Sharon M Weinstein MS RN CRNIreg FACW FAAN

ID Wellness December 3 2010

Discuss incidence of Diabesity and pandemic nature

State healthcare projections and cost factors associated with disease

Identify key dietary and pharmacological factors in managing disease process

Describe US and European approaches to management

An Epidemic

bull US newborn today has a 1 in 3 chance of developing diabetes

bull For Hispanics and African-Americans the risk is 1 in 2

Centers for Disease Control and Prevention (CDC)

A term coined by former US Surgeon General C Everett Koop

Raises awareness of the health effects of obesity

Diabesityreg is a registered trademark of Shape Up America (wwwshapeuporg)

Provides interactive information and guidance on weight management healthy eating physical activity childhood obesity and other topics related to the prevention and treatment of obesity

Is the terror within left unchecked could have a greater impact than 911

Dr Richard Carmona (former surgeon general)

Overweight kids become overweight adults

Robert Wood Johnson Foundation ndashspending at least $500 million over the next 5 years to reduce childhood obesity

Incidence of diabetes 800000 casesyear

Prevalence of diabetes 16 million total (includes ~ 8 million undiagnosed)

Number will double or triple by 2050 (1 in 3 adults)

$ 44 billion direct medical costs $ 138 billion in direct and indirect costs Medical costs are 3-8x higher for

Diabetic vs non-Diabetic In patient hospital costs are 5 ndash 9x higher

($7153 vs $1222) 60 ndash65 high blood pressure Leading cause of blindness Common cause of ESRD

50 reduction in sick days and no comp cases between 1997 and 2003

Expanded program to asthma and hypertension

Discuss incidence of Diabesity and pandemic nature

State healthcare projections and cost factors associated with disease

Identify key dietary and pharmacological factors in managing disease process

Describe US and European approaches to management

An Epidemic

bull US newborn today has a 1 in 3 chance of developing diabetes

bull For Hispanics and African-Americans the risk is 1 in 2

Centers for Disease Control and Prevention (CDC)

A term coined by former US Surgeon General C Everett Koop

Raises awareness of the health effects of obesity

Diabesityreg is a registered trademark of Shape Up America (wwwshapeuporg)

Provides interactive information and guidance on weight management healthy eating physical activity childhood obesity and other topics related to the prevention and treatment of obesity

Is the terror within left unchecked could have a greater impact than 911

Dr Richard Carmona (former surgeon general)

Overweight kids become overweight adults

Robert Wood Johnson Foundation ndashspending at least $500 million over the next 5 years to reduce childhood obesity

Incidence of diabetes 800000 casesyear

Prevalence of diabetes 16 million total (includes ~ 8 million undiagnosed)

Number will double or triple by 2050 (1 in 3 adults)

$ 44 billion direct medical costs $ 138 billion in direct and indirect costs Medical costs are 3-8x higher for

Diabetic vs non-Diabetic In patient hospital costs are 5 ndash 9x higher

($7153 vs $1222) 60 ndash65 high blood pressure Leading cause of blindness Common cause of ESRD

50 reduction in sick days and no comp cases between 1997 and 2003

Expanded program to asthma and hypertension

An Epidemic

bull US newborn today has a 1 in 3 chance of developing diabetes

bull For Hispanics and African-Americans the risk is 1 in 2

Centers for Disease Control and Prevention (CDC)

A term coined by former US Surgeon General C Everett Koop

Raises awareness of the health effects of obesity

Diabesityreg is a registered trademark of Shape Up America (wwwshapeuporg)

Provides interactive information and guidance on weight management healthy eating physical activity childhood obesity and other topics related to the prevention and treatment of obesity

Is the terror within left unchecked could have a greater impact than 911

Dr Richard Carmona (former surgeon general)

Overweight kids become overweight adults

Robert Wood Johnson Foundation ndashspending at least $500 million over the next 5 years to reduce childhood obesity

Incidence of diabetes 800000 casesyear

Prevalence of diabetes 16 million total (includes ~ 8 million undiagnosed)

