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The Science Diabetes Prevention

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					                                           Diabetes: Prevention


   The Science:
Diabetes Prevention




                                             Revised March 2010


  National Diabetes Education Program
 www.YourDiabetesInfo.org • 1-888-693-NDEP
          A joint program of NIH and CDC
                                                                     Diabetes: Prevention



Diabetes Prevention Program (DPP)

      The DPP was a major clinical trial to
      determine whether diet and exercise or
      the oral diabetes drug metformin could
      prevent or delay the onset of type 2
      diabetes.


DPP Research Group. N Engl J Med 2002, Vol.346, No. 6.                 Revised March 2010


                       National Diabetes Education Program
                     www.YourDiabetesInfo.org • 1-888-693-NDEP
                                    A joint program of NIH and CDC
                                                                         Diabetes: Prevention


                          DPP Participants
      Adults at high risk for type 2 diabetes
      •   Presence of IGT
      •   Mean age 51 years
      •   Mean body mass index (BMI) 34
      •   68% women
      •   45% minority groups
                – African Americans
                – Hispanics/Latinos
                – American Indians
                – Asian Americans and Pacific Islanders
DPP Research Group. N Engl J Med 2002, Vol.346, No. 6.                     Revised March 2010


                           National Diabetes Education Program
                         www.YourDiabetesInfo.org • 1-888-693-NDEP
                                        A joint program of NIH and CDC
                                                                       Diabetes: Prevention


                                 DPP Methods
  Lifestyle intervention
         5% to 7% weight reduction
         Healthy low-calorie, low-fat diet
         30 minutes of physical activity, 5 days a week

  Metformin
          Oral diabetes drug

  Placebo
DPP Research Group. N Engl J Med 2002, Vol.346, No. 6.                   Revised March 2010


                          National Diabetes Education Program
                       www.YourDiabetesInfo.org • 1-888-693-NDEP
                                      A joint program of NIH and CDC
                                                                        Diabetes: Prevention


                                 DPP Methods
        DPP Curriculum:
           Diet
           Exercise
           Behavior change modification

        Taught one-on-one by case
         managers
DPP Research Group. N Engl J Med 2002, Vol.346, No. 6.                    Revised March 2010


                          National Diabetes Education Program
                        www.YourDiabetesInfo.org • 1-888-693-NDEP
                                       A joint program of NIH and CDC
                                          Diabetes: Prevention




                                            Revised March 2010


 National Diabetes Education Program
www.YourDiabetesInfo.org • 1-888-693-NDEP
         A joint program of NIH and CDC
                                                 Diabetes: Prevention


Diabetes Prevention Program
 Outcomes Study (DPPOS)
• Follow-up study to the DPP
• Assess the long-term effects of the
  DPP interventions on the development
  of type 2 diabetes and its
  complications
                                                   Revised March 2010


        National Diabetes Education Program
       www.YourDiabetesInfo.org • 1-888-693-NDEP
                A joint program of NIH and CDC
                                                                        Diabetes: Prevention

             Diabetes Prevention Program
              Outcomes Study (DPPOS)
  After 10 years’ follow up, lifestyle intervention:
  • reduced the rate of developing type 2 diabetes
    by 34 %
  • reduced the rate of developing type 2 diabetes
    by 49 % in those age 60 and older
  • delayed type 2 diabetes by about 4 years
  • reduced cardiovascular risk factors.
  • Reduced A1C and FPG
DPP Research Group. The Lancet 2009: Vol.374, No. 9702.                   Revised March 2010


                           National Diabetes Education Program
                        www.YourDiabetesInfo.org • 1-888-693-NDEP
                                       A joint program of NIH and CDC
                                                                        Diabetes: Prevention


             Diabetes Prevention Program
              Outcomes Study (DPPOS)
  At 10 years’ follow up, metformin
  • reduced the rate of developing diabetes by 18 %
    compared with placebo.
  • delayed diabetes by 2 years compared with
    placebo.
  • reduced A1C and fasting glucose compared with
    placebo.
DPP Research Group. The Lancet 2009: Vol.374, No. 9702.                   Revised March 2010


                           National Diabetes Education Program
                        www.YourDiabetesInfo.org • 1-888-693-NDEP
                                       A joint program of NIH and CDC
                                                                         Diabetes: Prevention


             Diabetes Prevention Program
              Outcomes Study (DPPOS)
  Preliminary results
        • 8% of participants with pre-diabetes had
          diabetic eye disease (retinopathy)
        • 12.6% of participants with type 2 diabetes
          who developed diabetes during the DPP had
          diabetic eye disease
      These findings suggest that patients with pre-diabetes or newly
      diagnosed type 2 diabetes should be screened for retinopathy.
DPP Research Group. Diabetic Medicine 2007; 24 (2); 137-144.               Revised March 2010


                           National Diabetes Education Program
                         www.YourDiabetesInfo.org • 1-888-693-NDEP
                                        A joint program of NIH and CDC
                                                                            Diabetes: Prevention


                          Diabetes Prevention


    57 million U.S. adults ages 20
     and older have pre-diabetes


NIDDK, National Diabetes Statistics 2007.
www.diabetes.niddk.nih.gov/dm/pubs/statistics                                 Revised March 2010


                             National Diabetes Education Program
                           www.YourDiabetesInfo.org • 1-888-693-NDEP
                                           A joint program of NIH and CDC
                                                                          Diabetes: Prevention


