DiabetesType II Diabetes

Type I Diabetes An autoimmune disease in which Type I Diabetes An autoimmune disease in which the pancreas makes little or no insulin, resulting in the pancreas makes little or no insulin, resulting in an abnormally high blood sugar level. Formerly an abnormally high blood sugar level. Formerly known as insulin-dependent diabetes or juvenile known as insulin-dependent diabetes or juvenile diabetesdiabetes

Type II Diabetes insulin is present but doesn't work Type II Diabetes insulin is present but doesn't work adequately. Usually occurs over the age of 30 and is adequately. Usually occurs over the age of 30 and is controlled by diet and medication or diet and controlled by diet and medication or diet and insulin. Also known as non insulin dependent and insulin. Also known as non insulin dependent and maturity onset diabetes.maturity onset diabetes.

Comparison in Type I and Type II Diabetes

Type I Type I Type IIType II

Onset primarily in childhood and adolescence

Onset predominantly after 40 years of age*

Often thin or normal weight Often obese

Prone to ketoacidosis No ketoacidosis

Insulin administration required for survival

Insulin administration not required for survival

Pancreas is damaged by an autoimmune attack

Pancreas is not damaged by an autoimmune attack

Absolute insulin deficiency Relative insulin deficiency and/or insulin resistance

Treatment: insulin injections Treatment: (1) healthy diet and increased exercise; (2) hypoglycemic tablets; (3) insulin injections

Increased prevalence in relatives Increased prevalence in relatives

Identical twin studies: <50% concordance

Identical twin studies: usually above 70% concordance

Diagnosis Diagnosed and undiagnosed diabetes in African Americans, U.S, 1996 2006.

Mortality rates in African American and white diabetic men and women

Risk FactorsRisk Factors A family history of diabetes.A family history of diabetes. If a parent or sibling If a parent or sibling

in your family has diabetes, your risk of developing in your family has diabetes, your risk of developing diabetes increases. diabetes increases.

Age over 45Age over 45 Race or ethnic background.Race or ethnic background. The risk of diabetes is The risk of diabetes is

greater in Hispanics, blacks, Native Americans and greater in Hispanics, blacks, Native Americans and Asians. Asians.

Being overweight.Being overweight. If you are overweight, defined If you are overweight, defined as a body mass index (BMI) greater than 25. as a body mass index (BMI) greater than 25.

Hypertension.Hypertension. High blood pressure increases the High blood pressure increases the risk of developing diabetes. risk of developing diabetes.

Abnormal cholesterol levels.Abnormal cholesterol levels. HDL ("good") HDL ("good") cholesterol levels under 35 mg/dL (milligrams per cholesterol levels under 35 mg/dL (milligrams per deciliter) and/or a triglyceride level over 250 mg/dL deciliter) and/or a triglyceride level over 250 mg/dL increases your risk increases your risk

A person with some or all of the above listed risk factors may never develop diabetes, but your chances increase the more risk factors

you have.

Obesity is a factor!!!Obesity is a factor!!! To determine whether or not a patient is overweight or To determine whether or not a patient is overweight or

obese doctors use the body mass index. obese doctors use the body mass index. • body mass index (BMI) provides a relative measure of weight body mass index (BMI) provides a relative measure of weight

adjusted for the respective height.adjusted for the respective height.

More and more people are becoming affected with diabetes More and more people are becoming affected with diabetes because nations are switching to a westernized (American) because nations are switching to a westernized (American) lifestyle that emphasizes rich foods and sedentary livinglifestyle that emphasizes rich foods and sedentary living

In the U.S. one of three Americans are obese 33%, and two In the U.S. one of three Americans are obese 33%, and two of three, 67% of teenagers are at risk of becoming obese of three, 67% of teenagers are at risk of becoming obese and developing diabetes because of little or no vigorous and developing diabetes because of little or no vigorous physical activity. physical activity.

Affect of Obesity on DiabetesAffect of Obesity on Diabetes In the normal process of food metabolism, sugar called glucose In the normal process of food metabolism, sugar called glucose

enters the bloodstream. enters the bloodstream. Glucose is a source of fuel for the body.Glucose is a source of fuel for the body. An organ called the pancreas makes insulin. The role of insulin is to An organ called the pancreas makes insulin. The role of insulin is to

move glucose from the bloodstream into muscle, fat, and liver cells, move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel.where it can be used as fuel.

When an individual is obese food metabolism is slowed down When an individual is obese food metabolism is slowed down because of lack of exercise causing the sugar production to be because of lack of exercise causing the sugar production to be produced and a large quantity is built up within the body more produced and a large quantity is built up within the body more than the human body can handlethan the human body can handle

Making it difficult for the pancreas to regulate the normal amount Making it difficult for the pancreas to regulate the normal amount of blood sugar needed in the body, resulting in type II diabetes.of blood sugar needed in the body, resulting in type II diabetes.

