8/ 12/ 2015 Presentation Overview • Appreciate how important you are to diabetes prevention and control in Colorado by decreasing obesity in mothers • Define the burden of obesity, prediabetes and diabetes in Colorado Preventing and Managing • Explain the difference between type 2 diabetes, gestational Maternal Diabetes diabetes and prediabetes • Learn about healthy choices and guidelines to support mothers in managing gestational diabetes during pregnancy and weight loss after pregnancy Kelly McCracken, RD CDE • Learn how the Diabetes Prevention Program (DPP) can August 20, 2015 support your clients in the preconception and interconception period to meet weight loss goals The State of Diabetes in CO Exploring the Problem • 21 % of adults are obese (2013 BRFSS) • 1 in 15 Coloradans has diabetes (2013 BRFSS) • 6.3% of Colorado women who gave live birth reported having gestational diabetes (2011 PRAMS) • An estimated 1 in 3 Coloradans has prediabetes (CDC) • If trends continue, by 2050, 1 in 3 will have diabetes (CDC) Risk factors for Diabetes • Overweight or obese • Inact ive Women with a history of gestational diabetes have approximately a 35 - 60 percent chance of • Over age 45 developing diabetes within 10 to 20 years. • First degree relat ive wit h diabet es Additionally, the children of pregnancies where the • Family background is African American, mother had gestational diabetes may also be at Hispanic/ Lat ino, Nat ive American, Asian American, or increased risk for obesity and type 2 diabetes. Pacific Islander • Hist ory of gest at ional diabet es or polycyst ic ovarian syndrome • High blood pressure, high t riglycerides, low HDL S t andards of Medical Care in Diabet es – 2014, American Diabet es Associat ion www.ndep.nih.gov 1
8/ 12/ 2015 Children born after the year 2000: Overweight or obesity is the # 1 risk factor for type 2 1 in 3 will develop diabetes diabetes (1 in 2 Latino children) They will die 10 t o 15 years earlier than their parents ( 63 to 68 years old vs. 78 years old) Narayan KMV , Boyle JP , Thompson TJ, S orensen S W, Williamson DF . Lifet ime risk for diabet es mellit us in t he Unit ed S t at es. JAMA 2003 Oct ober 8;290(14):1884-1890. Insulin Cells Glucose or blood sugar Insulin Cells Glucose or blood sugar 2
8/ 12/ 2015 Cells are resistant to the insulin because of fat + Pancreas becomes exhausted and secretes less insulin = High blood sugar Diabetes: Defined • Prediabetes: A blood sugar level t hat is higher than normal but not high enough t o be classified as diabet es. • Type 2 diabetes: A lifelong ( chronic ) disease in which t here is a high level of glucose in t he blood. Type 2 diabet es is t he most common form of diabet es. • Gestational Diabetes: Diabet es t hat starts or is first diagnosed during pregnancy . Diabetes: Defined The road to diabetes • Normal blood sugar • Less than 100 fasting • Less than 140 two hours after a meal • Prediabetes • 100-125 fasting • 140-199 two hours after a 75g OGTT • 5.7-6.4% Hemoglobin A1c GDM Prediabet es Type 2 Normal • Type 2 Diabetes Diabet es Blood S ugar • Greater than or equal to 126 fasting • 200 or greater two hours after a 75g OGTT or anytime of day • Greater than or equal to 6.5% Hemoglobin A1c S t andards of Medical Care in Diabet es – 2014, American Diabet es Associat ion 3
8/ 12/ 2015 Medical Nutrition Therapy Treatment Recommendations for Gestational Diabetes: Gestational Diabetes WIC handout • Most recent guidelines from the American “ Get a t reat ment plan from your doct or and SHARE it wit h your WIC RD” Diabetes Association in 2013 • Not a “ one-size-fits-all” approach Treatment plans include • A healthy meal plan for people with diabetes nutrition therapy and, is a healthy meal plan for everyone. when necessary, medication American College of Obst et ricians and Gynecologist s (ACOG). Nut rit ion t herapy recommendat ions for t he management of adult s wit h diabet es, Gest at ional diabet es mellit us. Washingt on (DC): American College of Diabet es Care. 2013 Nov;36(11):3821-42. Obst et ricians and Gynecologist s (ACOG); 2013 Aug. 11 p. Goals of nutrition therapy Goals of nutrition therapy To promote and support healthful eating patterns, To address individual nutrition needs based on personal and emphasizing a variety of nutrient-dense foods in cultural preferences, health literacy and numeracy, access appropriate portion sizes, in order to improve overall health to healthful food choices, willingness and ability to make specifically to achieve: behavioral changes, as well as barriers to change. 