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LIFE STYLE INTERVENTION

HIGHLIGHTS

DIABETES UPDATE 2011

DIABETES CARE VOLUME 34 SUPPLEMENT 1 JANUARY 2011

care.diabetesjournals.orgAmerican Diabetes AssociationPresentator : dr. Putri Adimukti, M.kes

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Current criteria for the

diagnosis of diabetes

A1C 6.5%.

fasting plasma glucose (FPG) 126 mg/dl(7.0 mmol/l), or 2-h plasma glucose 200

mg/dl (11.1 mmol/l)

in a patient with classic symptoms ofhyperglycemia or hyperglycemic crisis,

a random plasma glucose 200 mg/dl(11.1 mmol/l)

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Current criteria for the

diagnosis of diabetesPrediabetes

FPG 100125 mg/dl (5.66.9 mmol/l): IFG

or

2-h plasma glucose in the 75-g OGTT 140199mg/dl (7.811.0 mmol/l): IGT

or

A1C 5.76.4%

Notice:

FPG=Fasting Plasma Glucose

IFG=Impaired Fasting Glucose

IGT=Impaired Glucose Tolerance

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Risk Factor For Diabetes

Overweight (BMI 25 Kg/m2), with additionalfactors:

Physical inactivity

First-degree relative with diabetes

High-risk race/ethnicity (e.g., African American, Latino,Native American, Asian American, Pacific Islander)

Women who delivered a baby weighing 9 lb or werediagnosed with GDM

Hypertension (140/90 mmHg or on therapy forhypertension)

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Risk Factor For Diabetes

HDL cholesterol level 35 mg/dl (0.90 mmol/l)

Triglyceride level 250 mg/dl (2.82 mmol/l)

Women with polycystic ovarian syndrome(PCOS)

A1C 5.7%

IGT, or IFG on previous testing

Other clinical conditions associated with insulinresistance (e.g., severe obesity, acanthosisnigricans)

History of CVD

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Testing for diabetes in

asymptomatic patients

In adults of any agewho are overweight or

obese (BMI 25 kg/m2)and who have one ormore additional riskfactors for diabetes.

In those without

these risk factors,testing should begin

at age 45 years.

If tests are normal,repeat testing carriedout at least at 3-year

intervals isreasonable.

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Prevention Prediabetes To

Diabetes

Patientswith:

impairedglucosetolerance

(IGT)

impairedfasting

glucose(IFG)

A1C of5.76.4%

should bereferred

to aneffectiveongoing

supportprogram

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Support Program

weight loss of 7% of body weight

increasing physical activity to at least 150min/week of moderate activity such as walking.

Follow-up counseling appears to be importantfor success.

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Support Program

Metformin therapy for prevention of type 2diabetes may be considered in :

those at highest risk for developing diabetes, such as thosewith multiple risk factors, especially if they demonstrateprogression of hyperglycemia (e.g. A1C 6%).

Monitoring for the development of diabetes inthose with prediabetes should be performedevery year.

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Macronutrients In

Diabetes Management

The best mix ofcarbohydrate,

protein, and fatmay be adjusted to

meet themetabolic goals

Monitoringcarbohydrate,

whether bycarbohydrate

counting, choices,or experience-

based estimation

Use of glycemic

index and glycemicload may provide amodest additional

benefit forglycemic control

Saturated fatintake should be

7% or less of totalcalories.

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Physical Activity In Diabetes

ManagementPeople with diabetes should be advised toperform at least 150 min/week of moderate-

intensity aerobic physical activity (5070% ofmaximum heart rate).

In the absence of contraindications, peoplewith type 2 diabetes should be encouragedto perform resistance training three timesper week.

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Dyslipidemia Screening

In most adult patients, measurefasting lipid profile at least annually.

Goals:

LDL cholesterol 100 mg/dl

HDL cholesterol 50 mg/dl

Triglycerides 150 mg/dl)

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Goals

Intensive lifestyle interventionresulted in

Average 8.6% weight loss

Significant reduction of A1C

Reduction in several CVD risk factors

Benefits sustained at 4 years

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Goals

A1C

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Correlation of A1C with

Estimated Average Glucose(eAG) Mean plasma glucose

A1C (%) mg/dl mmol/l

6 126 7.0

7 154 8.6

8 183 10.2

9 212 11.8

10 240 13.411 269 14.9

12 298 16.5

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