Preventing Diabetes

Cecilia Sauter MS, RD, CDE

Diabetes Self-Management Education Program

University of Michigan

Diabetes and Gestational Diabetes Trends Among

Adults in the U.S., BRFSS 1990

Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

No Data <4% 4%-6% 6%-8% 8%-10% >10%

Diabetes and Gestational Diabetes Trends Among

Adults in the U.S., BRFSS 1991-92

Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

No Data <4% 4%-6% 6%-8% 8%-10% >10%

Diabetes and Gestational Diabetes Trends Among

Adults in the U.S., BRFSS 1993-94

Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

No Data <4% 4%-6% 6%-8% 8%-10% >10%

Diabetes and Gestational Diabetes Trends Among

Adults in the U.S., BRFSS 1995-96

Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

No Data <4% 4%-6% 6%-8% 8%-10% >10%

Diabetes and Gestational Diabetes Trends Among

Adults in the U.S., BRFSS 1995

Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

No Data <4% 4%-6% 6%-8% 8%-10% >10%

Diabetes and Gestational Diabetes Trends Among

Adults in the U.S., BRFSS 1997-98

Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

No Data <4% 4%-6% 6%-8% 8%-10% >10%

Diabetes and Gestational Diabetes Trends Among

Adults in the U.S., BRFSS 1999

Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

No Data <4% 4%-6% 6%-8% 8%-10% >10%

Diabetes and Gestational Diabetes Trends Among

Adults in the U.S., BRFSS 2000

Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

No Data <4% 4%-6% 6%-8% 8%-10% >10%

Diabetes and Gestational Diabetes Trends Among

Adults in the U.S., BRFSS 2001

Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes, and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).

No Data <4% 4%-6% 6%-8% 8%-10% >10%

Diabetes in the US

• Currently 20.8 million have diabetes

• 14.6 million have the diagnosis

• 6.2 million don’t know they have diabetes

Etiology of Diabetes• Family history

• Ethnicity– African American– Native American– Hispanic– Asian Americans– Pacific Islanders

• Age

• Gestational Diabetes or babies over 9 pounds

Etiology of Diabetes• Increased weight

– BMI: • overweight = 25.0 to 29.9 kg/m2

• obese > 30.0 kg/m2

• Increased central (i.e., visceral) obesity– Waist circumference:

• Men > 40 in

• Women > 35 in

• Decreased activity

Metabolism without Diabetes

Insulin

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Metabolism without Diabetes

Insulin

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Blood Body

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Metabolism with Diabetes

Insulin

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BodyBlood

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Metabolism with Diabetes

Insulin

Sugar

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FBG: 80-125

10-30 years

Insulin Resistance

Insulin Production

Glucose Intolerance

Diagnosis of Diabetes

Fasting Blood Glucose

Progression of Diabetes

Pre-diabetes

• 2000– 40 % of people aged 40-74 years– 41 million

• 2002– 54 million

Prevention of Diabetes

• Diabetes Prevention Program

– Lifestyle changes• Changes in eating habits• Increase in physical activity• 58% reduction in type 2 diabetes

Prevention of Diabetes

• Weight loss– 5% to 10% weight loss– Weight loss rate of 1 to 2 lb/week– Decrease of 300 to 500 kcal/day = 1/2 to 1 lb weight

loss/week• Increased physical activity and/or decreased food intake

Prevention of Diabetes

• Healthy Nutrition Recommendations:– Decrease total fat intake

• smaller amounts of high fat foods

• broiling/stir fry vs. frying

• remove skin from chicken

• substitute with low calorie/low-fat foods

Prevention of Diabetes

• Healthy Nutrition Recommendations:– Increase fruits and vegetables

– Whole grains vs. processed

– Include dry beans and lentils

– Drink water & calorie free drinks

– Cut back on high calorie snacks

– Watch portion sizes

Prevention of Diabetes

• Healthy Nutrition Recommendations:– Rate your plate

• ¼ grains or starchy foods

• ¼ protein

• ½ non starchy vegetables

• Add 1 glass milk or small piece of fruit

Prevention of Diabetes

• Physical Activity– Benefits:

• Increases insulin sensitivity

• Decreases weight

• Decreases blood pressure and cholesterol

• Decreases stress

• DECREASES risk of type 2 diabetes

Prevention of Diabetes

• Physical Activity– Recommendations:

• 30 minutes/day for 5 to 7 days a week

• 10 minutes of activity 3 times/day

Prevention of Diabetes

• Getting started:– What activities can you do

– Realistic activities

– Start slow:• What, when, where, how often, how long

• Challenging but not overly difficult

– Be flexible

– Reward yourself

Calories Spent in Various Activities

• Walking, 3.0 miles/hr• Walking 5 miles/hr• Cycling, 8 miles/hour• Mopping, vacuuming• Scrubbing floors• Gardening• Vigorous dancing

• 275/hr• 420/hr• 325/hr• 240/hr• 300/hr• 220/hr• 320-500/hr

Fad Diets

• Watch for rapid weight loss

• Loss of muscle mass and water vs. fat

• Expensive

Nutritional Supplements

• They DO not reduce risk of Type 2 Diabetes

• Safety is uncertain

• No scientific evidence to aid in weight loss

• Expensive

Screening for Type 2 Diabetes

• Positive family history

• Ethnic group

• Increased weight and/or central obesity

• Gestational diabetes or big babies

• Decreased activity

• Symptoms of diabetes– Increased thirst, increased urination & weight loss

Diagnostic Criteria for Type 2 Diabetes

• Fasting blood sugar > 126 mg/dl

• 2 hour glucose tolerance > 200 mg/dl

• Acute symptoms plus random glucose > 200 mg/dl

Impaired Glucose Tolerance“Pre-diabetes”

• Impaired Fasting: – Level between >100 mg/dl and <126 mg/dl

• Impaired glucose:– During 2 hour glucose tolerance test– Level between >140 and <200 mg/dl

Thank you

If you would like a copy of this presentation please send an email to: diabetes@umich.edu

Questions?