1. A1C , blood pressure and LDL goals To maintain the pleasure of eating by providing positive messages about food choices while limiting food choices only when indicated by scientific evidence. 2. Body weight goals To provide the individual with diabetes with practical tools 3. Delay/ prevent complications for day-to-day meal planning rather than focusing on individual macronutrients, micronutrients, or single foods. Nut rit ion t herapy recommendat ions for t he management of adult s wit h diabet es, Nut rit ion t herapy recommendat ions for t he management of adult s wit h diabet es, Diabet es Care. 2013 Nov;36(11):3821-42. Diabet es Care. 2013 Nov;36(11):3821-42. A variety of Eating Patterns can help manage diabetes and Rethink you drink – choose water! promote weight loss: • Mediterranean-style • Dietary Approaches to S top Hypertension (DAS H) style • Plant-based (vegan or vegetarian) • Lower-fat • Lower-carbohydrate Bottom line: Weight loss = less calories in and more calories out Nut rit ion t herapy recommendat ions for t he management of adult s wit h ECOP Message diabet es, Diabet es Care. 2013 Nov;36(11):3821-42. 4
8/ 12/ 2015 There's no power like Parent Power! Healthy eating and staying active while you are pregnant matters for Eat well and move more to care for you and your baby's health yourself and your family ECOP Message ECOP Message Postpartum Screening The road to diabetes Recommendations for GDM GDM Prediabet es Type 2 Normal Diabet es Blood S ugar Postpartum Screening Recommendations Follow- up of gestational diabetes for GDM: mellitus in an urban safety net hospital: missed opportunities to launch S creen women with GDM for persistent diabetes preventive care for women. at 6– 12 weeks postpartum, using the OGTT and non-pregnancy diagnostic criteria. By 6 months postpartum, only 23.4%of GDM- affected women received any kind of glucose Women with a history of GDM should have test. lifelong screening for the development of diabetes or prediabetes at least every 3 years. Main message: Encourage women to get tested for diabetes when they visit their They should be tested yearly if they are found to provider for their postpartum visit. have prediabetes. S t andards of Medical Care in Diabet es – 2014, American Diabet es Associat ion J Womens Healt h (Larchmt ). 2014 Apr;23(4):327-34. 5
8/ 12/ 2015 Postpartum Recommendations for GDM: Postpartum Recommendations for WIC Appointments GDM: After Delivery: Gestational Diabetes WIC handout Please encourage screening at: • “ Get tested for diabetes 6 to 12 weeks 1. Add-a-baby- “ please screen” after your baby is born” • “ Ask your WIC counselor about the Diabetes Prevention Program” 2. 3 mont h f/ u appt- “ did you get screened? ” 3. 6 mont h f/ u appt- “ cont inue t o be screened” The Evidence Base DPP: an Effective Solution to Prevent Diabetes • The DPP is based on randomized control clinical research trials led by NIH & CDC . • 5% to 7% body weight loss and increased physical activity to 150 minutes/wk reduced risk of developing type 2 diabetes by 58% • 10-year follow up study showed reduced diabetes incidence of 34% in the lifestyle group DPP Program Elements DPP Program Elements • Year-long lifestyle intervention program • Nutrition information/ food diary • Facilitated by trained Lifestyle Coaches in • Reading food labels . . community organizations, clinics or • Dealing with stress without overeating worksites • Increasing physical activity • Includes 16 weekly sessions followed by six monthly sessions 6
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