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
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
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).
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1991-92
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
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).
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1993-94
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
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).
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1995-96
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
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).
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1995
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
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).
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1997-98
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
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).
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1999
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
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).
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 2000
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
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).
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 2001
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
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).
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
Blood
SI
S
Insulin
SI
SI
Sugar
SI
S
Body
Metabolism without Diabetes
Blood
Body
S
S
S
S
Insulin
S
S
S
Sugar
S
Metabolism with Diabetes
Blood
SI
S
Insulin
Sugar
SI
S
SI
S
S
S S
Body
Metabolism with Diabetes
Blood
Body
SI
S
Insulin
Sugar
SI
SI
S
S S
S
S
S
Progression of Diabetes
10-30 years
Insulin Resistance
Insulin Production
Fasting Blood Glucose
Glucose Intolerance
FBG: 80-125
Diagnosis 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?