THE MORE OVERWEIGHT OR OBESE YOU ARE, THE GREATER THE MORE OVERWEIGHT OR OBESE YOU ARE, THE GREATER YOUR RISK OF DIABETES!!YOUR RISK OF DIABETES!!

Prevalence of Diabetic Patients and Prevalence of Diabetic Patients and ObesityObesity

In 2003 the Journal of American Medical In 2003 the Journal of American Medical Association reported statistics that show Association reported statistics that show the correlation between obesity and the correlation between obesity and diabetes within the United States. diabetes within the United States.

They reported that obesity climbed from They reported that obesity climbed from 19.8% in American Adults to 20.9% 19.8% in American Adults to 20.9% between 2000 and 2001. Within that between 2000 and 2001. Within that same time frame the diagnosed cases of same time frame the diagnosed cases of diabetes increased from 7.3% to 7.9%.diabetes increased from 7.3% to 7.9%.

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Obesity Vs. DiabetesObesity Vs. Diabetes

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Diabetes in Impoverished Diabetes in Impoverished CommunitiesCommunities

Poverty has been under recognized as a contributor to the prevalence of type 2 diabetesPoverty has been under recognized as a contributor to the prevalence of type 2 diabetes

Low socioeconomic status within minority populations appear to particularly be affected Low socioeconomic status within minority populations appear to particularly be affected by overweight and obesityby overweight and obesity-- this is due to low education of proper nutrition and the dangers of disease -- this is due to low education of proper nutrition and the dangers of disease -- with little or no knowledge of a proper diet, poorer people are more likely -- with little or no knowledge of a proper diet, poorer people are more likely

to eat high calorie junk food and exercise less. to eat high calorie junk food and exercise less.

Also in such communities, they cannot afford proper health care and do not seek regular Also in such communities, they cannot afford proper health care and do not seek regular physician assistance. physician assistance. -- -- increasing the risk of the development of obesity leading to diabetes, increasing the risk of the development of obesity leading to diabetes,

hypertension, heart disease and much more. hypertension, heart disease and much more.

People with less than a high school education had higher rates of both obesity 27.4% People with less than a high school education had higher rates of both obesity 27.4% and diabetes 13% than people who had a high school educationand diabetes 13% than people who had a high school education

Information from Behavioral Risk Factor Surveillance System (BRFSS), a state-based telephone survey that Information from Behavioral Risk Factor Surveillance System (BRFSS), a state-based telephone survey that collects information from adults aged 18 years or older. For this survey, participants were asked about their collects information from adults aged 18 years or older. For this survey, participants were asked about their

height and weight and if they had ever been told by a doctor that they had diabetes.height and weight and if they had ever been told by a doctor that they had diabetes.

Diabetes is Also GeneticDiabetes is Also GeneticDiabetes is a hereditary disease. Diabetes is a hereditary disease.

The genes that make an individual susceptible to get The genes that make an individual susceptible to get diabetes is passed from one generation to the next. diabetes is passed from one generation to the next.

However, the risk of getting diabetes is passed However, the risk of getting diabetes is passed on NOT the disease itself. on NOT the disease itself.

First generation relatives have a higher risk of First generation relatives have a higher risk of developing type I diabetes than people whom do not developing type I diabetes than people whom do not have any past history of diabetes in their respective have any past history of diabetes in their respective families. families.

In type II diabetes studies have shown that the first In type II diabetes studies have shown that the first generation are at about 3X more likely to get diabetes generation are at about 3X more likely to get diabetes than those without. than those without. Also with identical twins, rates of diagnosing diabetes Also with identical twins, rates of diagnosing diabetes within sets range from 60-90%, which is significantly within sets range from 60-90%, which is significantly higher than fraternal twins , proving a strong genetic higher than fraternal twins , proving a strong genetic correlation.correlation.

Genetic StatisticsGenetic Statistics

KEY

Female Male Female Diabetic Male Diabetic

African-Americans and CommunityAfrican-Americans and Community Most African Americans with diabetes have Type 2, which develops in Most African Americans with diabetes have Type 2, which develops in

adulthood and requires treatment with some combination of exercise, adulthood and requires treatment with some combination of exercise, proper diet, medication and injected insulinproper diet, medication and injected insulin

African Americans are 1.8 times more likely to have diabetes than other African Americans are 1.8 times more likely to have diabetes than other ethnicities. ethnicities.

Obesity has reached near epidemic proportions in the United States. Obesity has reached near epidemic proportions in the United States. The prevalence of obesity is high among African Americans, particularly The prevalence of obesity is high among African Americans, particularly African American women, making them at high risk for developing African American women, making them at high risk for developing diabetes.diabetes.