Number will double or triple by 2050 (1 in 3 adults)

$ 44 billion direct medical costs $ 138 billion in direct and indirect costs Medical costs are 3-8x higher for

Diabetic vs non-Diabetic In patient hospital costs are 5 ndash 9x higher

($7153 vs $1222) 60 ndash65 high blood pressure Leading cause of blindness Common cause of ESRD

50 reduction in sick days and no comp cases between 1997 and 2003

Expanded program to asthma and hypertension

A term coined by former US Surgeon General C Everett Koop

Raises awareness of the health effects of obesity

Diabesityreg is a registered trademark of Shape Up America (wwwshapeuporg)

Provides interactive information and guidance on weight management healthy eating physical activity childhood obesity and other topics related to the prevention and treatment of obesity

Is the terror within left unchecked could have a greater impact than 911

Dr Richard Carmona (former surgeon general)

Overweight kids become overweight adults

Robert Wood Johnson Foundation ndashspending at least $500 million over the next 5 years to reduce childhood obesity

Incidence of diabetes 800000 casesyear

Prevalence of diabetes 16 million total (includes ~ 8 million undiagnosed)

Number will double or triple by 2050 (1 in 3 adults)

$ 44 billion direct medical costs $ 138 billion in direct and indirect costs Medical costs are 3-8x higher for

Diabetic vs non-Diabetic In patient hospital costs are 5 ndash 9x higher

($7153 vs $1222) 60 ndash65 high blood pressure Leading cause of blindness Common cause of ESRD

50 reduction in sick days and no comp cases between 1997 and 2003

Expanded program to asthma and hypertension

Provides interactive information and guidance on weight management healthy eating physical activity childhood obesity and other topics related to the prevention and treatment of obesity

Is the terror within left unchecked could have a greater impact than 911

Dr Richard Carmona (former surgeon general)

Overweight kids become overweight adults

Robert Wood Johnson Foundation ndashspending at least $500 million over the next 5 years to reduce childhood obesity

Incidence of diabetes 800000 casesyear

Prevalence of diabetes 16 million total (includes ~ 8 million undiagnosed)

Number will double or triple by 2050 (1 in 3 adults)

$ 44 billion direct medical costs $ 138 billion in direct and indirect costs Medical costs are 3-8x higher for

Diabetic vs non-Diabetic In patient hospital costs are 5 ndash 9x higher

($7153 vs $1222) 60 ndash65 high blood pressure Leading cause of blindness Common cause of ESRD

50 reduction in sick days and no comp cases between 1997 and 2003

Expanded program to asthma and hypertension

Is the terror within left unchecked could have a greater impact than 911

Dr Richard Carmona (former surgeon general)

Overweight kids become overweight adults

Robert Wood Johnson Foundation ndashspending at least $500 million over the next 5 years to reduce childhood obesity

Incidence of diabetes 800000 casesyear

Prevalence of diabetes 16 million total (includes ~ 8 million undiagnosed)

Number will double or triple by 2050 (1 in 3 adults)

$ 44 billion direct medical costs $ 138 billion in direct and indirect costs Medical costs are 3-8x higher for

Diabetic vs non-Diabetic In patient hospital costs are 5 ndash 9x higher

($7153 vs $1222) 60 ndash65 high blood pressure Leading cause of blindness Common cause of ESRD

50 reduction in sick days and no comp cases between 1997 and 2003

Expanded program to asthma and hypertension

Incidence of diabetes 800000 casesyear

Prevalence of diabetes 16 million total (includes ~ 8 million undiagnosed)

Number will double or triple by 2050 (1 in 3 adults)

$ 44 billion direct medical costs $ 138 billion in direct and indirect costs Medical costs are 3-8x higher for

Diabetic vs non-Diabetic In patient hospital costs are 5 ndash 9x higher

($7153 vs $1222) 60 ndash65 high blood pressure Leading cause of blindness Common cause of ESRD

