Intervention Presentation on diabetes

Diabetes- A public Health Problem

High disease burden to individual and society.Disproportionate burden to elderly and minorities.Effective primary and secondary prevention strategies.Systems approachIndividualFamily and friendsHealth care professionalsCommunityPolicy

Essential Public Health Strategies

Monitor health status to identify problemsDiagnose and investigate health problemsInform, educate and empower peopleMobilize community partnershipsDevelop policies and enforce regulationsEvaluate effectiveness of health servicesResearch innovative solutions to problems

Complications of Diabetes

Increased risk ofBlindness in adultsStroke and death due to strokeHeart attack and death due to heart attackLower limb amputationKidney failure

Cost of Diabetes- 132$ Billion

IndirectEstimate of lost work days, restricted activity days, prevalence of permanent disability, and mortality attributable to disease.Direct 23.2$ billion for diabetic care24.6 4 Biillion for chronic complications44.1$ billion for excess prevalence of general medical conditions.

Prevention of Complications

Insulin resistanceCauses impaired glucose toleranceNo complications as long as B cells functionB-cell dysfunctionStrategies may address eitherGood medical care including self management and preventionOutreach and education.

Chronic Disease Self- Management

Assess and specify problem/target behaviorProvide follow up careCollaboratively support and enhance social resources and barriers.Set goals and identifyGain motivatorsProvide personalized coping skills

Screening Options

For type 2 diabetesFor pre diabetes- estimated 21% of adultsImpaired glucose tolerance 104-190mg/dlImpaired fasting glucose 100-125mg/dlWho?Ethnic minoritiesObeseHypertension

Prevent or delay Type 2 Diabetes

Intervention in community health centersDiet, exercise, both or controlNo difference between intervention groupsFinish studyDiet plus exercise to achieve 5% weight loss4.2 kg weight loss, 58% reduction risk over 4 years43% reduction in 7 years

Lifestyle Interventions

Clearly definded goalsIndividual case managersIntensive intervention16week curriculumSupervised exercise sessionMaintenance programCultrually competent materials or strategiesExtensive network for training and support

Effectiveness

Metformin- 31% reduction in riskLifestyle intervention- 58% reduction risk Greater weight lossHigher levels of physical activityImproved insulin sensitivity and B-cell functionLower average HbA1c from 6 months to 3 years, no difference at 4 years vx metformin3 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 hoursIncreases glucose uptakeIncreases muscle mass requires more gluoseMetabolic adaptations enhance glucose useContracting muscles use glucose without insulinPrevent or delay complications of slow progression of existing complications.

References

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, 2014American Diabetes Association. (2010) .from www.diabetes.org. Retrieved on Oct 27, 2014 Nathan. M. et al. (2008