DIABETES.RISK REDUCTION PROGRAM.

Presented By: MPH(student) Gobinath PEmail: ponnusamig@aiias.edu

gopinathsteven@gmail.com

Out line of the presentation.

• Introduction.

• Different risk reduction program.

• Summary and conclusion.

• Recommendations.

Indroduction.

• Diabetes can strike anyone, from any walk of life.

• Worldwide, it afflicts more than 380 million people. And the World Health Organization estimates that by 2030, that number of people living with diabetes will more than double.

• Today, diabetes takes more lives than AIDS and breast cancer combined --claiming the life of 1 American every 3 minutes. It is a leading cause of blindness, kidney failure, amputations, heart failure and stroke.

• Living with diabetes places an enormous emotional, physical and financial burden on the entire family. Annually, diabetes costs the American public more than $245 billion.

(2016). Diabetes research institute.

• When you eat, your body turns food into sugars, or glucose. At that point, your pancreas is supposed to release insulin.

• Several major things can go wrong – causing the onset of diabetes. Type 1 and type 2 diabetes are the most common forms of the disease, but there are also other kinds, such as gestational diabetes, which occurs during pregnancy, as well as other forms.

(2016). Diabetes research institute retrieved from http://www.diabetesresearch.org/what-is-diabetes.

DIFFERENT RISK REDUCTION PROGRAMS.

1. Improving the Management of Chronic Disease at Community Health Centers

PARTICIPANTS: We enrolled 9658 patients at 44 intervention centers that had participated in the

collaboratives and 20 centers that had not participated (external control centers).

METHODS: We performed a controlled preintervention and postintervention study of community health

centers participating in quality-improvement collaboratives (the Health Disparities Collaboratives

sponsored by the HRSA) for the care of patients with diabetes, asthma, or hypertension. Each

intervention center also served as an internal control for another condition. Quality measures were

abstracted from medical records at each health center. We created overall quality scores by standardizing

and averaging the scores from all of the applicable measures. Changes in quality were evaluated with the

use of hierarchical regression models that controlled for patient characteristics.

RESULTS: Overall, the intervention centers had considerably greater improvement than the external and

internal control centers in the composite measures of quality for the care of patients with asthma and

diabetes, but not for those with hypertension. As compared with the external control centers, the

intervention centers had significant improvements in the measures of prevention and screening, including

a 21% increase in foot examinations for patients with diabetes, and in disease treatment and monitoring,

including a 14% increase in the use of antiinflammatory medication for asthma and a 16% increase in the

assessment of glycated hemoglobin. There was no improvement, however, in any of the intermediate

outcomes assessed (urgent care or hospitalization for asthma, control of glycated hemoglobin levels for

diabetes, and control of blood pressure for hypertension).

CONCLUSIONS: The Health Disparities Collaboratives significantly improved the processes of care for

two of the three conditions studied. There was no improvement in the clinical outcomes studied.

Reference: http://www.nejm.org/doi/pdf/10.1056/NEJMsa062860

2. Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin

PARTICIPANTS: We randomly assigned 3234 nondiabetic persons with elevated fasting and

post-load plasma glucose

METHODS: concentrations to placebo, metformin (850 mg twice daily), or a lifestyle-

modification program with the goals of at least a 7 percent weight loss and at least 150 minutes

of physical activity per week. The mean age of the participants was 51 years, and the mean

body-mass index (the weight in kilograms divided by the square of the height in meters) was

34.0; 68 percent were women, and 45 percent were members of minority groups.

RESULTS: The average follow-up was 2.8 years. The incidence of diabetes

was 11.0, 7.8, and 4.8 cases per 100 person-years in the placebo, metformin,

and lifestyle groups, respectively. The lifestyle intervention reduced the

incidence by 58 percent (95 percent confidence interval, 48 to 66 percent) and

metformin by 31 percent (95 percent confidence interval, 17 to 43 percent), as

compared with placebo; the lifestyle intervention was significantly more

effective than metformin. To prevent one case of diabetes during a period of

three years, 6.9 persons would have to participate in the lifestyle-intervention

program, and 13.9 would have to receive metformin.