The proportion of African American women who are obese is 80 percent The proportion of African American women who are obese is 80 percent higher than the proportion of men who are obese. When compared to higher than the proportion of men who are obese. When compared to non-Hispanic white women, 69 percent of African American women are non-Hispanic white women, 69 percent of African American women are overweight or obese.overweight or obese.

The prevalence of obesity increases up to age 60 after which there is a The prevalence of obesity increases up to age 60 after which there is a decline decline

Klauer, J., & Aronne, L. J., (2002). Managing Overweight and Obesity in Women. Clinical Obstetrics & Gynecology, 45(4), 1080-Klauer, J., & Aronne, L. J., (2002). Managing Overweight and Obesity in Women. Clinical Obstetrics & Gynecology, 45(4), 1080-1088.1088.

American diabetes associationAmerican diabetes association

African Americans + Diabetes+ Genetics = TheoryAfrican Americans + Diabetes+ Genetics = Theory

Some researchers believe that African Americans Some researchers believe that African Americans inherited a "thrifty gene" from their African inherited a "thrifty gene" from their African ancestors. Such a gene might have initially enabled ancestors. Such a gene might have initially enabled Africans to use energy more efficiently when food Africans to use energy more efficiently when food was scarce. The theory is that today, without "feast was scarce. The theory is that today, without "feast and famine" cycles, the thrifty gene may make and famine" cycles, the thrifty gene may make African Americans more likely to develop type 2 African Americans more likely to develop type 2 diabetes.diabetes.

Other study results found that African Americans Other study results found that African Americans had the highest rates of both obesity 31.1% and had the highest rates of both obesity 31.1% and diabetes 11.2 % compared with other ethnic groups. diabetes 11.2 % compared with other ethnic groups.

National Diabetes Information Clearinghouse, "Diabetes in African Americans," (National Diabetes Information Clearinghouse, "Diabetes in African Americans," (http://http://

www.niddk.nih.gov/health/diabetes/pubs/afam/afam.htmwww.niddk.nih.gov/health/diabetes/pubs/afam/afam.htm).).

Prevalence of Diabetes by RacePrevalence of Diabetes by Race Whites: 13.1 million, or 8.7% of all non-Hispanic whites aged Whites: 13.1 million, or 8.7% of all non-Hispanic whites aged

20 years or older have diabetes.20 years or older have diabetes.

Blacks: 3.2 million, or 13.3% of all non-Hispanic blacks aged Blacks: 3.2 million, or 13.3% of all non-Hispanic blacks aged 20 years or older have diabetes. After adjusting for 20 years or older have diabetes. After adjusting for population age differencespopulation age differences

Non-Hispanic blacks are 1.8 times as likely to have diabetes Non-Hispanic blacks are 1.8 times as likely to have diabetes as non-Hispanic whites.as non-Hispanic whites.

Diabetes results in death for 20 percent more African Diabetes results in death for 20 percent more African American men and 40 percent more African American women American men and 40 percent more African American women than whites.than whites.

Twenty-five percent of African Americans between the ages Twenty-five percent of African Americans between the ages of 65 and 74 have diabetes. of 65 and 74 have diabetes.

One in four African American women over 55 years of age has One in four African American women over 55 years of age has diabetes. diabetes.

Comparison of Diabetes Frequency Comparison of Diabetes Frequency by Race and Ageby Race and Age

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Under 45 45-64 65+

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Whites

Hunterdon and Camden CountyHunterdon and Camden County

Type I diabetes Type I diabetes affects 5-7.5% of the affects 5-7.5% of the US population in US population in Camden County, Camden County, New Jersey.New Jersey.

Diabetes affects the Diabetes affects the members of members of Hunterdon County, Hunterdon County, New Jersey at a rate New Jersey at a rate of 5.4%.of 5.4%.

Diabetes in The United StatesDiabetes in The United States

Type I in the United StatesType I in the United States

Type II in the United StatesType II in the United States

Diabetes in South Africa: Genetics Diabetes in South Africa: Genetics Vs CultureVs Culture

Projected statistics for Projected statistics for South Africa reveal a South Africa reveal a rapid increase in the rapid increase in the incidence of diabetes incidence of diabetes especially with especially with urbanization of the urbanization of the African populations.African populations.

For the people of South For the people of South Africa the increase in the Africa the increase in the rate of diagnosed diabetes rate of diagnosed diabetes is because of people opting is because of people opting to live a lifestyle similar to to live a lifestyle similar to that of the United States, that of the United States, which emphasize more which emphasize more eating habits and little to eating habits and little to no exercise. no exercise.

