Diabetes Basics for Health Care Professionals - wypca.org · American Association of Diabetes Educators ... From the triumvirate to the ominous octet: A new paradign from the treatment

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American Association of Diabetes Educators – Provider

is accredited as a provider of continuing nursing

education by the American Nurses Credentialing Center's

Commission on Accreditation.

American Association of Diabetes Educators (AM001) is a

Continuing Professional Education (CPE) Accredited Provider

with the Commission on Dietetic Registration (CDR). CDR

Credentialed Practitioners will receive 5.0 Continuing

Professional Education units (CPEUs) for completion of this

activities/materials.

The American Association of Diabetes Educators is accredited by

the Accreditation Council for Pharmacy Education as a provider of

continuing pharmacy education. This program provides 5.0 contact

hours (.50 CEU’s) of continuing education credit.

DIABETES EDUCATION FOR HEALTH CARE PROFESSIONALS –

SERIES

CONTINUING EDUCATION

April 2017 - April 2018

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activities/materials.

The American Association of Diabetes Educators is accredited by

the Accreditation Council for Pharmacy Education as a provider of

continuing pharmacy education. This program provides 5.0 contact

hours (.50 CEU’s) of continuing education credit.

Requirements for Successful Completion:For successful completion, participants are required to be in attendance in the full activity, complete and submit the program evaluation at the conclusion of the educational event.

Conflicts of Interest and Financial Relationships DisclosuresPlanners: Dian True, RN, MA, CDE, FAADE – None

Presenters; Dian True, RN, MA, CDE, FAADE – None

Maureen Molinari, PhD, RDN, LD, CDE – None

Codi Thompson, BS, RDN, LD – None

Disclosure of Relevant Financial Relationships and Mechanism to Identify and Resolve Conflicts of Interest: No conflicts of interest

Sponsorship/Commercial Support: None

Off-label Use: Participants will be notified by speakers to any product used for a purpose other than that for which it was approved by the Food and Drug Administration

Activity-Type: Knowledge-based

DISCLOSURES TO PARTICIPANTS

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CONTINUING EDUCATION INFORMATION










activities/materials. Module 1: 0069-0000-17-057-L01-P

The American Association of Diabetes Educators is accredited by the Accreditation Council for

Pharmacy Education as a provider of continuing pharmacy education. This program provides 1.0

contact hours (.10 CEU’s) of continuing education credit.

ACPE Universal Activity Number: 0069-0000-17-xxx-L01-P; 0069-0000-17-xxx-

L01-P; 0069-0000-17-xxx-L01-P; 0069-0000-17-xxx-L01-P; 0069-0000-17-xxx-L01-P

Effective Date: April 18, 2017 to April 18, 2018

I N D E P E N D E N T C O N T R A C T O R W O R K I N G W I T H T H E C H R O N I C D I S E A S E P R E V E N T I O N P R O G R A M ,

W Y O M I N G D E P A R T M E N T O F H E A L T H

DIABETES & HYPERTENSION

A TRAINING FOR HEALTH CARE PROFESSIONALS

Presented by: Dian True RN, MA, CDE, FAADE

This presentation is brought to you by the

Chronic Disease Prevention Program at the

Wyoming Department of Health and funded

through the State Public Health Actions to

Prevent and Control Diabetes, Heart

Disease, Obesity and Associated Risk

Factors and Promote School Health Grant

(DP13-1305).

FOR MORE INFORMATION PLEASE CONTACT, CHRONIC DISEASE PREVENTION PROGRAM MANAGER [email protected].

OR (307) 777.3579 5

mailto:[email protected]

Today’s presentation uses evidence-based research to promote evidence-

based best practice.

Research and data from the following organizations were used in developing this presentation:

• Centers for Disease Control and Prevention

• American Diabetes Association

• American Association of Clinical Endocrinologists

• American Heart Association

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PRESENTATION OVERVIEW

Review: Diabetes (DM) and Hypertension (HTN)

Discuss: Guidelines for classifying and managing

HTN and DM

Identify: Lifestyle and medication for treatment,

prevention, and management

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Medications

PREVENTING AND MANAGING DIABETES AND HYPERTENSION

Nutrition Activity

Stress

Lifestyle & Balance8

DIABETES IN THE US

• Total: 30.3 million people have diabetes (9.4% of the

US population)

• Diagnosed: 23.1 million people

• Undiagnosed: 7.2 million people (23.8% of people

with diabetes are undiagnosed)

Prediabetes Fast Facts• Total: 84.1 million adults aged 18 years or older have

prediabetes (33.9% of the adult US population)