50 reduction in sick days and no comp cases between 1997 and 2003

Expanded program to asthma and hypertension

$ 44 billion direct medical costs $ 138 billion in direct and indirect costs Medical costs are 3-8x higher for

Diabetic vs non-Diabetic In patient hospital costs are 5 ndash 9x higher

($7153 vs $1222) 60 ndash65 high blood pressure Leading cause of blindness Common cause of ESRD

50 reduction in sick days and no comp cases between 1997 and 2003

Expanded program to asthma and hypertension

50 reduction in sick days and no comp cases between 1997 and 2003

Expanded program to asthma and hypertension

Midwest Business Group on Health (Pactiv City of Naperville Jewish Federation of Chicago)

Rolled out in Milwaukee Pittsburgh and Los Angeles

Payment for medications and consultation Valued at $2000 per yearemployee

Usually diagnosed in children and young adults

Previously known as juvenile diabetes

The body does not produce insulin

Either the body does not produce enough insulin or the cells ignore the insulin

When glucose builds up in the blood instead of going into cellshellip

- your cells may be starved for energy

- high blood glucose levels affect vital organs

Emergence in children is one of the obesity epidemicrsquos most eye-opening symptoms

The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score

Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703

Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese

Depends on administrative data

Health risk appraisal (HRA)

Lab

Pharmacy

Claims

Yields only 15 of high risk cohort

Physician engagement

Practice level reports

Dietary and pharmacological factors

Peer comparisons

Performance-based incentives

Moving toward real-time reporting

Promoting utilization of services

Better patient compliance

Improved outcomes

Usually diagnosed in children and young adults

Previously known as juvenile diabetes

The body does not produce insulin

Either the body does not produce enough insulin or the cells ignore the insulin

When glucose builds up in the blood instead of going into cellshellip

- your cells may be starved for energy

- high blood glucose levels affect vital organs

Emergence in children is one of the obesity epidemicrsquos most eye-opening symptoms

The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score

Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703

Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese

Depends on administrative data

Health risk appraisal (HRA)

Lab

Pharmacy

Claims

Yields only 15 of high risk cohort

Physician engagement

Practice level reports

Dietary and pharmacological factors

Peer comparisons

Performance-based incentives

Moving toward real-time reporting

Promoting utilization of services

Better patient compliance

Improved outcomes

Either the body does not produce enough insulin or the cells ignore the insulin

When glucose builds up in the blood instead of going into cellshellip

- your cells may be starved for energy

- high blood glucose levels affect vital organs

Emergence in children is one of the obesity epidemicrsquos most eye-opening symptoms

The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score

Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703

Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese

Depends on administrative data

Health risk appraisal (HRA)

Lab

Pharmacy

Claims

Yields only 15 of high risk cohort

Physician engagement

Practice level reports

Dietary and pharmacological factors

Peer comparisons

Performance-based incentives

Moving toward real-time reporting

Promoting utilization of services

Better patient compliance

Improved outcomes

Emergence in children is one of the obesity epidemicrsquos most eye-opening symptoms

The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score

Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703

Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese

Depends on administrative data

Health risk appraisal (HRA)

Lab

Pharmacy

Claims

Yields only 15 of high risk cohort

Physician engagement

Practice level reports

Dietary and pharmacological factors

Peer comparisons

Performance-based incentives

Moving toward real-time reporting

Promoting utilization of services

Better patient compliance

Improved outcomes

The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score

Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703

Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese

Depends on administrative data

Health risk appraisal (HRA)

Lab

Pharmacy

Claims

Yields only 15 of high risk cohort

Physician engagement

Practice level reports

Dietary and pharmacological factors

Peer comparisons

Performance-based incentives

Moving toward real-time reporting

Promoting utilization of services

Better patient compliance

Improved outcomes

Depends on administrative data

Health risk appraisal (HRA)