CONCLUSIONS: Lifestyle changes and treatment with metformin both

reduced the incidence of diabetes in persons at high risk. The lifestyle

intervention was more effective than metformin.

Reference : http://www.nejm.org/doi/full/10.1056/NEJMoa012512#t=abstract

3. Increased colonic propionate reduces anticipatory reward responses in the human striatum to high-energy foods

Participants: 20 healthy non-obese men

Method: In a randomized crossover design, 20 healthy non-obese men completed a

functional magnetic resonance imaging (fMRI) food picture evaluation task after

consumption of control inulin or inulin-propionate ester, a unique dietary compound that

selectively augments colonic propionate production. The blood oxygen level–dependent

(BOLD) signal was measured in a priori brain regions involved in reward processing,

including the caudate, nucleus accumbens, amygdala, anterior insula, and orbitofrontal

cortex (n = 18 had analyzable fMRI data).

Reference: http://ajcn.nutrition.org/content/104/1/5.full.pdf+html

Results: Increasing colonic propionate production reduced BOLD signal during

food picture evaluation in the caudate and nucleus accumbens. In the caudate, the

reduction in BOLD signal was driven specifically by a lowering of the response to

high-energy food. These central effects were partnered with a decrease in subjective

appeal of high-energy food pictures and reduced energy intake during an ad libitum

meal. These observations were not related to changes in blood peptide YY (PYY),

glucagon-like peptide 1 (GLP-1), glucose, or insulin concentrations.

Conclusion: Our results suggest that colonic propionate production may play an

important role in attenuating reward-based eating behavior via striatal pathways,

independent of changes in plasma PYY and GLP-1.

Reference: http://ajcn.nutrition.org/content/104/1/5.full.pdf+html

4. The Stanford Nutrition Action Program: a dietary fat intervention for low-literacy adults.

PARTICIPANTS: 351 participants

METHODS: Twenty-four paired adult education classes (351 participants, 85% women, mean age =

31 years) were randomly assigned to receive a newly developed dietary fat curriculum (the Stanford

Nutrition Action Program) or an existing general nutrition curriculum. Food frequency and nutrition-

related data, body mass index, and capillary blood cholesterol were collected at baseline and at two

post-intervention follow-ups.

RESULTS: The Stanford Nutrition Action Program classes showed significantly greater

net improvements in nutrition knowledge (+7.7), attitudes (/0.2), and self-efficacy (-0.2)

than the general nutrition classes; they also showed significantly greater reductions in the

percentage of calories from total (-2.3%) and saturated (-0.9%) fat. There were no

significant differences in body mass index or blood cholesterol. All positive intervention

effects were maintained for 3 months post-intervention.

CONCLUSIONS: The Stanford Nutrition Action Program curriculum, tailored to the

cultural, economic, and learning needs of low-literacy, low-income adults, was

significantly more effective in achieving fat-related nutritional changes than the general

nutrition curriculum.

Reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1381239/

5. A Web-Based Health Promotion Program for Older Workers: Randomized Controlled Trial

Participants: workers aged 50 years and older who are at higher risk for chronic diseases.

Methods: The sample included 278 employees aged 50 to 68 who were recruited online and randomly

assigned to the Web-based HealthyPast50 program or to a wait-list control condition. Self-report

measures of diet, physical activity, stress, and tobacco use were collected online before and 3 months

after the program group was given access to the program. Use data included number of log-ins and

number of pages accessed. The primary analysis was multiple linear regression, following intent-to-

treat principles with multiple imputation using the Markov chain Monte Carlo (MCMC) approach for

nonmonotone missing data. Potential moderators from demographic characteristics and program dosage

effects were assessed using multiple linear regression models. Additional analyses were conducted on

complete (nonimputed) cases, excluding program participants who used the program for less than 30

minutes.

