Intervention presentation on Diabetes
NRS- 410V Module 5
Diabetes- A public Health Problem
High disease burden to individual and society.
Disproportionate burden to elderly and minorities.
Effective primary and secondary prevention strategies.
Family and friends
Health care professionals
Essential Public Health Strategies
Monitor health status to identify problems
Diagnose and investigate health problems
Inform, educate and empower people
Mobilize community partnerships
Develop policies and enforce regulations
Evaluate effectiveness of health services
Research innovative solutions to problems
Complications of Diabetes
Increased risk of
Blindness in adults
Stroke and death due to stroke
Heart attack and death due to heart attack
Lower limb amputation
Cost of Diabetes- 132$ Billion
Estimate of lost work days, restricted activity days, prevalence of permanent disability, and mortality attributable to disease.
23.2$ billion for diabetic care
24.6 4 Biillion for chronic complications
44.1$ billion for excess prevalence of general medical conditions.
Prevention of Complications
Causes impaired glucose tolerance
No complications as long as B cells function
Strategies may address either
Good medical care including self management and prevention
Outreach and education.
Chronic Disease Self- Management
Assess and specify problem/target behavior
Provide follow up care
Collaboratively support and enhance social resources and barriers.
Set goals and identify
Provide personalized coping skills
For type 2 diabetes
For pre diabetes- estimated 21% of adults
Impaired glucose tolerance 104-190mg/dl
Impaired fasting glucose 100-125mg/dl
Prevent or delay Type 2 Diabetes
Intervention in community health centers
Diet, exercise, both or control
No difference between intervention groups
Diet plus exercise to achieve 5% weight loss
4.2 kg weight loss, 58% reduction risk over 4 years
43% reduction in 7 years
Clearly definded goals
Individual case managers
Supervised exercise session
Cultrually competent materials or strategies
Extensive network for training and support
Metformin- 31% reduction in risk
Lifestyle intervention- 58% reduction risk
Greater weight loss
Higher levels of physical activity
Improved insulin sensitivity and B-cell function
Lower average HbA1c from 6 months to 3 years, no difference at 4 years vx metformin
3 year follow up showed improvements in BP, lipids, and C-reactive protein.
Roles in Diabetic prevention
Increases insulin sensitivity in contracting muscle for 24-72 hours
Increases glucose uptake
Increases muscle mass requires more gluose
Metabolic adaptations enhance glucose use
Contracting muscles use glucose without insulin
Prevent or delay complications of slow progression of existing complications.
Tuomi, T. (2005). Type 1 and Type 2 Diabetes: What do they have in common? Diabetes, 5 (suppl-2).S40-S45.
Center for Disease Control. (2010). from www.cdc.gov. Retrieved on Oct 27, 2014
American Diabetes Association. (2010) .from www.diabetes.org. Retrieved on Oct 27, 2014
Nathan. M. et al. (2008