Lab

Pharmacy

Claims

Yields only 15 of high risk cohort

Physician engagement

Practice level reports

Dietary and pharmacological factors

Peer comparisons

Performance-based incentives

Moving toward real-time reporting

Promoting utilization of services

Better patient compliance

Improved outcomes

Physician engagement

Practice level reports

Dietary and pharmacological factors

Peer comparisons

Performance-based incentives

Moving toward real-time reporting

Promoting utilization of services

Better patient compliance

Improved outcomes

Promoting utilization of services

Better patient compliance

Improved outcomes

A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians

Promotes a disease management approach

Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression

Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies

Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications

Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure

Safety related

Disease control

Health promotion

Higher levels of self-care

Diabetic Nephropathy40 of new cases of end-

stage renal disease (ESRD) are attributed to diabetes

In 2001 41312 people with diabetes began ESRD treatment

In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure

Minorities experience higher than average rates of nephropathy and kidney disease

Incidence of ESRD

Resulting from Primary

Diseases (1998)

43

23

12

3

19

Diabetes

Hypertension

Glomerulonephritis

Cystic Kidney

Other Causes

bull The most common cause of new

cases of blindness among adults 20-

74 years of age

bull Between 12000 to 24000 people

lose their sight because of diabetes

annually

bull Nearly all patients with type 1

diabetes and over 60 of patients

with type 2 diabetes have retinopathy

in first 20 years of disease

Diabetes

Cardiovascular Eye Disease Lower Extremity

Disease

Angina MICABG

AngioplastyDialysis Blindness Amputation

Renal Disease Depression

Poor Self-

Care

Abdominal obesity (excessive fat tissue in and around the abdomen)

Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)

Elevated blood pressure

Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)

Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)

Proinflammatory state (eg elevated C-reactive protein in the blood)

Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)

Elevated triglyceridesEqual to or greater than 150 mgdL

Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL

Elevated blood pressureEqual to or greater than 13085 mm Hg

Elevated fasting glucoseEqual to or greater than 100 mgdL

Weight loss to achieve a desirable weight (BMI less than 25 kgm2)

Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week

Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol

17 X more likely to develop for gangrene

30 X more likely to require amputation

2nd amputation likely to occur within 2 yrs of first

Within 5 years 50 will die

75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total

diabetes cost

Peripheral Vascular Disease

Peripheral Neuropathy

Great American diet

Nutritional goals

Improving metabolic function

Promotes a disease management approach

Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression

Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies

Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications

Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure

Safety related

Disease control

Health promotion

Higher levels of self-care

Diabetic Nephropathy40 of new cases of end-

stage renal disease (ESRD) are attributed to diabetes

In 2001 41312 people with diabetes began ESRD treatment

In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure

Minorities experience higher than average rates of nephropathy and kidney disease

Incidence of ESRD

Resulting from Primary

Diseases (1998)

43

23

12

3

19

Diabetes

Hypertension

Glomerulonephritis

Cystic Kidney

Other Causes

bull The most common cause of new

cases of blindness among adults 20-

74 years of age

bull Between 12000 to 24000 people

lose their sight because of diabetes

annually

bull Nearly all patients with type 1

diabetes and over 60 of patients

with type 2 diabetes have retinopathy

in first 20 years of disease

Diabetes

Cardiovascular Eye Disease Lower Extremity

Disease

Angina MICABG

AngioplastyDialysis Blindness Amputation

Renal Disease Depression

Poor Self-

Care

Abdominal obesity (excessive fat tissue in and around the abdomen)

Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)

Elevated blood pressure

Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)

Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)

Proinflammatory state (eg elevated C-reactive protein in the blood)

Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)

Elevated triglyceridesEqual to or greater than 150 mgdL

Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL

Elevated blood pressureEqual to or greater than 13085 mm Hg

Elevated fasting glucoseEqual to or greater than 100 mgdL

Weight loss to achieve a desirable weight (BMI less than 25 kgm2)

Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week

Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol

17 X more likely to develop for gangrene

30 X more likely to require amputation

2nd amputation likely to occur within 2 yrs of first

Within 5 years 50 will die

75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total

diabetes cost

Peripheral Vascular Disease

Peripheral Neuropathy

Great American diet

Nutritional goals

Improving metabolic function

Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies

Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications

Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure

Safety related

Disease control

Health promotion

Higher levels of self-care

Diabetic Nephropathy40 of new cases of end-

stage renal disease (ESRD) are attributed to diabetes

In 2001 41312 people with diabetes began ESRD treatment

In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure

Minorities experience higher than average rates of nephropathy and kidney disease

Incidence of ESRD

Resulting from Primary

Diseases (1998)

43

23

12

3

19

Diabetes

Hypertension

Glomerulonephritis

Cystic Kidney

Other Causes

bull The most common cause of new

cases of blindness among adults 20-

74 years of age

bull Between 12000 to 24000 people

lose their sight because of diabetes

annually

bull Nearly all patients with type 1

diabetes and over 60 of patients

with type 2 diabetes have retinopathy

in first 20 years of disease

Diabetes

Cardiovascular Eye Disease Lower Extremity

Disease

Angina MICABG

AngioplastyDialysis Blindness Amputation

Renal Disease Depression

Poor Self-

Care

Abdominal obesity (excessive fat tissue in and around the abdomen)

Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)

Elevated blood pressure

Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)

Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)

Proinflammatory state (eg elevated C-reactive protein in the blood)

Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)

Elevated triglyceridesEqual to or greater than 150 mgdL

Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL

Elevated blood pressureEqual to or greater than 13085 mm Hg

Elevated fasting glucoseEqual to or greater than 100 mgdL

Weight loss to achieve a desirable weight (BMI less than 25 kgm2)

Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week

Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol

17 X more likely to develop for gangrene

30 X more likely to require amputation

2nd amputation likely to occur within 2 yrs of first

Within 5 years 50 will die

75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total

diabetes cost

Peripheral Vascular Disease

Peripheral Neuropathy

Great American diet

Nutritional goals

Improving metabolic function

Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure

Safety related

Disease control

Health promotion

Higher levels of self-care

Diabetic Nephropathy40 of new cases of end-

stage renal disease (ESRD) are attributed to diabetes

In 2001 41312 people with diabetes began ESRD treatment

In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure

Minorities experience higher than average rates of nephropathy and kidney disease

Incidence of ESRD

Resulting from Primary

Diseases (1998)

43

23

12

3

19

Diabetes

Hypertension

Glomerulonephritis

Cystic Kidney

Other Causes

bull The most common cause of new

cases of blindness among adults 20-

74 years of age

bull Between 12000 to 24000 people

lose their sight because of diabetes

annually

bull Nearly all patients with type 1

diabetes and over 60 of patients

with type 2 diabetes have retinopathy

in first 20 years of disease

Diabetes

Cardiovascular Eye Disease Lower Extremity

Disease

Angina MICABG

AngioplastyDialysis Blindness Amputation

Renal Disease Depression

Poor Self-

Care

Abdominal obesity (excessive fat tissue in and around the abdomen)

Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)

Elevated blood pressure

Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)

Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)

Proinflammatory state (eg elevated C-reactive protein in the blood)

Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)

Elevated triglyceridesEqual to or greater than 150 mgdL

Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL

Elevated blood pressureEqual to or greater than 13085 mm Hg

Elevated fasting glucoseEqual to or greater than 100 mgdL

Weight loss to achieve a desirable weight (BMI less than 25 kgm2)

Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week

Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol

17 X more likely to develop for gangrene

30 X more likely to require amputation

2nd amputation likely to occur within 2 yrs of first

Within 5 years 50 will die

75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total

diabetes cost

Peripheral Vascular Disease

Peripheral Neuropathy

Great American diet

Nutritional goals

Improving metabolic function

Safety related

Disease control

Health promotion

Higher levels of self-care

Diabetic Nephropathy40 of new cases of end-

stage renal disease (ESRD) are attributed to diabetes

In 2001 41312 people with diabetes began ESRD treatment

In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure

Minorities experience higher than average rates of nephropathy and kidney disease