                  What is Pre-diabetes?
   • Pre-diabetes is a medical condition where
     blood glucose is higher than normal but not
     high enough to be called diabetes
   • It increases the risk for type 2 diabetes and
     cardiovascular disease
   • Most people have pre-diabetes before they
     develop type 2 diabetes
NIDDK, National Diabetes Statistics 2007.
www.diabetes.niddk.nih.gov/dm/pubs/statistics                               Revised March 2010


                            National Diabetes Education Program
                          www.YourDiabetesInfo.org • 1-888-693-NDEP
                                         A joint program of NIH and CDC
                                                                         Diabetes: Prevention


                What is Pre-diabetes?
 • Most people with pre-diabetes develop type 2
   diabetes within 10 years

 • People with pre-diabetes are identified by
   having a screening test which shows they
   have IFG, IGT or an A1C of 5.7% - 6.4%

 • Progression to diabetes is NOT inevitable
NIDDK, National Diabetes Statistics 2007.
www.diabetes.niddk.nih.gov/dm/pubs/statistics                              Revised March 2010


                           National Diabetes Education Program
                         www.YourDiabetesInfo.org • 1-888-693-NDEP
                                        A joint program of NIH and CDC
                                                                            Diabetes: Prevention


           Risk Factors for Diabetes
  •   Age 45 and older                                       • History of vascular disease
  •   Overweight (BMI ≥ 25)                                  • Signs of insulin resistance
  •   Hypertension                                                (such as PCOS or
  •   Abnormal lipid levels                                         acanthosis nigricans)
                                                             • Pre-diabetes
  •   Family history of diabetes
                                                             • Inactive lifestyle
  •   Race/ethnicity
  •   History of gestational
      diabetes


American Diabetes Association. Diabetes Care 2008; 31;(Suppl.1):S12-54.        Revised March 2010


                            National Diabetes Education Program
                         www.YourDiabetesInfo.org • 1-888-693-NDEP
                                         A joint program of NIH and CDC
                                                                          Diabetes: Prevention

                    Testing for Diabetes and
                          Pre-Diabetes
  Consider testing if person is:
       • Age 45 or older
       • An overweight adult with another risk factor
  Obtain: A1C or FPG or 2-hour plasma glucose post
             75-g oral glucose challenge

  Repeat testing every 3 years.

American Diabetes Association. Diabetes Care 2008; 31;(Suppl.1):S12-54.     Revised March 2010


                           National Diabetes Education Program
                         www.YourDiabetesInfo.org • 1-888-693-NDEP
                                         A joint program of NIH and CDC
                                                                            Diabetes: Prevention


              Diagnostic Criteria for
            Pre-diabetes and Diabetes
                                   A1C                   Fasting Plasma      2-Hour Oral
                                                          Glucose Test         Glucose
                                                              (FPG)           Challenge
Acceptable                                               Below 100 mg/dl    Below 140 mg/dl

Pre-diabetes                 5.7% - 6.4%                  100-125 mg/dl      140-199 mg/dl
                                                              (IFG)              (IGT)
Diabetes                         ≥ 6.5%                126 mg/dl or above    200 mg/dl or
                                                                                above


American Diabetes Association. Diabetes Care 2010; 33;(Suppl.1):S11-61.       Revised March 2010
.

                          National Diabetes Education Program
                        www.YourDiabetesInfo.org • 1-888-693-NDEP
                                        A joint program of NIH and CDC
                                                Diabetes: Prevention

National Diabetes Education Program
              Materials




                                                  Revised March 2010


       National Diabetes Education Program
      www.YourDiabetesInfo.org • 1-888-693-NDEP
               A joint program of NIH and CDC
                                          Diabetes: Prevention


     GAME PLAN




                                            Revised March 2010


 National Diabetes Education Program
www.YourDiabetesInfo.org • 1-888-693-NDEP
         A joint program of NIH and CDC
                                          Diabetes: Prevention


     GAME PLAN




     Health Care Professional Toolkit
                                            Revised March 2010


 National Diabetes Education Program
www.YourDiabetesInfo.org • 1-888-693-NDEP
         A joint program of NIH and CDC
                                                 Diabetes: Prevention


NDEP Diabetes Prevention Materials




                                                   Revised March 2010


        National Diabetes Education Program
       www.YourDiabetesInfo.org • 1-888-693-NDEP
                A joint program of NIH and CDC
                                              Diabetes: Prevention


   NDEP Campaign Tools
at www.YourDiabetesInfo.org
 • TV, radio, and print PSAs
 • Sample feature articles
 • Sample press releases and media
   advisories
 • Fact sheets
 • Web buttons/blurbs
 • NDEP logos and banners
                                                Revised March 2010


     National Diabetes Education Program
    www.YourDiabetesInfo.org • 1-888-693-NDEP
             A joint program of NIH and CDC
                                                          Diabetes: Prevention

For more information about NDEP and
   to order free diabetes materials:

        Call 1-888-693-NDEP (6337)
                     or
     Click www.YourDiabetesInfo.org
          The U.S. Department of Health and Human Services’
    National Diabetes Education Program is jointly sponsored by the
   National Institutes of Health and the Centers for Disease Control and
   Prevention with the support of more than 200 partner organizations.

                                                             Revised March 2010


             National Diabetes Education Program
            www.YourDiabetesInfo.org • 1-888-693-NDEP
                       A joint program of NIH and CDC

				
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