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DIABETES

DIABETES. How to address a complex problem in resource poor regions. Bob Lawrence Alaska Family Doctor September 2009. DIABETES DEFINED. Diabetes Mellitus Meaning = siphon sweetness. DIABETES in U.S. The Modern US Lifestyle is Diabetogenic. 23.6 million in the US have DM

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DIABETES

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  1. DIABETES How to address a complex problem in resource poor regions. Bob Lawrence Alaska Family Doctor September 2009

  2. DIABETES DEFINED Diabetes Mellitus Meaning = siphon sweetness

  3. DIABETES in U.S. The Modern US Lifestyle is Diabetogenic. • 23.6 million in the US have DM • ~ 7.8 % of total population • ~ 300 million estimated cases by 2025 • 52% of Americans will have DM or Pre- DM by 2020. • Cause of more deaths than AIDS and • Breast cancer combined.

  4. DIABETES in U.S. Where is diabetes affecting Americans?

  5. Diabetes Trends* Among Adults in the U.S.,(Includes Gestational Diabetes)BRFSS 1990 No data > 4 % 4-6 % 6-8 % 8-10 % > 10 % Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

  6. Diabetes Trends* Among Adults in the U.S.,(Includes Gestational Diabetes)BRFSS 1991-92 No data > 4 % 4-6 % 6-8 % 8-10 % > 10 % Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

  7. Diabetes Trends* Among Adults in the U.S.,(Includes Gestational Diabetes)BRFSS 1993-94 No data > 4 % 4-6 % 6-8 % 8-10 % > 10 % Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

  8. Diabetes Trends* Among Adults in the U.S.,(Includes Gestational Diabetes)BRFSS 1995-96 No data > 4 % 4-6 % 6-8 % 8-10 % > 10 % Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

  9. Diabetes Trends* Among Adults in the U.S.,(Includes Gestational Diabetes)BRFSS 1995 No data > 4 % 4-6 % 6-8 % 8-10 % > 10 % Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

  10. Diabetes Trends* Among Adults in the U.S.,(Includes Gestational Diabetes)BRFSS 1997-98 No data > 4 % 4-6 % 6-8 % 8-10 % > 10 % Source: Mokdad et al., Diabetes Care 2000;23:1278-83.

  11. Diabetes Trends* Among Adults in the U.S.,(Includes Gestational Diabetes)BRFSS 1999 No data > 4 % 4-6 % 6-8 % 8-10 % > 10 % Source: Mokdad et al., Diabetes Care 2001;24:412.

  12. Diabetes Trends* Among Adults in the U.S.,(Includes Gestational Diabetes)BRFSS 2000 No data > 4 % 4-6 % 6-8 % 8-10 % > 10 % Source: Mokdad et al., J Am Med Assoc 2001;286:10.

  13. Diabetes Trends* Among Adults in the U.S.,(Includes Gestational Diabetes)BRFSS 2001 No data > 4 % 4-6 % 6-8 % 8-10 % > 10 % Source: Mokdad et al., J Am Med Assoc 2001;286:10.

  14. OBESITY INCREASES RISK

  15. Obesity Trends Among U.S. AdultsBRFSS, 1990, 1999, 2009 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 1999 1990 2009 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  16. Obesity Trends Among U.S. Adults1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

  17. Obesity Trends Among U.S. Adults1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

  18. Obesity Trends Among U.S. Adults1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

  19. Obesity Trends Among U.S. Adults1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

  20. Obesity Trends Among U.S. Adults 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

  21. Obesity Trends Among U.S. Adults1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

  22. Obesity Trends Among U.S. Adults1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  23. Obesity Trends Among U.S. Adults1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  24. Obesity Trends Among U.S. Adults1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  25. Obesity Trends Among U.S. Adults1994 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  26. Obesity Trends Among U.S. Adults1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  27. Obesity Trends Among U.S. Adults1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

  28. Obesity Trends Among U.S. Adults1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

  29. Obesity Trends Among U.S. Adults1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

  30. Obesity Trends* Among U.S. Adults1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

  31. Obesity Trends Among U.S. Adults2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

  32. Obesity Trends Among U.S. Adults2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  33. Obesity Trends Among U.S. Adults2002 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  34. Obesity Trends Among U.S. Adults2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  35. Obesity Trends Among U.S. Adults2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

  36. Obesity Trends Among U.S. Adults2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  37. Obesity Trends Among U.S. Adults2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  38. Obesity Trends Among U.S. Adults2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  39. Obesity Trends Among U.S. Adults2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  40. Obesity Trends Among U.S. Adults2009 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

  41. Age-Adjusted Prevalence of Diabetes* by Race/Ethnicity in the US American Indians/Alaska Natives Non-Hispanic Blacks 19% Hispanic/LatinoAmericans 15% Non-Hispanic Whites 14% 7% Percent *In people 20+ years old Sources: 1997-1999 National Health Interview Survey and 1988-1994 National Health and Nutrition Examination Survey (NHANES) estimates projected to year 2000. 1998 outpatient database of the Indian Health Service www.hypertensiononline.org CDC. National Diabetes Fact Sheet. 2002.

  42. GLOBAL TRENDS Global Trends in Diabetes 2010 <4% 4% 5% 7% 9% ≥ 12%

  43. 2030 <4% 4% 5% 7% 9% ≥ 12% <4% 4% 5% 7% 9% ≥ 12%

  44. GLOBAL TRENDS Millions of Cases of Diabetes in 2000 and Projections for 2030, with Projected Percent Changes. Data are from Wild et al.

  45. GLOBAL TRENDS Global Trends in Diabetes 3.8 million DM related deaths world wide in 2007 6% total global mortality rate from DM (the same as HIV/AIDS). $557.7 billion in lost national income in China, and $236.6 billion in India by 2015. <4% 4% 5% 7% 9% ≥ 12%

  46. DIAGNOSIS Criteria for Diagnosis of Diabetes Normal Pre-Diabetes Diabetes Impaired glucose tolerance OGTT- oral glucose tolerance test

  47. DIAGNOSIS Criteria for Diagnosis of Diabetes Normal Pre-Diabetes Diabetes Impaired glucose tolerance Fasting Glucose <100 mg/dL 100-125 mg/dL > 125 mg/dL OGTT- oral glucose tolerance test

  48. DIAGNOSIS Criteria for Diagnosis of Diabetes Normal Pre-Diabetes Diabetes Impaired glucose tolerance Fasting Glucose <100 mg/dL 100-125 mg/dL > 125 mg/dL Casual >200 mg/dL with symptoms Glucose polyuria, polydipsia, wt loss OGTT- oral glucose tolerance test

  49. DIAGNOSIS Criteria for Diagnosis of Diabetes Normal Pre-Diabetes Diabetes Impaired glucose tolerance Fasting Glucose <100 mg/dL 100-125 mg/dL > 125 mg/dL Casual >200 mg/dL with symptoms Glucose polyuria, polydipsia, wt loss 2 hour < 140 mg/dL 140-199 mg/dL >200 mg/dL OGTT OGTT- oral glucose tolerance test using 75 g load

  50. DIAGNOSIS Criteria for Diagnosis of Diabetes Normal Pre-Diabetes Diabetes Impaired glucose tolerance HA1c < 6.0 6.0 - 6.5 > 6.5 % OGTT- oral glucose tolerance test using 75 g load

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