Incidence of ESRD

Resulting from Primary

Diseases (1998)

43

23

12

3

19

Diabetes

Hypertension

Glomerulonephritis

Cystic Kidney

Other Causes

bull The most common cause of new

cases of blindness among adults 20-

74 years of age

bull Between 12000 to 24000 people

lose their sight because of diabetes

annually

bull Nearly all patients with type 1

diabetes and over 60 of patients

with type 2 diabetes have retinopathy

in first 20 years of disease

Diabetes

Cardiovascular Eye Disease Lower Extremity

Disease

Angina MICABG

AngioplastyDialysis Blindness Amputation

Renal Disease Depression

Poor Self-

Care

Abdominal obesity (excessive fat tissue in and around the abdomen)

Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)

Elevated blood pressure

Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)

Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)

Proinflammatory state (eg elevated C-reactive protein in the blood)

Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)

Elevated triglyceridesEqual to or greater than 150 mgdL

Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL

Elevated blood pressureEqual to or greater than 13085 mm Hg

Elevated fasting glucoseEqual to or greater than 100 mgdL

Weight loss to achieve a desirable weight (BMI less than 25 kgm2)

Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week

Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol

17 X more likely to develop for gangrene

30 X more likely to require amputation

2nd amputation likely to occur within 2 yrs of first

Within 5 years 50 will die

75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total

diabetes cost

Peripheral Vascular Disease

Peripheral Neuropathy

Great American diet

Nutritional goals

Improving metabolic function

Diabetic Nephropathy40 of new cases of end-

stage renal disease (ESRD) are attributed to diabetes

In 2001 41312 people with diabetes began ESRD treatment

In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure

Minorities experience higher than average rates of nephropathy and kidney disease

Incidence of ESRD

Resulting from Primary

Diseases (1998)

43

23

12

3

19

Diabetes

Hypertension

Glomerulonephritis

Cystic Kidney

Other Causes

bull The most common cause of new

cases of blindness among adults 20-

74 years of age

bull Between 12000 to 24000 people

lose their sight because of diabetes

annually

bull Nearly all patients with type 1

diabetes and over 60 of patients

with type 2 diabetes have retinopathy

in first 20 years of disease

Diabetes

Cardiovascular Eye Disease Lower Extremity

Disease

Angina MICABG

AngioplastyDialysis Blindness Amputation

Renal Disease Depression

Poor Self-

Care

Abdominal obesity (excessive fat tissue in and around the abdomen)

Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)

Elevated blood pressure

Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)

Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)

Proinflammatory state (eg elevated C-reactive protein in the blood)

Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)

Elevated triglyceridesEqual to or greater than 150 mgdL

Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL

Elevated blood pressureEqual to or greater than 13085 mm Hg

Elevated fasting glucoseEqual to or greater than 100 mgdL

Weight loss to achieve a desirable weight (BMI less than 25 kgm2)

Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week

Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol

17 X more likely to develop for gangrene

30 X more likely to require amputation

2nd amputation likely to occur within 2 yrs of first

Within 5 years 50 will die

75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total

diabetes cost

Peripheral Vascular Disease

Peripheral Neuropathy

Great American diet

Nutritional goals

Improving metabolic function

bull The most common cause of new

cases of blindness among adults 20-

74 years of age

bull Between 12000 to 24000 people

lose their sight because of diabetes

annually

bull Nearly all patients with type 1

diabetes and over 60 of patients

with type 2 diabetes have retinopathy

in first 20 years of disease

Diabetes

Cardiovascular Eye Disease Lower Extremity

Disease

Angina MICABG

AngioplastyDialysis Blindness Amputation

Renal Disease Depression

Poor Self-

Care

Abdominal obesity (excessive fat tissue in and around the abdomen)

Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)

Elevated blood pressure

Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)

Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)

Proinflammatory state (eg elevated C-reactive protein in the blood)

Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)

