Diabetes Mellitus
PRESENTED BY:
Folasade Adesina
Michael Itidiare
Nicole Lafortune
Sophia Laguer
Lauren Young
Ali Zaidi
SPECIAL THANKS TO:
Dr. Aliya Brown
 Diabetes
mellitus is a disease
characterized by persistent
hyperglycemia (high blood sugar
levels). It is a metabolic disease that
requires medical diagnosis,
treatment and lifestyle changes.
Problem

Although many
resources and
programs have
been established
to decrease the
prevalence of
diabetes, diabetes
is still increasing
in the African
American
community
Question

Is the prevalence of diabetes within
the African American community
more linked to their socioeconomic
status or genetics?
What Are the Two
Types of Diabetes
 Type
I Diabetes
 Type II Diabetes


Type I Diabetes An autoimmune disease in
which the pancreas makes little or no insulin,
resulting in an abnormally high blood sugar
level. Formerly known as insulin-dependent
diabetes or juvenile diabetes
Type II Diabetes insulin is present but doesn't
work adequately. Usually occurs over the age of
30 and is controlled by diet and medication or
diet and insulin. Also known as non insulin
dependent and maturity onset diabetes.
Comparison in Type I and Type II Diabetes
Type I
Type II
 Onset primarily in childhood
and adolescence
 Onset predominantly after 40
years of age*
 Often thin or normal weight
 Often obese
 Prone to ketoacidosis
 No ketoacidosis
 Insulin administration required
for survival
 Insulin administration not
required for survival
 Pancreas is damaged by an
autoimmune attack
 Pancreas is not damaged by an
autoimmune attack
 Absolute insulin deficiency
 Relative insulin deficiency
and/or insulin resistance
 Treatment: insulin injections
 Treatment: (1) healthy diet and
increased exercise; (2)
hypoglycemic tablets; (3) insulin
injections
 Increased prevalence in relatives
 Increased prevalence in relatives
 Identical twin studies: <50%
concordance
 Identical twin studies: usually
above 70% concordance
Diagnosis

Diagnosed and undiagnosed diabetes in African Americans, U.S, 1996 2006.
Mortality rates in African American and white diabetic men and women
Risk Factors






A family history of diabetes. If a parent or sibling
in your family has diabetes, your risk of developing
diabetes increases.
Age over 45
Race or ethnic background. The risk of diabetes is
greater in Hispanics, blacks, Native Americans and
Asians.
Being overweight. If you are overweight, defined
as a body mass index (BMI) greater than 25.
Hypertension. High blood pressure increases the
risk of developing diabetes.
Abnormal cholesterol levels. HDL ("good")
cholesterol levels under 35 mg/dL (milligrams per
deciliter) and/or a triglyceride level over 250 mg/dL
increases your risk
A person with some or all of the above listed risk factors may never develop
diabetes, but your chances increase the more risk factors you have.
Obesity is a factor!!!

To determine whether or not a patient is overweight or
obese doctors use the body mass index.
• body mass index (BMI) provides a relative measure of weight
adjusted for the respective height.


More and more people are becoming affected with diabetes
because nations are switching to a westernized (American)
lifestyle that emphasizes rich foods and sedentary living
In the U.S. one of three Americans are obese 33%, and
two of three, 67% of teenagers are at risk of becoming
obese and developing diabetes because of little or no
vigorous physical activity.
Affect of Obesity on Diabetes

In the normal process of food metabolism, sugar called glucose
enters the bloodstream.
 Glucose is a source of fuel for the body.
 An organ called the pancreas makes insulin. The role of insulin is to
move glucose from the bloodstream into muscle, fat, and liver cells,
where it can be used as fuel.


