Preventing diabetes

Preventing DiabetesPreventing Diabetes
Dany Zayour, MDDany Zayour, MD
Via Christi ClinicVia Christi Clinic
Diabetes and Endocrinology CenterDiabetes and Endocrinology Center

Why talk about Diabetes?Why talk about Diabetes?
 26 million americans (11.3%) have diabetes26 million americans (11.3%) have diabetes
 7 million do not know it7 million do not know it
 2 new million cases diagnosed each year2 new million cases diagnosed each year
 79 million americans have prediabetes79 million americans have prediabetes
 37 million (15%) will have diabetes in 201537 million (15%) will have diabetes in 2015
 1 in 3 adults will have diabetes in 20501 in 3 adults will have diabetes in 2050

What is prediabetes?What is prediabetes?

What is prediabetes?What is prediabetes?
 Blood sugar is higher than normal but not asBlood sugar is higher than normal but not as
high as diabeteshigh as diabetes
 Touch of sugarTouch of sugar
 Mild diabetesMild diabetes
 Prediabetes is likely to progress to diabetes in 10Prediabetes is likely to progress to diabetes in 10
years or lessyears or less
 Already started complicationsAlready started complications

How do I know if I have prediabetes?How do I know if I have prediabetes?

SymptomsSymptoms
 No signs or symptomsNo signs or symptoms
 Darkened areas of skin called acanthosis nigricansDarkened areas of skin called acanthosis nigricans
 Signs of diabetesSigns of diabetes
 Increased thirstIncreased thirst
 Frequent urinationFrequent urination
 FatigueFatigue
 Blurred visionBlurred vision
 Recurrent infectionRecurrent infection
 Tingling and numbnessTingling and numbness
 Cuts and bruises that are slow to healCuts and bruises that are slow to heal

What increases my risk for diabetesWhat increases my risk for diabetes
and should I get tested?and should I get tested?

What increases the risk of diabetes?What increases the risk of diabetes?
 Overweight or obese (BMI above 25)Overweight or obese (BMI above 25)
 Extra weight in your bellyExtra weight in your belly
 Not physically activeNot physically active
 SmokingSmoking
 Family history of type 2 diabetesFamily history of type 2 diabetes
 Gestational diabetes or baby more than 9 lbsGestational diabetes or baby more than 9 lbs
 PCOSPCOS
 Sleep fewer than 6 hrs or more than 9 hrs per daySleep fewer than 6 hrs or more than 9 hrs per day
 Race: african american, asian, HispanicRace: african american, asian, Hispanic

Are there any blood tests to diagnose prediabetes?Are there any blood tests to diagnose prediabetes?

Blood tests to diagnose prediabetesBlood tests to diagnose prediabetes
 Fasting glucoseFasting glucose
 8 hrs fast8 hrs fast
 BS 100-125 mg/dlBS 100-125 mg/dl
 Glucose tolerance testGlucose tolerance test
 Drink sugary solutionDrink sugary solution
 BS 2 hrs after that 140-199BS 2 hrs after that 140-199
 Hemoglobin A1c or HbA1cHemoglobin A1c or HbA1c
 HbA1c 5.7-6.4%HbA1c 5.7-6.4%

A1C eAGA1C eAG
%% mg/dlmg/dl
66 126126
6.56.5 140140
77 154154
7.57.5 169169
88 183183
8.58.5 197197
99 212212
9.59.5 226226
1010 240240
HbA1c and average glucose

ADA Diagnostic Criteria:ADA Diagnostic Criteria:
Normal, Diabetes, and Pre-diabetesNormal, Diabetes, and Pre-diabetes
Clinical Practice Recommendations 2010Clinical Practice Recommendations 2010
ParameterParameter NormalNormal DiabetesDiabetes Pre-diabetesPre-diabetes MethodMethod
11 Fasting PlasmaFasting Plasma
GlucoseGlucose
(mg/dl)(mg/dl)
<100<100 ≥≥126126 100–125100–125 No caloric intakeNo caloric intake
for at least 8 hfor at least 8 h
22 2-h plasma2-h plasma
glucose onglucose on
OGTT (mg/dl)OGTT (mg/dl)
<140<140 ≥≥200200 140–199140–199 WHO method: 75WHO method: 75
g glucose loadg glucose load
33 RandomRandom
plasma glucoseplasma glucose
(mg/dl)(mg/dl)
<140<140 ≥≥200200 -- with classicwith classic
symptomssymptoms
of hyperglycemiaof hyperglycemia
or crisisor crisis
44 A1CA1C
%%
<5.7<5.7 ≥≥6.56.5 5.7 – 6.45.7 – 6.4 NGSP certifiedNGSP certified
methodmethod
standardized tostandardized to
the DCCT assaythe DCCT assay

What is the treatment of prediabetes?What is the treatment of prediabetes?

Reducing risk of DiabetesReducing risk of Diabetes
 Losing 7% (5-10%) of body weightLosing 7% (5-10%) of body weight
 Decrease risk by 58%Decrease risk by 58%
 11% per year of prediabetes develop diabetes in11% per year of prediabetes develop diabetes in
the first 3 yearsthe first 3 years

DietDiet
 DietDiet
 Low in fatLow in fat
 High in fibersHigh in fibers
 Focus on fruits, vegetables and whole grainsFocus on fruits, vegetables and whole grains
 VarietyVariety

Physical activityPhysical activity
 30-60 minutes daily 5 days a week ( there are 1440 min in a day)30-60 minutes daily 5 days a week ( there are 1440 min in a day)
 Brisk daily walkingBrisk daily walking
 Ride your bikeRide your bike
 DancingDancing
 Low impact aerobic classLow impact aerobic class
 SwimmingSwimming
 Exercise while sittingExercise while sitting
 Use stairsUse stairs
 Park away from entrancePark away from entrance

MedicationsMedications
 MetforminMetformin
 ActosActos
 AcarboseAcarbose
 GLP-1 agonistsGLP-1 agonists

Alternative medicineAlternative medicine
 CinnamonCinnamon
 ChromiumChromium
 GinsengGinseng
 Prickly pear cactusPrickly pear cactus
 SoySoy
 SteviaStevia
 GymnemaGymnema

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