Results: Retention rates were good for both groups: 80.4% (111/138) for the program group and 94.3%

(132/140) for the control group. Program group participants spent a mean of 102.26 minutes in the program

(SD 148.32), logged in a mean of 4.33 times (SD 4.28), and viewed a mean of 11.04 pages (SD 20.08). In

the analysis of the imputed dataset, the program group performed significantly better than the control group

on diet behavioral change self-efficacy (estimated adjusted difference [Δ]=0.16, P=.048), planning healthy

eating (Δ=0.17, P=.03), and mild exercise (Δ=1.03, P=.01). Moderator and dosage analyses of the dataset

found no significant program effects. Analyses of the nonimputed dataset comparing program users with

controls found additional significant program effects on eating practices (Δ=0.09, P=.03), exercise self-

efficacy (Δ=0.12, P=.03), exercise planning (Δ=0.18, P=.03), and aging beliefs (Δ=0.17, P=.01).

Moderator analysis of this dataset also found significant moderator effects of gender on multiple measures

of exercise.

Conclusions: A Web-based health promotion program showed promise for making a significant

contribution to the short-term dietary and exercise practices of older working adults. Gender effects suggest

that the program effects on exercise are due mainly to improvements among women.

Reference: http://www.jmir.org/2015/3/e82/

6. Cohort studies of Sugar Sweeten Beverage

(SSB)

Method: cohort studies of SSB intake and risk of metabolic syndrome and type 2

diabetes. We identified 11 studies (three for metabolic syndrome and eight for

type 2 diabetes) for inclusion in a random-effects meta-analysis comparing SSB

intake in the highest to lowest quantiles in relation to risk of metabolic syndrome

and type 2 diabetes.

Result: Based on data from these studies, including 310,819 participants and

15,043 cases of type 2 diabetes, individuals in the highest quantile of SSB intake

(most often 1–2 servings/day) had a 26% greater risk of developing type 2

diabetes than those in the lowest quantile (none or <1 serving/month) (relative

risk [RR] 1.26 [95% CI 1.12–1.41]). Among studies evaluating metabolic

syndrome, including 19,431 participants and 5,803 cases, the pooled RR was 1.20

[1.02–1.42].

CONCLUSIONS In addition to weight gain, higher consumption of

SSBs is associated with development of metabolic syndrome and type 2

diabetes. These data provide empirical evidence that intake of SSBs

should be limited to reduce obesity-related risk of chronic metabolic

diseases.

B, F. (2010). Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes. American

Diabetes Association, 2477-2483.

7. Reduction in WeightParticipants: 5,145 individuals with type 2 diabetes, aged 45-74 years

Method: A multi-centered randomized controlled trial of 5,145 individuals with type 2 diabetes,

aged 45-74 years, with body mass index >25 kg/m2 (>27 kg/m2if taking insulin). An Intensive

Lifestyle Intervention (ILI) involving group and individual meetings to achieve and maintain

weight loss through decreased caloric intake and increased physical activity was compared to a

Diabetes Support and Education (DSE) condition.

Result: Participants assigned to ILI lost an average 8.6% of their initial weight versus 0.7% in DSE

group (p<0.001). Mean fitness increased in ILI by 20.9% versus 5.8% in DSE (p<0.001). A greater

proportion of ILI participants had reductions in diabetes, hypertension, and lipid-lowering

medicines. Mean HbA1c dropped from 7.3% to 6.6% in ILI (p<0.001) versus from 7.3% to 7.2% in

DSE. Systolic and diastolic pressure, triglycerides, HDL-cholesterol, and urine albumin/creatinine

improved significantly more in ILI than DSE participants (all p<0.01).

Conclusions: At 1 year, ILI resulted in clinically significant weight loss in persons with type

2 diabetes. This was associated with improved diabetes control and CVD risk factors and

reduced medicine use in ILI versus DSE. Continued intervention and follow-up will

determine whether these changes are maintained and will reduce CVD risk.

Reference: Espeland, M. (2007, March). Reduction in Weight and Cardiovascular Disease Risk Factors in Individuals With Type 2 Diabetes: One-Year Results of the Look AHEAD Trial. Diabetes care.

8. Smoking cessation among diabetes patients: results of a pilot

randomized controlled trial in Kerala, India.