When an individual is obese food metabolism is slowed down
because of lack of exercise causing the sugar production to be
produced and a large quantity is built up within the body more
than the human body can handle
Making it difficult for the pancreas to regulate the normal amount
of blood sugar needed in the body, resulting in type II diabetes.
THE MORE OVERWEIGHT OR OBESE YOU ARE, THE GREATER
YOUR RISK OF DIABETES!!
Prevalence of Diabetic Patients
and Obesity


In 2003 the Journal of American Medical
Association reported statistics that show
the correlation between obesity and
diabetes within the United States.
They reported that obesity climbed from
19.8% in American Adults to 20.9%
between 2000 and 2001. Within that
same time frame the diagnosed cases of
diabetes increased from 7.3% to 7.9%.
DIABETES
25
20.9
19.8
PERCENT
20
15
10
7.9
7.3
5
0
1
2
UNITED STATES
Series1
Series2
Obesity Vs. Diabetes
6
Relative Risk
5
4
Men
Women
3
2
1
0
-10
-5
0
5
10
Weight Change (kg)
15
20
Diabetes in Impoverished
Communities




Poverty has been under recognized as a contributor to the prevalence of
type 2 diabetes
Low socioeconomic status within minority populations appear to
particularly be affected by overweight and obesity
-- this is due to low education of proper nutrition and the
dangers of disease
-- with little or no knowledge of a proper diet, poorer people
are more likely to eat high calorie junk food and exercise
less.
Also in such communities, they cannot afford proper health care and do
not seek regular physician assistance.
-- increasing the risk of the development of obesity leading to
diabetes, hypertension, heart disease and much more.
People with less than a high school education had higher rates of both
obesity 27.4% and diabetes 13% than people who had a high school
education
Information from Behavioral Risk Factor Surveillance System (BRFSS), a state-based
telephone survey that collects information from adults aged 18 years or older. For this
survey, participants were asked about their height and weight and if they had ever been
told by a doctor that they had diabetes.
Diabetes is Also Genetic
Diabetes is a hereditary disease.
The genes that make an individual susceptible to get
diabetes is passed from one generation to the next.
However, the risk of getting diabetes is passed
on NOT the disease itself.
First generation relatives have a higher risk of
developing type I diabetes than people whom do not
have any past history of diabetes in their respective
families.
In type II diabetes studies have shown that the first
generation are at about 3X more likely to get diabetes
than those without.
Also with identical twins, rates of diagnosing diabetes
within sets range from 60-90%, which is significantly
higher than fraternal twins , proving a strong genetic
correlation.
Genetic Statistics
KEY
Female
Male
Female Diabetic
Male Diabetic
African-Americans and Community





Most African Americans with diabetes have Type 2, which
develops in adulthood and requires treatment with some
combination of exercise, proper diet, medication and
injected insulin
African Americans are 1.8 times more likely to have
diabetes than other ethnicities.
Obesity has reached near epidemic proportions in the
United States. The prevalence of obesity is high among
African Americans, particularly African American women,
making them at high risk for developing diabetes.
The proportion of African American women who are obese
is 80 percent higher than the proportion of men who are
obese. When compared to non-Hispanic white women, 69
percent of African American women are overweight or
obese.
The prevalence of obesity increases up to age 60 after
which there is a decline
African Americans + Diabetes+ Genetics = Theory


Some researchers believe that African Americans
inherited a "thrifty gene" from their African
ancestors. Such a gene might have initially enabled
Africans to use energy more efficiently when food
was scarce. The theory is that today, without "feast
and famine" cycles, the thrifty gene may make
African Americans more likely to develop type 2
diabetes.
Other study results found that African Americans had
the highest rates of both obesity 31.1% and diabetes
11.2 % compared with other ethnic groups.
National Diabetes Information Clearinghouse, "Diabetes in African Americans,"
(http://www.niddk.nih.gov/health/diabetes/pubs/afam/afam.htm
).
Prevalence of Diabetes by Race




Whites: 13.1 million, or 8.7% of all non-Hispanic
whites aged 20 years or older have diabetes.
Blacks: 3.2 million, or 13.3% of all non-Hispanic
blacks aged 20 years or older have diabetes. After
adjusting for population age differences
Non-Hispanic blacks are 1.8 times as likely to have
diabetes as non-Hispanic whites.
Diabetes results in death for 20 percent more
African American men and 40 percent more African
American women than whites.

Twenty-five percent of African Americans between
the ages of 65 and 74 have diabetes.

