Diabetes for Designers Part 1: Definition, Burden, and Diagnosis

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Transcript

1. Joyce Lee, MD, MPH Pediatric Endocrinology, University of Michigan http://www.doctorasdesigner.com/ Twitter: @joyclee Diabetes: A Guide for Designers: Part 1: Definition, Burden, Diagnosis
2. What is diabetes?
3. Believe it or not, there’s a committee who sets the definition, called the “Expert Committee on the Diagnosis and Classification of Diabetes Mellitus”
4. The Official Definition “A group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action, or both” a.k.a. "high blood sugar”
5. Having diabetes puts individuals at risk for complications
6. Kidney Failure Eye Disease & Blindness Nerve problems & Amputations Heart Disease & Stroke Complications of diabetes
7. What’s the difference between Type 1 and Type 2 Diabetes?
8. Type 1 Diabetes Due to absolute deficiency of insulin Caused by “autoimmune”disease & genes Not related to obesity Can only be treated with insulin *Autoimmune is another way of saying that the body’s own immune system attacked the pancreas
9. Type 2 Diabetes Due to inability of body to respond to insulin Caused by genes and obesity Can be treated with diet and exercise, or oral medications, or insulin
10. Who gets Type 1 vs. Type 2 diabetes?
11. Most kids have Type 1 Most adults have Type 2 BUT Type 1 can happen in adults Type 2 can happen in kids
12. How common is diabetes?
13. The next graph shows the burden of diabetes (all types) for the US population in 2000 (yes it’s from a while back but it allows for comparison of adult and childhood trends)
14. SEARCH, NHANES This slide shows that the absolute burden is much higher in adults compared with children 0 2 4 6 8 10 12 14 16 18 Females Males 0-9 10-19 20-39 40-59 ≥60 Age Group (yrs) % with diabetes Mostly T1D Mostly T2D
15. How have diabetes rates changed over the years?
16. Keep in mind, the definition changed over time…
17. In 1998, The definition changed to a lower threshold, from a fasting glucose of ≥ 140 mg/dl to ≥126 mg/dl. As a result, the number of people with diabetes automatically increased with the change in definition!
18. The largest increases in diabetes in the US have occurred in older adults ≥65 yrs 0.83 1.91 1.9 9.96 10.16 12.25 19.77 23.67 28.16 0 5 10 15 20 25 30 1988-1994 1999-2004 2005-2010 20-34 yrs 35-64 yrs >65 yrs % with diabetes Cheng et al 2013
19. Finally, just in case you are curious, how do you diagnose diabetes?
20. You have to have your blood drawn Glucometers are not accurate for diagnosing diabetes (although they are useful for managing diabetes)
21. There are 4 ways to be diagnosed:
22. You have diabetes if: (1)  You have a random blood glucose performed (you have eaten within the last 8 hours) and your blood sugar is ≥ 200 mg/dl* *Technically to be diagnosed, you have to test abnormal on two separate days
23. You have diabetes if: (2) You have fasted (no food or drink for at least 8 hours) and your blood sugar is ≥ 126 mg/dl* *Technically to be diagnosed, you have to test abnormal on two separate days
24. You have diabetes if: (3) You have a 2 hour glucose tolerance test* and your blood sugar 2 hours later is ≥ 200 mg/dl** *2 hr glucose tolerance test: You fast for 8 hours, drink a sugary drink, and test blood sugar 2 hours later **Technically to be diagnosed, you have to test abnormal on two separate days
25. You have diabetes if: (4) You have a hemoglobin A1c (a 3 month measure of glucose) that is ≥ 6.5%* *Technically to be diagnosed, you have to test abnormal on two separate days. The HbA1c is a new definition that’s controversial (more on that later).
26. More to come, stay tuned. Questions? Twitter: @joyclee http://www.doctorasdesigner.com/