Elevated triglyceridesEqual to or greater than 150 mgdL

Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL

Elevated blood pressureEqual to or greater than 13085 mm Hg

Elevated fasting glucoseEqual to or greater than 100 mgdL

Weight loss to achieve a desirable weight (BMI less than 25 kgm2)

Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week

Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol

17 X more likely to develop for gangrene

30 X more likely to require amputation

2nd amputation likely to occur within 2 yrs of first

Within 5 years 50 will die

75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total

diabetes cost

Peripheral Vascular Disease

Peripheral Neuropathy

Great American diet

Nutritional goals

Improving metabolic function

Diabetes

Cardiovascular Eye Disease Lower Extremity

Disease

Angina MICABG

AngioplastyDialysis Blindness Amputation

Renal Disease Depression

Poor Self-

Care

Abdominal obesity (excessive fat tissue in and around the abdomen)

Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)

Elevated blood pressure

Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)

Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)

Proinflammatory state (eg elevated C-reactive protein in the blood)

Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)

Elevated triglyceridesEqual to or greater than 150 mgdL

Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL

Elevated blood pressureEqual to or greater than 13085 mm Hg

Elevated fasting glucoseEqual to or greater than 100 mgdL

Weight loss to achieve a desirable weight (BMI less than 25 kgm2)

Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week

Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol

17 X more likely to develop for gangrene

30 X more likely to require amputation

2nd amputation likely to occur within 2 yrs of first

Within 5 years 50 will die

75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total

diabetes cost

Peripheral Vascular Disease

Peripheral Neuropathy

Great American diet

Nutritional goals

Improving metabolic function

Abdominal obesity (excessive fat tissue in and around the abdomen)

Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)

Elevated blood pressure

Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)

Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)

Proinflammatory state (eg elevated C-reactive protein in the blood)

Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)

Elevated triglyceridesEqual to or greater than 150 mgdL

Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL

Elevated blood pressureEqual to or greater than 13085 mm Hg

Elevated fasting glucoseEqual to or greater than 100 mgdL

Weight loss to achieve a desirable weight (BMI less than 25 kgm2)

Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week

Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol

17 X more likely to develop for gangrene

30 X more likely to require amputation

2nd amputation likely to occur within 2 yrs of first

Within 5 years 50 will die

75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total

diabetes cost

Peripheral Vascular Disease

Peripheral Neuropathy

Great American diet

Nutritional goals

Improving metabolic function

Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)

Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)

Proinflammatory state (eg elevated C-reactive protein in the blood)

Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)

Elevated triglyceridesEqual to or greater than 150 mgdL

Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL

Elevated blood pressureEqual to or greater than 13085 mm Hg

Elevated fasting glucoseEqual to or greater than 100 mgdL

Weight loss to achieve a desirable weight (BMI less than 25 kgm2)

Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week

Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol

17 X more likely to develop for gangrene

30 X more likely to require amputation

2nd amputation likely to occur within 2 yrs of first

Within 5 years 50 will die

75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total

diabetes cost

Peripheral Vascular Disease

Peripheral Neuropathy

Great American diet

Nutritional goals

Improving metabolic function

Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)

Elevated triglyceridesEqual to or greater than 150 mgdL

Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL

Elevated blood pressureEqual to or greater than 13085 mm Hg

Elevated fasting glucoseEqual to or greater than 100 mgdL

Weight loss to achieve a desirable weight (BMI less than 25 kgm2)

Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week

Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol

17 X more likely to develop for gangrene

30 X more likely to require amputation

2nd amputation likely to occur within 2 yrs of first

Within 5 years 50 will die

75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total

diabetes cost

Peripheral Vascular Disease

Peripheral Neuropathy

Great American diet

Nutritional goals

Improving metabolic function

Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL

Elevated blood pressureEqual to or greater than 13085 mm Hg

Elevated fasting glucoseEqual to or greater than 100 mgdL

Weight loss to achieve a desirable weight (BMI less than 25 kgm2)

Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week

Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol

17 X more likely to develop for gangrene

30 X more likely to require amputation

2nd amputation likely to occur within 2 yrs of first

Within 5 years 50 will die

75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total

diabetes cost

Peripheral Vascular Disease

Peripheral Neuropathy

Great American diet

Nutritional goals

Improving metabolic function

Weight loss to achieve a desirable weight (BMI less than 25 kgm2)

Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week

Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol

17 X more likely to develop for gangrene

30 X more likely to require amputation

2nd amputation likely to occur within 2 yrs of first

Within 5 years 50 will die

75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total

diabetes cost

Peripheral Vascular Disease

Peripheral Neuropathy

Great American diet

Nutritional goals

Improving metabolic function

17 X more likely to develop for gangrene

30 X more likely to require amputation

2nd amputation likely to occur within 2 yrs of first

Within 5 years 50 will die

75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total

diabetes cost

Peripheral Vascular Disease

Peripheral Neuropathy

Great American diet

Nutritional goals

Improving metabolic function

75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total

diabetes cost

Peripheral Vascular Disease

Peripheral Neuropathy

Great American diet

Nutritional goals

Improving metabolic function

Peripheral Vascular Disease

Peripheral Neuropathy

Great American diet

Nutritional goals

Improving metabolic function

Great American diet

Nutritional goals

Improving metabolic function

Glucose disposal

Current pharmaceuticals

Effect on kidney function

Sulphonylureas stimulate insulin secretion

Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia

Medical management generally improves blood glucose regulation in Type 2 diabetes patients

Evidence base

Smoking drinking overeating

Shape Up America

Neurocircuitry of weight control

Evidence base

Smoking drinking overeating

Shape Up America

Neurocircuitry of weight control

Common and often disabling complication of diabetes mellitus

Impaired sensation or pain in the feet or hands

Conduction is required for nervous system function

Weintraub study- Annals of Rehabilitation Medicine April 2003

Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-

Conduction is required for nervous system function

Weintraub study- Annals of Rehabilitation Medicine April 2003

Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-

Weintraub study- Annals of Rehabilitation Medicine April 2003

Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-

Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-

Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device

Intervention nerve conduction and or quantified sensory testing performed serially

Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues

Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)

Numbness and tingling (magnet -10 sham + 1 P lt05)

Exercise-induced foot pain (magnet -12 sham -4 Plt05)

Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation

Intervention nerve conduction and or quantified sensory testing performed serially

Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues

Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)

Numbness and tingling (magnet -10 sham + 1 P lt05)

Exercise-induced foot pain (magnet -12 sham -4 Plt05)

Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation

Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)

Numbness and tingling (magnet -10 sham + 1 P lt05)

Exercise-induced foot pain (magnet -12 sham -4 Plt05)

Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation

Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation

High percentage of population screened

Reduction in lower extremity amputations

Reduction in hospital admissions

Reduction in hospital length of stay

Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering

A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes

Diabesity knows no bordershellipthat is why we all need to be a part of the solution

sharonwcorelimitedcom

wwwcorelimitedcom

wwwgedinfpcom

wwwihfglobalcom

wwwmynikkennetcorewellness

Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering

A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes

Diabesity knows no bordershellipthat is why we all need to be a part of the solution

sharonwcorelimitedcom

wwwcorelimitedcom

wwwgedinfpcom

wwwihfglobalcom

wwwmynikkennetcorewellness

A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes

Diabesity knows no bordershellipthat is why we all need to be a part of the solution

sharonwcorelimitedcom

wwwcorelimitedcom

wwwgedinfpcom

wwwihfglobalcom

wwwmynikkennetcorewellness

Diabesity knows no bordershellipthat is why we all need to be a part of the solution

sharonwcorelimitedcom

wwwcorelimitedcom

wwwgedinfpcom

wwwihfglobalcom

wwwmynikkennetcorewellness

sharonwcorelimitedcom

wwwcorelimitedcom

wwwgedinfpcom

wwwihfglobalcom

wwwmynikkennetcorewellness