One in four African American women over 55 years of
age has diabetes.
Comparison of Diabetes Frequency
by Race and Age
200
180
160
140
120
Cases per
100
1000 people
80
60
40
20
0
Blacks
Whites
Under 45
45-64
Age (years)
65+
Hunterdon and Camden County


Type I diabetes
affects 5-7.5% of
the US population
in Camden County,
New Jersey.
Diabetes affects
the members of
Hunterdon County,
New Jersey at a
rate of 5.4%.
Diabetes in The United States
Type I in the United States
Type II in the United States
Diabetes in South Africa: Genetics
Vs Culture


Projected statistics for
South Africa reveal a
rapid increase in the
incidence of diabetes
especially with
urbanization of the
African populations.
For the people of South
Africa the increase in the
rate of diagnosed diabetes
is because of people opting
to live a lifestyle similar to
that of the United States,
which emphasize more
eating habits and little to
no exercise.
By 2025, the number of people with diabetes is
expected to more than double in Africa, the
Eastern Mediterranean and Middle East, and
South-East Asia, and rise by 20% in Europe,
50% in North America, 85% in South and
Central America and 75% in the Western
Pacific.
FACTS






7.8 million (8.3%) of all men in the US have diabetes
9.1 million (8.9%) of all women in the US have diabetes
About ½ of all diabetes cases occur in people over the age of 55
-- The risk for Type 2 increases with age
2.8 million (13%) of African Americans have diabetes
105,000 Native Americans and Alaska Natives (15.1%) have
diabetes
 Heart disease: leading cause of diabetes related deaths
-- 2 to 4 times higher in adults with diabetes
 Stroke: risk is 2 to 4 times higher among people with diabetes
 73% of adults with diabetes have high blood pressure or hypertension
 Leading cause of blindness among adults 20-74 years old
 Diabetic nerve related disease
-- leads to lower-extremity amputations
 Complications during pregnancy
TYPE 1 - “Juvenile Diabetes”
 No known methods to prevent
Type 1 diabetes
TYPE 2
 Lifestyle Changes
- - Diet, physical activity
AFRICAN AMERICANS ARE AT A HIGHER
RISK FOR TYPE 2 DIABETES AND BEING
OVERWEIGHT INCREASES THEIR RISK.
 Proper diet
-- lots of fruits, vegetables, whole grains
-- broils meats (poultry and fish)
 Exercise
-- varies with age
-- proper diet and exercise must be
balanced to avoid risk of hypoglycemia
(low blood sugar) and hyperglycemia
(high blood sugar)
 Insulin Injections
 Home sugar monitoring
 Balance and moderation
 Reduce portion size
-- Split restaurant meals or have the other half wrapped to go
 Physical Activity
-- 60 mins every day for children
ex: hopscotch, basketball, dance
-- 30 mins every day for adults
ex. walk, dance
MAKE A HEALTHY LIFESTYLE A FAMILY AFFAIR
 Plan ahead. Make a list of meal ideas for the coming week
 Buy in season fruits and vegetables
-- Prefer local farmer markets (foods fresher and cheaper)
 Purchase canned & frozen fruits and vegetables when fresh ones are not affordable
 Stock up on sale items
 Assemble snacks at home in small baggies and use foods healthy foods
-- nuts & seeds
-- low fat cheese
-- fresh fruits & vegetables
Weigh to Go
-- 4 wk. weight management group for kids age 10-14 (fee: $90)
Smart Cart
-- Personal Grocery Shopper (fee: $30)
Shapedown Children’s Weight Management Program (6-18 years of age)
-- 10 wk. program that promotes changes in food habits, exercise, self-esteem and weight
Diabetes Fitness Program
-- 6 sessions over a 2 wk. period (fee: $164)
Yoga
CAMDEN COUNTY
VS
HUNTERDON COUNTY
Facility: Virtua Health
Facility: Hunterdon Medical Center
Program: Virtua Camden
Program: Diabetes Health Center
 Diabetes Self-Management Education Group
 Individual and Groups Sessions
 Individual Nutrition Counseling
 Nutrition Counseling
 Pregnancy Diabetes Counseling
 Insulin Pump Classes and Support
 Community Lectures
 Student with Diabetes School Program
 Support Groups
 Yoga for People with Diabetes
 Syringe Disposal Program
 Safe Syringe Disposal Program
 Glucose and Foot Screenings
 Stress Management Program
 vHealthHighway
 Diabetes Fitness Program
-- Monthly email of wellness articles
 Group Home Instruction
 Speaker Services
If both areas offer very similar programs, why is there
such a huge disparity in the prevalence of diabetes in
each area?
City of Camden in Camden
County
City of Flemington in Hunterdon
County
Est. Pop in 2003: 80,089
Est. Pop. in 2003: 4,234
Median Household Income:
$23,421
Median Household Income: $39,886
Ancestry & Family History:
African American - 53%; Puerto
Rican - 29%; Other Hispanic or
Latino - 4%; Sub-Saharan African
- 2%; African - 2%; West Indian
(excluding Hispanic groups)
Support for Libraries: Local gov.
funding was below national
average in 2001-2002
Education: 5% of residents age
25 or older have a bachelor’s or
advanced college degree
Ancestry & Family History:
African American - 3%; Puerto Rican
7%; Other Hispanic or Latino; West
Indian (excluding Hispanic groups) 1%
Support for Libraries: Local gov.
funding was above the national average
in 2001-2002
Education: 27% of residents age 25 and
older have a bachelor’s or advanced
college degree
Comparison between the city of
Camden and Flemington
90000
80000
70000
60000
50000
40000
30000
20000
10000
0
Camden
Flemington
Pop.
Income
Edu.
Treatment Focus for Type 1