• 65 years or older: 23.1 million adults aged 65 years

or older have prediabeteswww.cdc.gov/diabetes 8/2017 9

http://www.cdc.gov/diabetes

ESTIMATED COSTS OF DIABETES IN US, 2014

Total Cost: $245 billion

• Direct Medical Costs: $176 billion• Average medical expenditures among people with

diagnosed diabetes were 2.3 times higher than people without diabetes

• Indirect Costs: $69 billion• Disability, work loss, premature deaths

American Diabetes Association. (2015): “The Cost of Diabetes.” Retrieved from:

http://www.diabetes.org/advocacy/news-events/cost-of- diabetes.html

10.6%

9.0% 9.2% 4.6%

10.5%

9.4%7.7%

5.0%13.2%9.5%9.7%

5.1%

5.1%

4.3%

5.9%

7.6%

18.1% 6.6%

6.2%

12.2%

8.5%

8.7%

10.0%

PREVALENCE OF DIABETES IN WYOMING 8.4%

Source: 2011-2015 Wyoming BRFSS, retrieved from https://health.wyo.gov/publichealth/prevention/chronicdisease/data/ 11

DIABETES PREVALENCE BY RACE AND ETHNICITY IN WYOMING

• These data demonstrate a statistically significant difference in diabetes prevalence among White and American Indian populations

Wyoming Diabetes Prevalence by Race and Ethnicity (BRFSS, 2011-2014)

White 7.7%

Hispanic 10.4%

American Indian 17.8%

2014 Behavioral Risk Factor Surveillance System (BRFSS); www.cdc.gov/diabetes/wyoming 12

DIABETES PREVALENCE BY AGE IN WYOMING

Ages <18 18-44 45-64 65-74 >75

Lower

Range

Upper

Range

Lower

Range

Upper

Range

Lower

Range

Upper

Range

Lower

Range

Upper

Range

Not

Avail.

2.1% 4.6% 8.6% 12.4% 15.2% 20.4% 15.6% 21.1%

2014 Behavioral Risk Factor Surveillance System (BRFSS); www.cdc.gov/diabetes/wyomingCDC: Prevalence by age

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http://www.cdc.gov/diabetes/wyoming

AGE-ADJUSTED PREVALENCE OF OBESITY AND DIAGNOSED DIABETES AMONG US ADULTS

Obesity (BMI ≥30 kg/m2)

Diabetes

1994

1994

2000

2000

No Data <14.0% 14.0%–17.9% 18.0%–21.9% 22.0%–25.9% > 26.0%

No Data <4.5% 4.5%–5.9% 6.0%–7.4% 7.5%–8.9% >9.0%

CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available

at http://www.cdc.gov/diabetes/statistics

2013

2013

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Metabolic disorder

• Blood glucose levels are above normal

• Normal = fasting below 100 mg/dl

• Most food is digested and converted to glucose

(sugar) and used for energy

• The pancreas makes insulin, a hormone

• Insulin helps transport glucose from blood to the cells

• With diabetes:

• Insufficient insulin

• Inefficient use of insulin

• Excess glucose in your blood

WHAT IS DIABETES

Standards of Medical Care in Diabetes” https://www.diabetes.org

was originally approved in 1988. Most recent review/revision: December 2017

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TYPES OF DIABETES

• Type 1 Diabetes – Autoimmune destruction of beta cells to make insulin, insulin required

• Type 2 Diabetes - Insulin resistant

• Gestational Diabetes – Hyperglycemia from the hormonal changes during pregnancy

• Up to 60% develop diabetes in their lifetime

• Secondary - Impaired fasting glucose and impaired glucose tolerances.

CDC: November 2016; https://www.cdc.gove/diabetes16

• Pancreas

• Beta cell function

• alpha cell stimulation

• hepatic glucose production

• Brain

• Impaired satiety

• Dopamine

• Peripheral Tissue

• GLUT-4

• Kidney

• Glucose reabsorption

• GI tract

• Incretin deficiency and/or resistance

• Adipose tissue

• Cytokines

(communicators)

• Inflammatory mediators

• Free fatty acids

• Adinopectin

PATHOPHYSIOLOGIC CHANGES IN DIABETIC PATIENT

Defronzo, R.A. (2009). From the triumvirate to the ominous octet: A new paradign from the treatment of type 2 diabetes mellitus. Diabetes,

