So c ia l Sa b o ta g e o f the Pe rso n with Dia b e te s A T - PowerPoint PPT Presentation

So c ia l Sa b o ta g e o f the Pe rso n with Dia b e te s A T ria l Cha lle ng ing Our Appro a c h to Ca re

Me g a n Muño z, MSN, CMSRN, CDCE S Ba c he lo r’ s a nd Ma ste r’ s o f Nursing Ce rtific a tio ns in Me dic a l Surg ic a l Nursing & Dia b e te s Ca re & E duc a tio n UnityPo int I npa tie nt Glyc e mic Ma na g e me nt & Outpa tie nt E duc a to r Ho st o f T ype 2a ndYo u with Me g Disc lo sure s: Se lf-Ma na g e d Sto c k in T a nde m a nd De xc o m

Ob je c tive s  I de ntify c urre nt pe rso na l, so c ia l, a nd he a lthc a re b ia se s tha t e xist a g a inst the pe rso n with dia b e te s (PWD)  I de ntify a t le a st two wa ys the se b ia se s impa c t the PWD’ s he a lth a nd a b ility to re c e ive time ly, a ppro pria te he a lthc a re  E xa mine e vide nc e tha t c ha lle ng e s the se b ia se s a g a inst the PWD  De sc rib e te c hniq ue s fo r re duc ing stig ma s a nd fo ste ring the he a lth a nd we llb e ing o f the PWD

Pe o ple ’ s L ive s De pe nd o n Yo ur De c isio n T o da y…  Yo u Be the Judg e …

Pro se c utio n: “dia b e tic s” so c ie ty… in o ur

Co mmo n Me ssa g ing : Are T he re T ruths in T he se Me ssa g e s?

“ Sho uld Pa ula De e n lo se a lo t o f we ig ht a nd influe nc e o the rs to do so , a nd sho uld she sho w tho se who wa tc h he r sho w ho w to do it, she c o uld b e c o me a g o dde ss.“ -Ca rla Wo lpe r in 2012 ABC Ne ws Re po rt title d: “Pa ula De e n T e a ms Up with Dia b e te s Drug ma ke r No vo No rdisk”

“T his me a ns we c a n no w se e type 2 dia b e te s a s a simple c o nditio n whe re the individua l ha s a c c umula te d mo re fa t tha n the y c a n c o pe with…….thro ug h die t a nd pe rsiste nc e , pa tie nts a re a b le to lo se the fa t a nd po te ntia lly re ve rse the ir dia b e te s.” -Pro f. Ro y T a ylo r (c o -le a d o f DI RE CT study) in 2020 Me dic a lNe wsT o da y a rtic le title d: “S tudy re ve als what c ause s type 2 diabe te s and ho w to re ve rse it.”

T he Pro se c utio n’ s Clo sing Arg ume nts  T 2D is a life style dise a se  T 2D c a n b e re ve rse d o r pre ve nte d in mo st c a se s  We ig ht is a mo difia b le risk fa c to r fo r T 2D a nd its c o urse  Using me dic a tio n, inc luding insulin, is no t c o mmo n a nd is a n indic a to r o f po o r se lf-c a re …T 2D de ve lo pme nt a nd its c o urse is he a vily de pe nde nt o n the de dic a tio n o f the individua l to c a re fo r the mse lve s….

NSE AND NOW… E F DE HE T

Wha t if this me ssa g ing is no t o nly ina c c ura te b ut ha rmful?

