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Nutrition for Health Promotion & Disease Prevention
Katie Ferraro,
MPH, RD, CDE
Diabetes: Definitions and Diagnoses
What is Diabetes?
o Chronlc dlsease
o Cccurs when pancreas doesn'L produce enough lnsulln,
or
o When pancreas cannoL eecuvely use Lhe lnsulln lL
produces
o Pyperglycemla - damage of nerves and blood vessels
o Leadlng cause of bllndness, ampuLauon & kldney
fallure
wotlJ neoltb Otqoolzouoo, ulobetes ltoqtomme, 2012.
Gl obal Diabetes Statistics
o 347 mllllon people worldwlde have dlabeLes
o > 80 of people wlLh dlabeLes llve ln low- and
mlddle-lncome counLrles
o WPC pro[ecLs LhaL dlabeLes deaLhs wlll double
beLween 2003-2030
wotlJ neoltb Otqoolzouoo, ulobetes ltoqtomme, ovolloble ot. bup.//www.wbo.lot/Jlobetes/eo/
Gl obal Cost of Diabetes
o lndla: low-lncome famlly may spend up Lo 23 of
famlly lncome devoLed Lo dlabeLes care for one person
o ln uS, lf one chlld wlLh dlabeLes, 10 of famlly lncome
o WPC's WesLern aclc reglon: 16 of hosplLal
expendlLure on people wlLh dlabeLes
o 20 of oshore expendlLure ln ll[l was on dlabeLes
relaLed condluons
o lnLanglble cosLs: paln, anxleLy, lower quallLy of llfe.
wotlJ neoltb Otqoolzouoo, ulobetes. tbe cost of Jlobetes, ovolloble ot.
bup.//www.wbo.lot/meJloceotte/foctsbeets/fs2J6/eo/
US Diabetes Statistics
o 23.8 mllllon chlldren and adulLs ln uS (8.3 of
populauon) have dlabeLes
ulagnosed: 18.8 mllllon people
undlagnosed: 7.0 mllllon people
o redlabeLes: 79 mllllon people (23 of populauon)
o $174 bllllon LoLal cosL of dlagnosed uM ln uS 2007
o Medlcal cosLs for Lhose wlLh dlabeLes are 2.3 umes
hlgher Lhan for Lhose wlLhouL
Ametlcoo ulobetes Assoclouoo, ulobetes 8oslcs. ulobetes 5tousucs, ovolloble ot.
bup.//www.Jlobetes.otq/Jlobetes-boslcs/Jlobetes-stousucs/
Types 1 and 2 Diabetes
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8esulLs from -cell desLrucuon, usually leadlng Lo absoluLe lnsulln declency
3-10 of all cases of dlabeLes
lormerly called lnsulln dependenL dlabeLes melllLus (luuM) or [uvenlle-onseL dlabeLes
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8esulLs from progresslve lnsulln secreLory defecL on background of lnsulln reslsLance
90-93 of all cases of dlabeLes
lormerly called non-lnsulln dependenL dlabeLes melllLus (nluuM) or adulL-onseL
ulobetes cote. Iooooty 2012 vol J5 oo 5opplemeot 1 511-56J.
Diagnosis
o PlsLorlcally: fasung plasma glucose (lC) or 2-
hour value ln 73-g oral glucose Lolerance LesL
(CC11)
o 2009: lnLernauonal LxperL Commluee
recommended use of PbA1c wlLh Lhreshold of
> 6.3
Diagnosing Diabetes
2*304 > 6.3
567 > 126 mg/dL (7.0 mmol/L) - fasung ls 8 hrs
87-- 2-hour plasma glucose > 200 mg/dL (11.1 mmol/L)
73 g anhydrous glucose dlssolved ln waLer
9):;<= 8andom plasma glucose > 200 mg/dL wlLh classlc
sympLoms of hyperglycemla or hyperglycemlc crlsls
ulobetes cote. Iooooty 2012 vol J5 oo 5opplemeot 1 511-56J.
Prediabetes
o Croup of people whose glucose levels - alLhough
don'L meeL crlLerla for dlabeLes - are Loo hlgh Lo
be consldered normal
o redlabeLes = hlgh rlsk for fuLure dlabeLes
o noL cllnlcal facLors by lLself, buL rlsk facLor for
fuLure dlabeLes and Cvu
o redlabeLes assoclaLed wlLh obeslLy (abdomlnal
or vlsceral), dysllpldemla, ^ 1C, P1n, j PuL
ulobetes cote. Iooooty 2012 vol J5 oo 5opplemeot 1 511-56J.
Diagnosing Prediabetes
2*304 3.7-6.4
567 lmpalred lasung Clucose (llC) lf fasung plasma
glucose ls 100-123 mg/dL (3.6-6.9 mmol/L)
87-- lmpalred Clucose 1olerance (lC1) lf 2-hr value aer
CC11 ls 140-199 mg/dL (7.8-11.0 mmol/L)
!28 uene cuLo for ll1 aL 110 mg/dL (6.1 mmol/L)
ulobetes cote. Iooooty 2012 vol J5 oo 5opplemeot 1 511-56J.
Diagnostic Cutpoints
lmoqe. Iose loolo 5. 8ottomeo
Who is at risk & shoul d be tested?
All adulLs who are overwelghL (8Ml > 23) and who have 1 or more of Lhe followlng:

o hyslcal lnacuvlLy
o llrsL-degree relauve wlLh dlabeLes
o Plgh-rlsk race/eLhnlclLy (e.g., Afrlcan, Launo, nauve Amerlcan, Aslan, aclc lslander)
o Women who dellvered a baby welghlng >9 lb or who were dlagnosed wlLh CuM
o PyperLenslon (blood pressure >140/90 mmPg or on Lherapy for hyperLenslon)
o PuL <33 mg/dL (0.90 mmol/L) and/or 1C >230 mg/dL (2.82 mmol/L)
o Women wlLh CCS
o A1C >3.7, lC1, or llC on prevlous Lesung
o CLher cllnlcal condluons assoclaLed w/ lnsulln reslsLance (e.g., severe obeslLy,
acanLhosls nlgrlcans)
o PlsLory of Cvu
ulobetes cote. Iooooty 2012 vol J5 oo 5opplemeot 1 511-56J.
Gestational Diabetes
o CesLauonal ulabeLes MelllLus (CuM)
o ulabeLes dlagnosed durlng pregnancy LhaL ls noL
clearly overL dlabeLes
o regnanL women wlLhouL prevlous known
dlabeLes, screen for CuM aL 24-48 weeks'
gesLauon
o use 73-g 2-hr CC11 of >200 mg/dL (11.1 mmol/L)
For More Infor mation
o Amerlcan ulabeLes Assoclauon SLandards of Medlcal Care ln
ulabeLes 2012:
hup://care.dlabeLes[ournals.org/conLenL/33/SupplemenL_1/S11.full
o Medllnelus - ulabeLes:
hup://www.nlm.nlh.gov/medllneplus/dlabeLes.hLml
o Medllnelus - ulabeLes lnLeracuve 1uLorlal:
hup://www.nlm.nlh.gov/medllneplus/LuLorlals/
dlabeLeslnLroducuon/hLm/lndex.hLm
o lnLernauonal ulabeLes lederauon: hup://www.ldf.org/