PARTICIPANTS: we selected 224 adult diabetes patients aged 18 years or older who smoked

in the last month, from two diabetes clinics in South India.

METHODS:

In our parallel-group randomized controlled trial, Using a computer generated random sequence

with block size four; the patients were randomized equally into intervention-1 and intervention-

2 groups. Patients in both groups were asked and advised to quit smoking by a doctor and

distributed diabetes specific education materials. The intervention-2 group received an

additional diabetes specific 30 minutes counseling session using the 5As (Ask, Advise, Assess,

Assist and Arrange), and 5 Rs (Relevance, Risks, Rewards, Roadblocks and Repetition) from a

non-doctor health professional. Follow up data were available for 87.5% of patients at six

months. The Quit Tobacco International Project is supported by a grant from the Fogarty

International Centre of the US National Institutes of Health (RO1TW005969-01).The primary

outcomes were quit rate (seven day smoking abstinence) and harm reduction (reduction of the

number of cigarettes / bidis smoked per day > 50% of baseline use) at six months.

RESULTS:

In the intention to treat analysis, the odds for quitting was 8.4 [95% confidence interval (CI):

4.1-17.1] for intervention-2 group compared to intervention-1 group. Even among high level

smokers the odds of quitting was similar. The odds of harm reduction was 1.9 (CI: 0.8-4.1)

for intervention-2 group compared to intervention-1 group.

CONCLUSIONS:

The value addition of culturally sensitive diabetic specific cessation counseling sessions

delivered by non-doctor health professional was an impressive and efficacious way of

preventing smoking related diabetic complications.

R, T. K. (2013, January 13). Smoking cessation among diabetes patients: results of a pilot randomized controlled

trial in Kerala, India. Pubmed. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23331722

9. Specific Types of Alcoholic Beverage Consumption and Risk of Type 2 Diabetes: A Systematic Review and Meta-analysis.

PARTICIPANTS: 397296 study participants and 20641 cases of type 2 diabetes.

MATERIALS AND METHODS:

Search of PubMed, Embase and Cochrane Library databases from January 1966 to February 2016

was conducted for prospective cohort studies that assessed the effects of specific types of alcoholic

beverage on the risk of type 2 diabetes. The pooled relative risks (RRs) with 95% confidence

interval (CI) were calculated using random- or fixed-effect models when appropriate.

RESULTS:

13 prospective studies were included in this meta-analysis, with 397296 study participants and 20641 cases

of type 2 diabetes. Relative to no or rare alcohol consumption, wine consumption was associated with a

significant reduction of the risk of type 2 diabetes, with the pooled RRs of 0.85, while beer or spirits

consumption led to a slight trend of decreasing risk of type 2 diabetes (RR, 0.96, 0.95, respectively).

Further dose-response analysis displayed a U-shaped relationship between all three alcohol types and type

2 diabetes. Additionally, the peak risk reduction emerged at 20-30 g/day for wine and beer, at 7-15 g/day

for spirits, with a decrease of 20%, 9%, 5% respectively.

CONCLUSIONS:

Compared with beer or spirits, wine was associated with a more significant decreased risk of type

2 diabetes. This study indicated that wine may be more helpful for protection against type 2 diabetes than

beer or spirits. This article is protected by copyright. All rights reserved.

J, H. (2016, May 10). Alcoholic Beverage Consumption and Risk of Type 2 Diabetes: A Systematic Review and Meta-analysis.

Pubmed. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/27181845

10. Mediterranean diet and mortality risk in metabolically healthy obese and metabolically unhealthy obese phenotypes

PARTICIPANTS: Data from 1739 adults aged 20-88 years

METHODS: Data from 1739 adults aged 20-88 years were analyzed from participants of the National

Health and Nutrition Examination Survey III, 1988-1994 followed up for deaths until December 31,

2011 in a prospective cohort analysis. Mediterranean Diet Scores (MDS) were created to assess the

adherence to Mediterranean diet. Participants were classified as metabolically healthy obese (MHO)

phenotype (0 or 1 metabolic abnormality) or metabolically unhealthy obese (MUO) phenotype (two or

more metabolic abnormalities), based on high glucose, insulin resistance, blood pressure, triglycerides,

C-reactive protein, and low high-density lipoprotein-cholesterol.