E xhib it A: “L ife style Dise a se ” tha t c a n b e pre ve nte d AK A “I t’ s Yo ur F a ult…”

E xhib it A1: T 2D Risk F a c to rs Ove rwe ig ht o r ”o b e se ” 1. Ove r a g e 45 2. F a mily histo ry o f dia b e te s 3. Afric a n Ame ric a n, Ala ska Na tive , Ame ric a n I ndia n, Asia n Ame ric a n, 4. Hispa nic / L a tino , Na tive Ha wa iia n, o r Pa c ific I sla nde r Hig h b lo o d pre ssure 5. L o w le ve l o f HDL(“g o o d”) c ho le ste ro l, o r a hig h le ve l o f trig lyc e ride s 6. Hx o f g e sta tio na l dia b e te s o r g a ve b irth to a b a b y we ig hing 9 po unds 7. o r mo re No t physic a lly a c tive 8. Hx o f he a rt dise a se o r stro ke 9. De pre ssio n 10. Po lyc ystic o va ry syndro me (PCOS) 11. Ac a ntho sis nig ric a ns—da rk, thic k, a nd ve lve ty skin a ro und yo ur ne c k 12. o r a rmpits

E xhib it A1: T 2D Risk F a c to rs Syste m. Gis.c dc .g o v. (2020 Braveman & Gottlieb, 2014; U.S. Dia b e te s Surve illa nc e Adve rse Childho o d E ve nts (ACE S): in priso ne d 13. pa re nt, drug / a lc o ho l a b use , physic a l, e mo tio na l, o r se xua l a b use , ne g le c t, pa re nt se pa ra tio n Chro nic stre ss: inc luding ra c ism, we ig ht stig ma 14. Affo rda b le / e a sy a c c e ss to he a lthc a re 15. E xpo sure to c he mic a ls (a g e nt o ra ng e ) 16. T hyro id c o nditio ns 17. Bing e e a ting diso rde r 18. E duc a tio n lo we r tha n a hig h sc ho o l diplo ma 19. L o we r inc o me 20. Ro ta ting shifts/ po o r sle e p ro utine s 21. F e w so c ia l c o nne c tio ns o r suppo rts 22.

Afric a n Ame ric a n, Ala ska Na tive , Ame ric a n I ndia n, Asia n Ame ric a n, Hispa nic / L a tino , Na tive Ha wa iia n, o r Pa c ific I sla nde r Syste m. Gis.c dc .g o v. (2020 Braveman & Gottlieb, 2014; U.S. Dia b e te s Surve illa nc e CDC’ s Ra te o f Dia b e te s Ba se d o n Ra c e / E thnic ity 12 Hispanic 11 Syste mic AA 12 8 Ra c ism 10 8 6 White Adve rse Childho o d E ve nts (ACE s) 4 2 Chro nic Stre ss 0 L o we r E duc a tio n Ra c e / E thnic ity Disa dva nta g e d Ne ig hb o rho o ds Hig he r Ra te s o f T o b a c c o / Alc o ho l Use L e ss Ac c e ss to He a lthy F o o ds, Re c re a tio na l Ac tivitie s L e ss Ac c e ss to He a lthc a re

E xhib it A1: He a lth I nflue nc e rs De te rmina nts o f Po pula tio n He a lth He a lth Ha b its 25- 30% So c ia l/ He a lthc a re E nviro nme nta l Ge ne s/ Bio lo g y

E xhib it A2: Wha t We K no w Ab o ut Pre ve nting T 2D  De la ye d a T 2D dia g no sis b y 2-4 ye a rs  Me tfo rmin: 34% fe we r pe o ple de ve lo pe d T 2D*  “L ife style :” 56% fe we r pe o ple de ve lo pe d T 2D* * At 3 ye a rs c o mpa re d to no inte rve ntio n

E xhib it A2- Dia b e te s Pre ve ntio n Pro g ra m a nd Outc o me s Study L ife style a t 15 ye a rs - 55% Pla c e bo a t 15 ye a rs De ve lo pe d - 62% Dia b e te s No Dia b e te s Dia b e te s De ve lo pe d Me tformin a t 15 Ye a rs - No 56% Dia b e te s Dia b e te s De ve lo pe d No Dia b e te s

E xhib it A2- Dia b e te s Pre ve ntio n Pro g ra m a nd Outc o me s Study “Pre -dia b e te s re pre se nts a hig h-risk sta te fo r dia b e te s… de spite I L S (inte nsive life style ).”