By 2025, the number of people with diabetes is By 2025, the number of people with diabetes is expected to more than double in Africa, the expected to more than double in Africa, the

Eastern Mediterranean and Middle East, and Eastern Mediterranean and Middle East, and South-East Asia, and rise by 20% in Europe, South-East Asia, and rise by 20% in Europe,

50% in North America, 85% in South and 50% in North America, 85% in South and Central America and 75% in the Western Central America and 75% in the Western

Pacific.Pacific.

7.8 million (8.3%) of all men in the US have diabetes 9.1 million (8.9%) of all women in the US have diabetes About ½ of all diabetes cases occur in people over the age of 55 -- The risk for Type 2 increases with age 2.8 million (13%) of African Americans have diabetes 105,000 Native Americans and Alaska Natives (15.1%) have

diabetes

FACTSFACTS

Heart disease: leading cause of diabetes related deaths

-- 2 to 4 times higher in adults with diabetes

Stroke: risk is 2 to 4 times higher among people with diabetes

73% of adults with diabetes have high blood pressure or hypertension

Leading cause of blindness among adults 20-74 years old

Diabetic nerve related disease

-- leads to lower-extremity amputations

Complications during pregnancy

TYPE 1 - “Juvenile Diabetes”

No known methods to prevent Type 1 diabetes

TYPE 2 Lifestyle Changes - - Diet, physical activity

AFRICAN AMERICANS ARE AT A HIGHER RISK FOR TYPE 2 DIABETES AND BEING OVERWEIGHT INCREASES THEIR RISK.

Proper diet

-- lots of fruits, vegetables, whole grains

-- broils meats (poultry and fish)

Exercise

-- varies with age

-- proper diet and exercise must be balanced to avoid risk of hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar)

Insulin Injections

Home sugar monitoring

Balance and moderation

Reduce portion size

-- Split restaurant meals or have the other half wrapped to go

Physical Activity

-- 60 mins every day for children

ex: hopscotch, basketball, dance

-- 30 mins every day for adults

ex. walk, dance

MAKE A HEALTHY LIFESTYLE A FAMILY AFFAIR

Plan ahead. Make a list of meal ideas for the coming week

Buy in season fruits and vegetables

-- Prefer local farmer markets (foods fresher and cheaper)

Purchase canned & frozen fruits and vegetables when fresh ones are not affordable

Stock up on sale items

Assemble snacks at home in small baggies and use foods healthy foods

-- nuts & seeds

-- low fat cheese

-- fresh fruits & vegetables

Weigh to Go

-- 4 wk. weight management group for kids age 10-14 (fee: $90)

Smart Cart

-- Personal Grocery Shopper (fee: $30)

Shapedown Children’s Weight Management Program (6-18 years of age)

-- 10 wk. program that promotes changes in food habits, exercise, self-esteem and weight

Diabetes Fitness Program

-- 6 sessions over a 2 wk. period (fee: $164)

Yoga

CAMDEN COUNTY VS HUNTERDON COUNTY

Facility: Virtua Health

Program: Virtua Camden

Facility: Hunterdon Medical Center

Program: Diabetes Health Center

Diabetes Self-Management Education Group

Individual Nutrition Counseling

Pregnancy Diabetes Counseling

Community Lectures

Support Groups

Syringe Disposal Program

Glucose and Foot Screenings

vHealthHighway

-- Monthly email of wellness articles

Individual and Groups Sessions

Nutrition Counseling

Insulin Pump Classes and Support

Student with Diabetes School Program

Yoga for People with Diabetes

Safe Syringe Disposal Program

Stress Management Program

Diabetes Fitness Program

Group Home Instruction

Speaker Services

If both areas offer very similar programs, why is there such a huge disparity in the prevalence of diabetes in

each area?

Est. Pop in 2003: 80,089

Median Household Income: $23,421

Ancestry & Family History:

African American - 53%; Puerto Rican - 29%; Other Hispanic or Latino - 4%; Sub-Saharan African - 2%; African - 2%; West Indian (excluding Hispanic groups)

Support for Libraries: Local gov. funding was below national average in 2001-2002

Education: 5% of residents age 25 or older have a bachelor’s or advanced college degree

Est. Pop. in 2003: 4,234

Median Household Income: $39,886

Ancestry & Family History:

African American - 3%; Puerto Rican 7%; Other Hispanic or Latino; West Indian (excluding Hispanic groups) - 1%

Support for Libraries: Local gov. funding was above the national average in 2001-2002

Education: 27% of residents age 25 and older have a bachelor’s or advanced college degree

City of Camden in Camden County

City of Flemington in Hunterdon County

Comparison between the city of Comparison between the city of Camden and FlemingtonCamden and Flemington

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Treatment Focus for Type 1Treatment Focus for Type 1

PathophysiologyPathophysiology-- -- The pancreas does not The pancreas does not

produce insulinproduce insulin

-- This is an autoimmune -- This is an autoimmune diseasedisease

-- develops because the -- develops because the body destroys the beta body destroys the beta cells in the islet tissue of cells in the islet tissue of the pancreas that the pancreas that produces insulin. produces insulin.