Pathophysiology
The pancreas does not
produce insulin
-- This is an autoimmune
disease
-- develops because the
body destroys the beta
cells in the islet tissue of
the pancreas that
produces insulin.
--

So the main treatment
goal for Type 1 diabetes
is giving supplemental
insulin.
Treatment Focus for Type 2

Pathophysiology
– Insulin resistance, which is a
condition in which body cells do
not fully respond to the action of
insulin
– Your pancreas does not make
enough insulin

So the treatment goal for Type 2
Diabetes is increase body’s
sensitivity to insulin and reduce
sugar intake.
Pharmaceutical Agents for Type 1

Insulin- a hormone
produced in the pancreas
that allows sugar to enter
body cells, where it is used
for energy. It also helps
store extra body sugar in
muscle, fat, and liver cells.

Sources of Insulin
-- Pigs
-- Cow
-- Recombinant DNA
The Almighty Insulin


Insulin has to enter the body's
bloodstream to be effective. This is
accomplished through injections into the
fat layer usually in the arm, thigh, or
abdomen.
The timing of insulin injections is very
important. Insulin usually needs to be
administered before mealtimes.
Alternative Ways of Administering
Insulin
Injection aids
 Insulin pens
 Insulin jet injectors
 An inhaled insulin delivery
system
 Subcutaneous infusion
 External insulin pumps

The Insulin Pump
An insulin pump is a small mechanical
battery operated device that is about
the same size as a pager or cell
phone. The insulin pump is made of a
durable plastic that will withstand the
wear and tear that is required in daily
activity.
“Waiting to Inhale”
The Insulin Inhaler


The FDA approved
Pfizer's Exubera, the first
inhalable form of insulin
for diabetics in Late
January of this year.
Exubera is a dry,
powdered form of insulin
that is inhaled into the
lungs. This is the first
new form of delivery
since diabetics started
injecting insulin in the
1920s.
Pharmaceutical Agents for Type 2.
Cont.


Biguanides-They lower blood sugar by
decreasing the amount of sugar produced by the
liver.
-- Metformin (Glucophage®)
Alpha Glucosidase Inhibitors- block the
enzymes that digest the starches you eat. This
action causes a slower and lower rise of blood
glucose through the day, but mainly right after
meals.
-- Miglitol (Glyset®)
-- Acarbose (Precose®)
Pharmaceutical Agents for Type 2


Thazolinediones- They improve the way cells in the body
respond to insulin by lowering insulin resistance.
-- Piglitazone (Actos® )
-- Rosiglitazone.
Sulfonylureas- work by causing your pancreas to release
more insulin into the bloodstream. this way it lowers blood
sugar and helps the way you use food to make energy.
-- glipizide,
-- tolazamide,
-- glyburide.
TLC Please!!!
Therapeutic Lifestyle Changes

Diet
Of all racial groups, African Americans have the most
difficulty in eating diets that are low in fat and high in
fruits, vegetables, and whole grains. Some explanations for
this include:
-- The greater market availability of packaged and processed
foods
-- The high cost of fresh fruit, vegetables, and lean cuts of meat
-- The common practice of frying food
-- Using fats in cooking.