AL NT RONME NVI E GMA AL SOCI I ife style Dise a se ”= ST HCARE T AL HE CS I T NE GE “L

GE NE T I CS HE AL T HCARE E NVIRONME NT AL / SOCIAL

A Windo w into the I mpa c t o f Stig ma …. (2015); Sc ha b e rt, Bro wne , Mo se ly, & Spe ig ht. (2013). Mulla n, (2012); Po we rs, e t a l. (2015); Winkle y, e t a l. Holmes-Truscott, et al. (2020); Fi ishe r, He ssle r, Po lo nsky &  T he MI L E S-2 study sho we d a sso c ia tio ns b e twe e n stig ma s & de pre ssio n/ a nxie ty & dia b e te s distre ss  Dia b e te s distre ss is linke d to po o re r g lyc e mic o utc o me s & lo we r e ng a g e me nt in se lf-c a re  L e ss tha n 7% o f pe o ple with T 2D a re re fe rre d to DSMT a t dia g no sis  1 in 3 pe o ple re po rt no t a tte nding DSMT se rvic e s due to fe a r o f stig ma tiza tio n  He a lth c a mpa ig ns e mpha sizing a pe rso n’ s ro le in c hro nic dise a se de ve lo pme nt inc re a se s “b la me -induc e d stig ma s”

E xhib it B: Dia b e te s Ca n Be Re ve rse d/ L iving with Dia b e te s is a Cho ic e Me dic a tio n is a Sig n Of Po o r Se lf- Ca re

E xhib it B1: T 1D  Be fo re the disc o ve ry o f insulin in 1921, life spa n o f so me o ne with T 1D a fte r dia g no sis typic a lly le ss tha n 1 ye a r  Auto immune

E xhib it B1: T 2D “Re ve rsa l” https:/ / do i.o rg / 10.2337/ dc 09-9036 2009 ADA E xpe rt Co nse nsus “Pa rtia l “Co mple te “Pro lo ng e d Re missio n” Re missio n” Re missio n” • Off me ds • Off me ds • Off me ds • A1c < 6.5% • A1c < 5.7% • A1c < 5.7% fo r a t le a st fo r a t le a st fo r a t le a st o ne ye a r o ne ye a r five ye a rs

E xhib it B1: T 2D “Re ve rsa l” Study F la ws DI RE CT & L o o k AHE AD study • Hig he r pa nc re a s func tio n 1 • Se ve re c a lo rie re stric tio ns 2 • I nte nsive suppo rt tha t is diffic ult to tra nsla te into the “re a l” wo rld 3 • De fine re ve rsa l , o r “c ure ” a s le ss tha n 6.5% x1 ye a r a nd o ff me ds 4 • T he numb e r in re missio n de c line d e a c h ye a r o f the study 5

E xhib it B1: T 2D “Re ve rsa l” Study F la ws-Ga stric Bypa ss •T e nd to b e sma lle r studie s 1 • BMI in studie s we re o fte n sma lle r tha n “re a l wo rld” c rite ria 2 •Ana to mic a lly diffe re nt a fte r a po rtio n o f sto ma c h a nd inte stine is a mputa te d 3 •Re c o mme nde d lo ng -te rm da ily c a lo ric inta ke 900 to 1,000 c a lo rie s o fte n with lo ng -te rm vita min/ supple me nts 1 4 •Re missio n de fine d a s A1c le ss tha n 6.5% a nd o ff me ds (va rie d time line s) 5 •Suic ide a nd me nta l illne ss strug g le s a re sig nific a ntly hig he r tha n g e ne ra l po pula tio n 6

K a ise r He a lth Syste m Study… https:/ / do i.o rg / 10.2337/ dc 14-0874  Ge ne ra l po pula tio n re missio n ra te (in a study o f o ve r 122,000 pe o ple ) = Dura tio n o f dia b e te s a nd insulin use a t time o f surg e ry = lo we r c ha nc e o f re missio n