So the main treatment So the main treatment goal for Type 1 diabetes goal for Type 1 diabetes is giving supplemental is giving supplemental insulininsulin..

Treatment Focus for Type 2Treatment Focus for Type 2

PathophysiologyPathophysiology– Insulin resistance, which is a Insulin resistance, which is a

condition in which body cells do condition in which body cells do not fully respond to the action of not fully respond to the action of insulin insulin

– Your pancreas does not make Your pancreas does not make enough insulinenough insulin

So the treatment goal for Type 2 So the treatment goal for Type 2 Diabetes is increase body’s Diabetes is increase body’s sensitivity to insulin and reduce sensitivity to insulin and reduce sugar intake.sugar intake.

Pharmaceutical Agents for Type 1Pharmaceutical Agents for Type 1

Insulin-Insulin- a hormone a hormone produced in the pancreas produced in the pancreas that allows sugar to enter that allows sugar to enter body cells, where it is used body cells, where it is used for energy. It also helps for energy. It also helps store extra body sugar in store extra body sugar in muscle, fat, and liver cells.muscle, fat, and liver cells.

Sources of InsulinSources of Insulin

-- Pigs-- Pigs

-- Cow-- Cow

-- Recombinant DNA-- Recombinant DNA

The Almighty InsulinThe Almighty Insulin

Insulin has to enter the body's Insulin has to enter the body's bloodstream to be effective. This is bloodstream to be effective. This is accomplished through injections into the accomplished through injections into the fat layer usually in the arm, thigh, or fat layer usually in the arm, thigh, or abdomen. abdomen.

The timing of insulin injections is very The timing of insulin injections is very important. Insulin usually needs to be important. Insulin usually needs to be administered before mealtimes.administered before mealtimes.

Alternative Ways of Administering Alternative Ways of Administering InsulinInsulin

Injection aidsInjection aids Insulin pensInsulin pens Insulin jet injectorsInsulin jet injectors An inhaled insulin delivery An inhaled insulin delivery

systemsystem Subcutaneous infusion Subcutaneous infusion External insulin pumpsExternal insulin pumps

The Insulin PumpThe Insulin Pump An insulin pump is a small mechanical An insulin pump is a small mechanical

battery operated device that is about battery operated device that is about the same size as a pager or cell the same size as a pager or cell

phone.  The insulin pump is made of a phone.  The insulin pump is made of a durable plastic that will withstand the durable plastic that will withstand the wear and tear that is required in daily wear and tear that is required in daily

activity.  activity. 

““Waiting to Inhale”Waiting to Inhale”The Insulin InhalerThe Insulin Inhaler

The FDA approved The FDA approved Pfizer's Exubera, the first Pfizer's Exubera, the first inhalable form of insulin inhalable form of insulin for diabetics in Late for diabetics in Late January of this year. January of this year.

Exubera is a dry, Exubera is a dry, powdered form of insulin powdered form of insulin that is inhaled into the that is inhaled into the lungs. This is the first lungs. This is the first new form of delivery new form of delivery since diabetics started since diabetics started injecting insulin in the injecting insulin in the 1920s.1920s.

Pharmaceutical Agents for Type 2. Pharmaceutical Agents for Type 2. Cont.Cont.

BiguanidesBiguanides-They lower blood sugar by -They lower blood sugar by decreasing the amount of sugar produced by the decreasing the amount of sugar produced by the liver. liver. -- Metformin (Glucophage-- Metformin (Glucophage®®))

Alpha Glucosidase Inhibitors- Alpha Glucosidase Inhibitors- block the block the enzymes that digest the starches you eat. This enzymes that digest the starches you eat. This action causes a slower and lower rise of blood action causes a slower and lower rise of blood glucose through the day, but mainly right after glucose through the day, but mainly right after meals. meals. -- Miglitol (Glyset-- Miglitol (Glyset®®))-- Acarbose (Precose-- Acarbose (Precose®®))

Pharmaceutical Agents for Type 2Pharmaceutical Agents for Type 2

ThazolinedionesThazolinediones- They improve the way cells in the body - They improve the way cells in the body respond to insulin by lowering insulin resistance. respond to insulin by lowering insulin resistance. -- Piglitazone (Actos-- Piglitazone (Actos®® ) )-- Rosiglitazone.-- Rosiglitazone.

SulfonylureasSulfonylureas- work by causing your pancreas to release - work by causing your pancreas to release more insulin into the bloodstream. this way it lowers blood more insulin into the bloodstream. this way it lowers blood sugar and helps the way you use food to make energy. sugar and helps the way you use food to make energy. -- glipizide, -- glipizide, -- tolazamide, -- tolazamide, -- glyburide.-- glyburide.