Exercise
-- According to Initiative Media blacks watch 73.6 hours of TV a
week, about 17 hours more than Latinos and 22 hours more
than Whites and Asians.

Stress
-- “Living while black” Index
Can we be compliant??


African-Americans with type 2 diabetes appear to be less likely
than whites to take prescribed medications, reported in the July
issue of the Journal of the National Medical Association.
Factors that may lead to noncompliance with therapy include
-- Onerous life-style changes,
-- Drug side effects
-- Failure to perceive benefit in the short term or believe that benefit will
accrue in the long term.
-- Cost (money and time)

EDUCATION is the key!!!
-- Explain to patients the importance of compliance when taking
medications for type 2 diabetes.
-- Explain that oral medications, combined with diet changes and
exercise, may prevent or delay the need for insulin injections, and can
reduce the risk for complications such as blindness, heart disease,
kidney failure, and vascular and neurological problems leading to
amputations.
A key reason of non-compliance in African Americans is
the cultural factor.
Definition:
Customary beliefs, social forms
and material traits of a racial,
religious or social group
May also refer to characteristics
of everyday existence shared by
a people in a place or time
Culture can include the
language, music, food, and
rituals.
African American Culture
Nutrition
General Dietary Influences
--African Americans have difficulty eating
diets low in fat and high in vegetables, fruits
and whole grain
--Explanations may include:
– Availability of packaged and processed foods
– High cost of healthy foods, including vegetables,
fresh fruits and lean cuts of meat.
– Common culture of frying foods and using fat in
soul food preparation.
African American Culture
Derived from slavery and rural
impoverished conditions
Traditionally cooked and seasoned
with pork products and fried in lard
or oil
Foods include chitterlings (chitlins),
pork chops, potlikker, turnips, grits,
and hushpuppies
African American Culture

African American Belief in Healthcare
-- Culture affects African Americans
taking symptoms seriously.
-- Health beliefs stem from religious
beliefs
-- Many often turn to home remedies
 Yellow
root tea lowers blood sugar
 Fresh pork helps improve hypertension
African American Culture

African American Belief in Healthcare
-- Beliefs about diabetes
 Common
themes include
– “Running in families”
– “Eating too much sugar”
– “Not taking care of yourself”
African Americans And Healthcare

Disparities reflect a long history of
economic deprivation and barriers to
healthcare
--African American adults are less likely to have
job based insurance
--African Americans are twice as likely as Whites
to report treatment with disrespect during a
healthcare visit.
--African Americans were almost twice as likely
as whites to believe their doctor’s looked down
on them.

Questions to consider:
--How does the African American culture
deal with illness?
--How are medical decisions made in the
African American community?
--What is the African American culture’s
norms about healthcare and sickness?
Cultural Sensitivity
 Incorporation
of experiences, norms,
values, behavioral patterns, and
beliefs of a specific population.
Role Of the Government
Is Congress Helping?
Gestational Act
 Health Insurance
Options
 School Legislative
Action

Gestational Act



Gestational Diabetes occurs is 4 to 8 percent of all
pregnant women. With this being the case,
135,000 women in the United States alone are
affected by this type of diabetes.
In response to this, Sens. Hillary Rodham Clinton
and Susan Collins presented the Gestational
Diabetes (GEDI) Act to the U.S. Senate.
The bill aims to lower the incidence of gestational
diabetes and prevent women afflicted with this
condition and their children from developing type
2 diabetes.
Health Insurance Options
 Diabetes is a disease that is for most people self- managed. In order to
stay healthy, a person with diabetes needs access to supplies like test
strips, meters and insulin.
 Usually, people are able to get these medications and supplies through
their health insurance policies.
 Ironically those who have diabetes may find difficulty obtaining and or
keeping health insurance and life insurance!
 But through American Diabetes Association (ADA) these is hope!
This association is committed to improving the quality of life for seniors
affected with diabetes. Under the Medicare and Modernization Act,
millions of people with Medicare will be able to live longer and healthier
lives through utilization of new preventative services that became
effective January 1, 2005.
School Legislative Action