58(4), 773-795. doi: 10.2337/db09-9028

ROLE OF THE PANCREAS

Role of the Pancreas

• Anabolic hormone• Helps store glucose as

glycogen in muscle and liver

• Secreted in response to elevated glucose

• Halts breakdown of glycogen in liver

• Increases protein synthesis, fat storage

• Powerful hypoglycemic

Beta Cells – Amylin

• Secreted in 1:1 ratio with insulin

• Satiety

• Lowers post-prandial glucagon response

• Slows gastric emptying

• Type 1 = make non

• Type 2 make less than usual amount

An Overview of the Pancreas - Understanding Insulin and Diabetes

https://www.endocrineweb.com/endocrinology/overview-pancreas

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ROLE OF THE PANCREAS

Alpha Cells

• Synthesize glucagon

• Stimulated in response to low blood sugar

• Stimulates liver to convert glucagon to glucose

• Inhibits liver uptake of glucose

• May cause hyperglycemia

b

An Overview of the Pancreas - Understanding Insulin and Diabetes


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PATHOPHYSIOLOGIC CHANGES IN DIABETIC PATIENT

Leading to:

• Inflammation

• Insulin resistance

• Increase in BP

• Dyslidemia

• Impaired thrombolysis

• Increase in body weight

Defronzo, R.A. (2009). From the triumvirate to the ominous octet: A new paradign from the treatment of type 2 diabetes mellitus. Diabetes,

58(4), 773-795. doi: 10.2337/db09-9028

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International Diabetes Center: www.idcpublishing.com/2014 21

PRE-DIABETES

Increased risk for diabetes

Standards of Medical Care in Diabetes” https://www.diabetes.org


Always

hungry

Sudden

weight loss

Wounds that

won’t heal

Sexual

problems

Frequent

Urination

Vaginal

infections

Blurry vision

Always ThirstyNumb/tingling hands or feet

Always tired

Symptoms of

Diabetes

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TYPE 1 DIABETES

• Autoimmune disease

• Progressive destruction of beta cells

• Autoimmune diseases, such as t1d may be passed down

through families

• Onset is usually rapid

• Extreme thirst, weight loss, extreme fatigue, and

elevated glucose levels

• Commonly diagnosed in childhood

• May occur at any age

Standards of Medical Care in Diabetes https://www.diabetes.org


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TYPE 1 & 2 DIABETES



SELF-MONITORING BLOOD GLUCOSE

Before

meals

80-130

mg/dl

2 hours

after

eating

<180 mg/dl

Hemoglobin

A1c

<7%

American Diabetes Association.(2016). Standards of medical care in diabetes. Diabetes Care, 8(S1):S4. doi: 10.2337/dc15-S00326

Comprehensive

Diabetes Eye Exam

VISION

At Least Annually

• Measure

pressures

• Look at retina

• Look at vessel



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ANNUAL FLU SHOT

https://cdc.gov/diabetes/influenzavaccinations/2016 28

• One before age 65

• One after age 65

• Separated by 5-7

years

• New Prevnar 13

booster now available

PNEUMONIA SHOT

https://cdc.gov/diabetes//pneumococcalvaccinations/201629

Teach and Encourage

Daily Self Foot Exam

FOOT EXAMS

Identify

Redness Swellings

Cuts Nails Callouses



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Microvascular DiseasePatients with microvascular disease

should have the feet seen every visit.

• Microalbumin, measured annually

• Goal : 30 or less

• Medication may be indicated

• ACE

• ARBS

• Important to control A1c/BS

• Important to control BP

KIDNEY- URINE TEST

Standards of Medical Care in Diabetes www.diabetes.org


Kidney

failure

Loss of

limb

Nerve

damage

Blindness

Stroke

Heart

Disease

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HEMOGLOBIN A1C

The American Diabetes

Association suggests:

A1C of 7% or less

eAG 154 mg/dl.

More or less stringent based on each

individual goals.

http://www.diabetes.org/standardsofinmedicalcareindiabetes/2016 33

Abridged version of the American Diabetes Association Position Statement: Standards of Medical Care in Diabetes— 2015. Diabetes Care

2015;38(Suppl. 1): S1–S94, http://clinical.diabetesjournals.org/ content/33/2/97/suppl/DC1. doi: 10.2337/diaclin.33.2.97 34

Diabetes Self-Management Programs

Diabetes Prevention Programs

Lions Club Eye Care

Medication Assistance Programs

Senior Services

Churches

Community Volunteer Clinic,

Casper, Cody & Powell, Riverton,

Rocksprings & others

Wellness Centers

ADDITIONAL RESOURCES

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Thank you for participating!

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Diabetes Basics for Health Care Professionals - wypca.org · American Association of Diabetes Educators ... From the triumvirate to the ominous octet: A new paradign from the treatment