TLC Please!!! TLC Please!!! TTherapeuticherapeutic LLifestyleifestyle CChangeshanges

DietDiet Of all racial groups, African Americans have the most Of all racial groups, African Americans have the most

difficulty in eating diets that are low in fat and high in difficulty in eating diets that are low in fat and high in fruits, vegetables, and whole grains. Some explanations fruits, vegetables, and whole grains. Some explanations for this include: for this include: -- The greater market availability of packaged and processed -- The greater market availability of packaged and processed

foodsfoods-- The high cost of fresh fruit, vegetables, and lean cuts of meat-- The high cost of fresh fruit, vegetables, and lean cuts of meat-- The common practice of frying food-- The common practice of frying food-- Using fats in cooking.-- Using fats in cooking.

ExerciseExercise-- According to Initiative Media blacks watch 73.6 hours of TV a -- According to Initiative Media blacks watch 73.6 hours of TV a

week, about 17 hours more than Latinos and 22 hours more week, about 17 hours more than Latinos and 22 hours more than Whites and Asians.than Whites and Asians.

StressStress-- “Living while black” Index-- “Living while black” Index

Can we be compliant??Can we be compliant?? African-Americans with type 2 diabetes appear to be less likely African-Americans with type 2 diabetes appear to be less likely

than whites to take prescribed medications, reported in the July than whites to take prescribed medications, reported in the July issue of the issue of the Journal of the National Medical AssociationJournal of the National Medical Association. .

Factors that may lead to noncompliance with therapy include Factors that may lead to noncompliance with therapy include -- Onerous life-style changes, -- Onerous life-style changes, -- Drug side effects-- Drug side effects-- Failure to perceive benefit in the short term or believe that benefit -- Failure to perceive benefit in the short term or believe that benefit

will accrue in the long term.will accrue in the long term.-- Cost (money and time)-- Cost (money and time)

EDUCATION is the key!!!EDUCATION is the key!!!-- Explain to patients the importance of compliance when taking -- Explain to patients the importance of compliance when taking

medications for type 2 diabetes.medications for type 2 diabetes.-- Explain that oral medications, combined with diet changes and -- Explain that oral medications, combined with diet changes and

exercise, may prevent or delay the need for insulin injections, and exercise, may prevent or delay the need for insulin injections, and can reduce the risk for complications such as blindness, heart can reduce the risk for complications such as blindness, heart disease, kidney failure, and vascular and neurological problems disease, kidney failure, and vascular and neurological problems leading to amputations.leading to amputations.

A key reason of non-compliance in African Americans is A key reason of non-compliance in African Americans is the cultural factor.the cultural factor.

Definition:Definition: Customary beliefs, social forms Customary beliefs, social forms

and material traits of a racial, and material traits of a racial, religious or social groupreligious or social group

May also refer to characteristics May also refer to characteristics of everyday existence shared by of everyday existence shared by a people in a place or timea people in a place or time

Culture can include the Culture can include the language, music, food, and language, music, food, and rituals.rituals.

African American CultureAfrican American Culture

NutritionNutritionGeneral Dietary InfluencesGeneral Dietary Influences

--African Americans have difficulty eating --African Americans have difficulty eating diets low in fat and high in vegetables, fruits diets low in fat and high in vegetables, fruits and whole grainand whole grain

--Explanations may include:--Explanations may include:– Availability of packaged and processed foodsAvailability of packaged and processed foods– High cost of healthy foods, including vegetables, High cost of healthy foods, including vegetables,

fresh fruits and lean cuts of meat.fresh fruits and lean cuts of meat.– Common culture of frying foods and using fat in Common culture of frying foods and using fat in

soul food preparation.soul food preparation.

African American CultureAfrican American Culture

Derived from slavery and rural Derived from slavery and rural impoverished conditionsimpoverished conditions

Traditionally cooked and seasoned Traditionally cooked and seasoned with pork products and fried in lard or with pork products and fried in lard or oiloil

Foods include chitterlings (chitlins), Foods include chitterlings (chitlins), pork chops, potlikker, turnips, grits, pork chops, potlikker, turnips, grits, and hushpuppiesand hushpuppies

African American CultureAfrican American Culture

African American Belief in HealthcareAfrican American Belief in Healthcare-- Culture affects African Americans taking -- Culture affects African Americans taking

symptoms seriously. symptoms seriously.

