SERIES Professional Education units (CPEUs) for completion of this - - PowerPoint PPT Presentation

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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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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.

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 Disclosures Planners: 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

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 1.0 Continuing Professional Education units (CPEUs) for completion of this 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 hannah.herold@wyo.gov. OR (307) 777.3579

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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 & Balance

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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
• r older have prediabetes

www.cdc.gov/diabetes 8/2017

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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/

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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/wyoming CDC: Prevalence by age

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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/diabetes

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

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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 was originally approved in 1988. Most recent review/revision: December 2016

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Always hungry Sudden weight loss Wounds that won’t heal Sexual problems Frequent Urination Vaginal infections Blurry vision Always Thirsty

Numb/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 was originally approved in 1988. Most recent review/revision: December 2016

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TYPE 1 & 2 DIABETES

Standards of Medical Care in Diabetes https://www.diabetes.org was originally approved in 1988. Most recent review/revision: December 2016

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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-S003

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Comprehensive Diabetes Eye Exam

VISION

At Least Annually

• Measure

pressures

• Look at retina
• Look at vessel

Standards of Medical Care in Diabetes https://www.diabetes.org was originally approved in 1988. Most recent review/revision: December 2016

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ANNUAL FLU SHOT

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

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• 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/2016

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Teach and Encourage Daily Self Foot Exam

FOOT EXAMS

Identify Redness Swellings Cuts Nails Callouses

Standards of Medical Care in Diabetes https://www.diabetes.org was originally approved in 1988. Most recent review/revision: December 2016

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Microvascular Disease

Patients 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 was originally approved in 1988. Most recent review/revision: December 2017 31

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

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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

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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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