Students with diabetes should have the
same access to educational opportunities as
other students. In some schools this
principle is not exercised. As a result federal
laws such as the Individual with
Diabetes in Education Act (IDEA) have
been instituted.
The states that have passed
school diabetes care
legislation are marked in red.
Diabetes Outreach and Education
(DOES)

The Diabetes Outreach and Education
System program (DOES) works with
individuals and organizations to increase
public awareness and encourage actions
that will help communities control diabetes
and its complications. This initiative
supports the National Diabetes Education
Program effort to help communities across
the country develop comprehensive
outreach programs and education
campaigns to control type 2 diabetes.
Diabetes Outreach and Education
(DOES) cont.
 The
DOES program targets five
southern Jersey communities:
Atlantic , Camden , Cumberland ,
Salem and Ocean Counties . It is the
first program of its kind in New
Jersey and is a statewide model.
Lightened Hunterdon is a Partnership for Health
initiative to raise awareness about weight management
and increasing physical activity to Hunterdon County
residents and health professionals


The New Jersey Area Health Education Centers
(AHEC) were established in 1978, in partnership
with the University of Medicine and Dentistry of
New Jersey, as part of a national initiative to
strengthen the health of communities through
educational partnerships.
Camden AHEC is committed to improving the
health of the medically underserved - the ethnic
and culturally diverse, the aged, the poor, the
very young, the unemployed, the homeless and
the uninsured. Particular emphasis is on
providing services in the communities of Camden
and Camden and Burlington Counties.
The Positives of (DOES)
Increases knowledge of diabetes
through educational programs and an
annual congress
 Engages with statutory organizations
on behalf of the people with diabetes.
 Promotes research that is relevant to
people with diabetes in underserved
areas.

The Diabetes Association of South
Africa (DASA)
 Diabetes
South Africa is a non-profit
organization, funded in 1969 to be a
support and an advocate for all
people with diabetes in South Africa
The Goal of DASA
 Our mission is to assist all people
affected by diabetes so that their
lives may be as healthy and
satisfying as possible
The Positives of (DASA)
 Informing,
encouraging and
supporting all people who have
diabetes and their families.
 Acting as an advocate for people with
diabetes, lobbying for better
facilities, cheaper medication and
better services.
 Promoting public awareness of
diabetes, its symptoms and risks.
The Bird’s Eye View of the Two
D.A.S.A
Vs.
Education
 The Bird’s Eye
View of the Two
 Government Role
 Public Awareness

D.O.E.S

Education

Community Role

Research
By consolidating the
pros of both programs
we created our own
Model.
Solution
Government officials should
establish a program that’s more
cultural sensitive.
Four Point Strategy




Educate the public, caregivers & providers
Simplify the patient-physician education &
monitor their progress
Motivate patients and providers through
financial incentives, such as discounts
Regulate health care standards and quality
HEAL (Helping Every African
American Live)
Motto: Exceptional living begins with diabetes!
Goals: Be effective by providing cultural sensitive
services through:
-- Ongoing Support Groups
-- Free Screenings for Diabetes and other incentives, such as
discounts
-- Seminars to educate diabetics on insulin injections and other
treatments
Implemented in areas with low socioeconomic
status, such as Camden
Funding for HEAL







State funding
American Heart and Lung Association
ADA (American Diabetes Association)
CDC (Center for Disease Control and Prevention)
One Touch (machine that test blood sugar)
NAACP
Pharmaceutical Companies
Interview with Dr. Aliya Brown
From Hunterdon Cardiovascular Group
Hunterdon Medical Center
190 Hwy 31, Suite 300
Flemington, NJ 08822
(908) - 788 - 6136