-- Health beliefs stem from religious -- Health beliefs stem from religious beliefsbeliefs

-- Many often turn to home remedies-- Many often turn to home remediesYellow root tea lowers blood sugarYellow root tea lowers blood sugarFresh pork helps improve hypertensionFresh pork helps improve hypertension

African American CultureAfrican American Culture

African American Belief in HealthcareAfrican American Belief in Healthcare-- Beliefs about diabetes-- Beliefs about diabetes

Common themes includeCommon themes include– ““Running in families”Running in families”– ““Eating too much sugar”Eating too much sugar”– ““Not taking care of yourself”Not taking care of yourself”

African Americans And HealthcareAfrican Americans And Healthcare Disparities reflect a long history of Disparities reflect a long history of

economic deprivation and barriers to economic deprivation and barriers to healthcarehealthcare--African American adults are less likely to have --African American adults are less likely to have

job based insurancejob based insurance

--African Americans are twice as likely as Whites --African Americans are twice as likely as Whites to report treatment with disrespect during a to report treatment with disrespect during a healthcare visit.healthcare visit.

--African Americans were almost twice as likely --African Americans were almost twice as likely as whites to believe their doctor’s looked down as whites to believe their doctor’s looked down on them.on them.

Questions to consider:Questions to consider:--How does the African American culture --How does the African American culture

deal with illness?deal with illness?

--How are medical decisions made in the --How are medical decisions made in the African American community?African American community?

--What is the African American culture’s --What is the African American culture’s norms about healthcare and sickness?norms about healthcare and sickness?

Cultural SensitivityCultural Sensitivity

Incorporation of experiences, norms, Incorporation of experiences, norms, values, behavioral patterns, and values, behavioral patterns, and beliefs of a specific population.beliefs of a specific population.

Role Of the GovernmentGovernment

Is Congress Helping?Is Congress Helping?

Gestational ActGestational Act Health Insurance Health Insurance

OptionsOptions School Legislative School Legislative

ActionAction

Gestational ActGestational Act Gestational Diabetes occurs is 4 to 8 Gestational Diabetes occurs is 4 to 8

percent of all pregnant women. With this percent of all pregnant women. With this being the case, 135,000 women in the being the case, 135,000 women in the United States alone are affected by this United States alone are affected by this type of diabetes. type of diabetes.

In response to this, Sens. Hillary Rodham In response to this, Sens. Hillary Rodham Clinton and Susan Collins presented the Clinton and Susan Collins presented the Gestational Diabetes (GEDI) Act to the U.S. Gestational Diabetes (GEDI) Act to the U.S. Senate.Senate.

The bill aims to lower the incidence of The bill aims to lower the incidence of gestational diabetes and prevent women gestational diabetes and prevent women afflicted with this condition and their afflicted with this condition and their children from developing type 2 diabetes.children from developing type 2 diabetes.

Health Insurance OptionsHealth Insurance Options

Diabetes is a disease that is for most people self- managed. In order to stay healthy, a person with diabetes needs access to supplies like test strips, meters and insulin.

Usually, people are able to get these medications and supplies through their health insurance policies.

Ironically those who have diabetes may find difficulty obtaining and or keeping health insurance and life insurance!

But through American Diabetes Association (ADA) these is hope!

This association is committed to improving the quality of life for seniors affected with diabetes. Under the Medicare and Modernization Act, millions of people with Medicare will be able to live longer and healthier lives through utilization of new preventative services that became effective January 1, 2005.

School Legislative Action

Students with diabetes should have the Students with diabetes should have the same access to educational opportunities as same access to educational opportunities as other students. In some schools this other students. In some schools this principle is not exercised. As a result federal principle is not exercised. As a result federal laws such as the laws such as the Individual with Diabetes Individual with Diabetes in Education Actin Education Act (IDEA) have been (IDEA) have been instituted.instituted.

The states that have passed school diabetes care legislation are marked in red.

Diabetes Outreach and Education Diabetes Outreach and Education (DOES)(DOES)

The Diabetes Outreach and Education The Diabetes Outreach and Education System program (DOES) works with System program (DOES) works with individuals and organizations to increase individuals and organizations to increase public awareness and encourage actions public awareness and encourage actions that will help communities control diabetes that will help communities control diabetes and its complications. This initiative and its complications. This initiative supports the National Diabetes Education supports the National Diabetes Education Program effort to help communities across Program effort to help communities across the country develop comprehensive the country develop comprehensive outreach programs and education outreach programs and education campaigns to control type 2 diabetes. campaigns to control type 2 diabetes.

Diabetes Outreach and Education Diabetes Outreach and Education (DOES) cont.(DOES) cont.

The DOES program targets five The DOES program targets five southern Jersey communities: southern Jersey communities: Atlantic , Camden , Cumberland , Atlantic , Camden , Cumberland , Salem and Ocean Counties . It is the Salem and Ocean Counties . It is the first program of its kind in New Jersey first program of its kind in New Jersey and is a statewide model. and is a statewide model.

