10th Biennial Conference
Management of Diabetes
in Youth
Keystone, July 12-16, 2008
Barbara Davis Center
for Childhood Diabetes
Goals
• Learn to serve better children and youth
suffering from diabetes
• Meet colleagues, enjoy the mountains,
have fun
Tradition
CDF
1977- present
Professor Peter Chase, MD
BDC Clinical Director 1980-2000
Keystone Conference Program Director 1990-2006
Sponsors
Platinum: Abbott Diabetes Care
Novo Nordisk
Gold: LifeScan; Roche Diagnostics; Smith Medical
Silver: Medtronic Diabetes, Pfizer, Sanofi-Aventis
Brass: Agamatrix; ADA; Animas Corp; BD Medical/DC;
Cumberland Hospital; Eli Lilly & Co; Insulet Corp;
Nipro Diabetes Systems
Organizers
Marijane Engel (CDF)
Linda Schneider (CDF)
Ariel Quigley (CDF)
Volunteers (Guild)
Carissa Figal (BDC)
Ian Smith (BDC) - slides
Barbara Davis Center for Childhood Diabetes
www.BarbaraDavisCenter.org
Pediatric Clinic:
3,500 T1D & T2D patients
Young Adult Clinic: 1,800 T1D patients
Eye Clinic, Laboratories
Since 2005
1980-2005
Tours of the BDC
• Thursday 8-3
• 30 min- 1 hour
• Contact Carissa Figal to sign up
Diabetes in Youth
in the U.S.
170,000 patients younger than 20 y
1,500,000 patients with type 1 diabetes
all ages
Number of new patients annually has tripled
in the past 20 years
T1D incidence is rising 3-5% per year
Due to environmental cause(s)
70
Incidence /100,000/ yr
in children aged 0-14
60
Finland
50
Sweden
40
30
Colorado
20
Germany
10
0
1950
1960
1970
1980
1990
2000
Technology
Where are We Today?
Average A1c by Age, 2005-06
Sweden
(80% of
the nation)
Los
Angeles
N=1664
BDC
Denver
N=3910
<6
7.5
8.0
7.8
6-12
7.9
7.8
8.2
8.4
8.4*
8.6
Age
Intensive Rx
DCCT
N=195
EDIC
N=175 N=1,295^
13-18 8.1
8.4
>18
7.9
7.1
Hvidoere
8.6*^
8.0
7.8
*11-18 yrs; ^the original 14 centers, unchanged compared to 1998
T1D patients diagnosed in childhood
live longer
1
1975-79
1975
19701970-74
0.9
0.8
19651965-69
0.7
0.6
0.5
0
5
10 15 20 25 30 35
NishmuraR, et al. Diabetes Care 2001
Duration of diabetes (yrs)
Incidence of microvascular complications is declining
Proliferative diabetic retinopathy
Diabetic nephropathy
1965-69
1961-65
1970-74
1965-69
40
1966-70
1970-74
30
1975-79
1971-75
20
1966-70
1980-84
1976-80
Hovind P, et al. Diabetes Care 2003
10
19751971-75
79
1980-84
1976-80
Poor control of hypertension and dyslipidemia
in young adult patients with T1D
Normal
Treated, controlled
Treated, uncontrolled
Untreated
11%
30%
6%
16%
53%
67%
10%
7%
Hypertension
Dyslipidemia
Maahs D, Diabetes Care 2005
Wadwa P, Diabetes Care 2005
CME Credits
• Nurses must sign in daily
• All others need to sign in only once
• The sheets are at the Conference
Registration desk
• The American Dietetic Association may
award additional credits.
Evaluation sheets
• Sheets included with your materials
• Please turn in on the last day at the
Conference Registration desk
• Your feedback and suggestions for the
future are important!
Books
• “Understanding Insulin Pumps & CGMs”
by Peter Chase included in your backpack
• Additional copies as well as the “Pink
Panther” books available for sale at the
Registration desk
Dinner tonight
• Here, Longs Peak room, 5:45-6:45
Speaker: Dr. Robert Slover (BDC)
• Topic: “Closing the loop with insulin pumps
and glucose sensors”
• Sponsored by: LifeScan, Medtronic Diabetes &
Novo Nordisk
• Followed by “Meet with Counterparts”,
here 6:45-8:00
Altitude sickness
Above
8000 ft - 20-30% of visitors from low altitude affected
Keystone 9300 ft (2800 m) - 72% of the oxygen at sea level
Mountains 12000-14000 ft (3650-4300 m) – 60-65% of the oxygen
Symptoms last usually 1-2 days only, if severe – seek help !
•
•
•
•
•
•
•
•
•
•
Headache
Poor appetite, nausea, vomiting
Fatigue or weakness
Dizziness or light-headedness
Insomnia
Pins and needles
Shortness of breath on exertion
Persistent rapid pulse
General malaise, drowsiness
Swelling of hands, feet & face)
Prevent altitude sickness
•
•
•
•
•
•
Stay at low elevation
Do not exercise hard
Drink more water (avoid carbonated drinks)
Eat more carbs, less fat and less salt
Reduce alcohol and caffeine intake
Feeling worse? - seek help
• smoking, emphysema, asthma, anemia,
diabetes, high blood pressure
• UV, lightning, cold, dehydration