RESULTS:

The MHO phenotype (n=598) was observed in 34.8% (s.e., 1.7%) of those who were obese (mean body

mass index was 33.4 and 34.8 in MHO and MUO phenotypes, respectively). During a median follow-up of

18.5 years, there were 77 (12.9%) and 309 (27.1%) deaths in MHO and MUO individuals, respectively. In

MHO individuals, the multivariable-adjusted HR of all-cause mortality in the highest tertile compared to the

first tertile of MDS was 0.44 (95% CI, 0.26-0.75; P for trend <0.001), after adjustment for potential

confounders. The corresponding HR for cancer mortality was 0.23 (95% CI, 0.02-2.10; P trend=0.03). A

five-point (1 s.d.) increment in the adherence to MDS was associated with a 41%reduction in the risk of all-

cause mortality (HR, 0.59; 95% CI, 0.37-0.94). Similar findings were obtained when we restricted our

analyses to those with or without prevalent diabetes mellitus and hypertension. We did not observe

mortality risk reduction in either individuals with MUO phenotype or all obese participants combined.

CONCLUSIONS:

Adherence to a Mediterranean dietary pattern appears to reduce mortality in the MHO phenotype, but not

among the MUO phenotype in an obese population.International Journal of Obesity accepted article preview

online, 24 June 2016. doi:10.1038/ijo.2016.114.

Reference: Park Y.M, Zhang J. (2016, June 24). Mediterranean diet and mortality risk in metabolically healthy obese and metabolically

unhealthy obese phenotypes. Pubmed. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/27339604

SUMMARY

In the global perspective point of view everyone are not

excuse in all of the non-communicable diseases (NCDs)

around us especially Diabetes Mellitus (DM). Moreover

whether categorize in urban or rural areas, poor and rich

countries, young and old, and male or female. Though

biologically we acquire diabetes but still we have hope to

prevent it through our lifestyle practices.

CONCLUSION

Our group analyzed the following recommended healthy preventive measures to lower the risk of Diabetes Mellitus. It is a process in order an individual can change their habits, attitude and lifestyle. The ten scientific guiding principles of risk reduction program can be a starting tools to help the people in our community and society especially who are suffering from Diabetes Mellitus.

RECOMMENDATIONS Build a healthier plate

Shop Smart

Eat Smart

Regular exercise

Drink at least 8-10 glasses of water a day.

Get your rest

Be social

Be careful

Get regular exams

Avoid anything harmful

Be grateful

Be helpful

Forgive others

Be happy

And enjoy a full life!

References

http://www.nejm.org/doi/pdf/10.1056/NEJMsa062860

http://www.nejm.org/doi/full/10.1056/NEJMoa012512#t=abstract

http://ajcn.nutrition.org/content/104/1/5.full.pdf+html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1381239

http://www.jmir.org/2015/3/e82/

B, F. (2010). Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes.

American Diabetes Association, 2477-2483.

Espeland, M. (2007, March). Reduction in Weight and Cardiovascular Disease Risk Factors in

Individuals With Type 2 Diabetes: One-Year Results of the Look AHEAD Trial. Diabetes care.

R, T. K. (2013, January 13). Smoking cessation among diabetes patients: results

of a pilot randomized controlled trial in Kerala, India. Pubmed. Retrieved from

http://www.ncbi.nlm.nih.gov/pubmed/23331722

J, H. (2016, May 10). Alcoholic Beverage Consumption and Risk of Type 2

Diabetes: A Systematic Review and Meta-analysis. Pubmed. Retrieved from

http://www.ncbi.nlm.nih.gov/pubmed/27181845

Park Y.M, Zhang J. (2016, June 24). Mediterranean diet and mortality risk in

metabolically healthy obese and metabolically unhealthy obese phenotypes.

Pubmed. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/27339604