Lightened Hunterdon is a Hunterdon is a Partnership for HealthPartnership for Health initiative to raise awareness about weight management initiative to raise awareness about weight management and increasing physical activity to Hunterdon County and increasing physical activity to Hunterdon County residents and health professionalsresidents and health professionals

The New Jersey Area Health Education Centers The New Jersey Area Health Education Centers (AHEC) were established in 1978, in partnership (AHEC) were established in 1978, in partnership with the University of Medicine and Dentistry of with the University of Medicine and Dentistry of New Jersey, as part of a national initiative to New Jersey, as part of a national initiative to strengthen the health of communities through strengthen the health of communities through educational partnerships. educational partnerships.

Camden AHEC is committed to improving the Camden AHEC is committed to improving the health of the medically underserved - the ethnic health of the medically underserved - the ethnic and culturally diverse, the aged, the poor, the and culturally diverse, the aged, the poor, the very young, the unemployed, the homeless and very young, the unemployed, the homeless and the uninsured. Particular emphasis is on the uninsured. Particular emphasis is on providing services in the communities of Camden providing services in the communities of Camden and Camden and Burlington Counties.and Camden and Burlington Counties.

The Positives of (DOES)

Increases knowledge of diabetes Increases knowledge of diabetes through educational programs and an through educational programs and an annual congressannual congress

Engages with statutory organizations Engages with statutory organizations on behalf of the people with diabetes.on behalf of the people with diabetes.

Promotes research that is relevant to Promotes research that is relevant to people with diabetes in underserved people with diabetes in underserved areas.areas.

The Diabetes Association of South Africa (DASA)

Diabetes South Africa is a non-profit Diabetes South Africa is a non-profit organization, funded in 1969 to be a organization, funded in 1969 to be a support and an advocate for all support and an advocate for all people with diabetes in South Africa people with diabetes in South Africa

The Goal of DASAThe Goal of DASA Our mission is to assist all people Our mission is to assist all people

affected by diabetes so that their affected by diabetes so that their lives may be as healthy and lives may be as healthy and satisfying as possible satisfying as possible

The Positives of (DASA)The Positives of (DASA)

Informing, encouraging and Informing, encouraging and supporting all people who have supporting all people who have diabetes and their families. diabetes and their families.

Acting as an advocate for people Acting as an advocate for people with diabetes, lobbying for better with diabetes, lobbying for better facilities, cheaper medication and facilities, cheaper medication and better services. better services.

Promoting public awareness of Promoting public awareness of diabetes, its symptoms and risks. diabetes, its symptoms and risks.

The Bird’s Eye View of the TwoThe Bird’s Eye View of the Two

D.A.S.A D.O.E.SVs.

Education Education The Bird’s Eye The Bird’s Eye

View of the TwoView of the Two Government RoleGovernment Role Public AwarenessPublic Awareness

Education Education

Community RoleCommunity Role

ResearchResearch

By consolidating the pros of both programs we created our own

Model.

SolutionSolution

Government officials should establish Government officials should establish a program that’s more cultural a program that’s more cultural

sensitive.sensitive.

Four Point StrategyFour Point Strategy

Educate the public, caregivers & providersEducate the public, caregivers & providers

Simplify the patient-physician education & Simplify the patient-physician education & monitor their progressmonitor their progress

Motivate patients and providers through Motivate patients and providers through financial incentives, such as discountsfinancial incentives, such as discounts

Regulate health care standards and Regulate health care standards and qualityquality

Motto:Motto: Exceptional living begins with diabetes! Exceptional living begins with diabetes!

Goals:Goals: Be effective by providing cultural sensitive Be effective by providing cultural sensitive services through:services through:

-- Ongoing Support Groups-- Ongoing Support Groups

-- Free Screenings for Diabetes and other incentives, such as -- Free Screenings for Diabetes and other incentives, such as discounts discounts

-- Seminars to educate diabetics on insulin injections and other -- Seminars to educate diabetics on insulin injections and other treatments treatments

Implemented in areas with low socioeconomic Implemented in areas with low socioeconomic status, such as Camdenstatus, such as Camden

HEAL (Helping Every African American Live)

Funding for HEALFunding for HEAL

State fundingState funding American Heart and Lung AssociationAmerican Heart and Lung Association ADA (American Diabetes Association)ADA (American Diabetes Association) CDC (Center for Disease Control and Prevention)CDC (Center for Disease Control and Prevention) One Touch (machine that test blood sugar)One Touch (machine that test blood sugar) NAACPNAACP Pharmaceutical CompaniesPharmaceutical Companies

Interview with Dr. Aliya Brown

From Hunterdon Cardiovascular Group

Hunterdon Medical Center

190 Hwy 31, Suite 300

Flemington, NJ 08822

(908) - 788 - 6136