SERIES Professional Education units (CPEUs) for completion of this - PowerPoint PPT Presentation

American Association of Diabetes Educators – Provider is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's DIABETES EDUCATION Commission on Accreditation. FOR HEALTH CARE American Association of Diabetes Educators (AM001) is a PROFESSIONALS – Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). CDR Credentialed Practitioners will receive 5.0 Continuing SERIES Professional Education units (CPEUs) for completion of this activities/materials. CONTINUING EDUCATION The American Association of Diabetes Educators is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program provides 5.0 contact hours (.50 CEU’s) of continuing education credit. April 2017 - April 2018 1

American Association of Diabetes Educators – Provider DISCLOSURES TO PARTICIPANTS is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Requirements for Successful Completion: Commission on Accreditation. For successful completion, participants are required to be in attendance in the full activity, complete and submit the program evaluation at the conclusion of the educational event. American Association of Diabetes Educators (AM001) is a Conflicts of Interest and Financial Relationships Disclosures Continuing Professional Education (CPE) Accredited Provider Planners: Dian True, RN, MA, CDE, FAADE – None with the Commission on Dietetic Registration (CDR). CDR Presenters; Dian True, RN, MA, CDE, FAADE – None Credentialed Practitioners will receive 5.0 Continuing Maureen Molinari, PhD, RDN, LD, CDE – None Professional Education units (CPEUs) for completion of this Codi Thompson, BS, RDN, LD – None activities/materials. Disclosure of Relevant Financial Relationships and Mechanism to Identify and Resolve Conflicts of Interest: No conflicts of interest Sponsorship/Commercial Support: None The American Association of Diabetes Educators is accredited by Off-label Use: Participants will be notified by speakers to any product used for a the Accreditation Council for Pharmacy Education as a provider of purpose other than that for which it was approved by the Food and Drug Administration continuing pharmacy education. This program provides 5.0 contact hours (.50 CEU’s) of continuing education credit. Activity-Type: Knowledge-based 2

CONTINUING EDUCATION INFORMATION American Association of Diabetes Educators – Provider is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. American Association of Diabetes Educators (AM001) is a Continuing Professional Education (CPE) Accredited Provider with the Commission on Dietetic Registration (CDR). CDR Credentialed Practitioners will receive 1.0 Continuing Professional Education units (CPEUs) for completion of this activities/materials. Module 1: 0069-0000-17-057-L01-P The American Association of Diabetes Educators is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program provides 1.0 contact hours (.10 CEU’s) of continuing education credit. ACPE Universal Activity Number: 0069-0000-17-xxx-L01-P; 0069-0000-17-xxx- L01-P; 0069-0000-17-xxx-L01-P; 0069-0000-17-xxx-L01-P; 0069-0000-17-xxx-L01-P 3 Effective Date: April 18, 2017 to April 18, 2018

DIABETES & HYPERTENSION A TRAINING FOR HEALTH CARE PROFESSIONALS Presented by: Dian True RN, MA, CDE, FAADE I N D E P E N D E N T C O N T R A C T O R W O R K I N G W I T H T H E C H R O N I C D I S E A S E P R E V E N T I O N P R O G R A M , W Y O M I N G D E P A R T M E N T O F H E A L T H

This presentation is brought to you by the Chronic Disease Prevention Program at the Wyoming Department of Health and funded through the State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity and Associated Risk Factors and Promote School Health Grant (DP13-1305). FOR MORE INFORMATION PLEASE CONTACT, CHRONIC DISEASE PREVENTION PROGRAM MANAGER hannah.herold@wyo.gov. OR (307) 777.3579 5

Today’s presentation uses evidence -based research to promote evidence- based best practice. Research and data from the following organizations were used in developing this presentation: • Centers for Disease Control and Prevention • American Diabetes Association • American Association of Clinical Endocrinologists American Heart Association • 6

PRESENTATION OVERVIEW Review: Diabetes (DM) and Hypertension (HTN) Discuss: Guidelines for classifying and managing HTN and DM Identify: Lifestyle and medication for treatment, prevention, and management 7

PREVENTING AND MANAGING DIABETES AND HYPERTENSION Medications Stress Activity Nutrition Lifestyle & Balance 8

DIABETES IN THE US • Total: 30.3 million people have diabetes (9.4% of the US population) • Diagnosed: 23.1 million people • Undiagnosed: 7.2 million people (23.8% of people with diabetes are undiagnosed) Prediabetes Fast Facts • Total: 84.1 million adults aged 18 years or older have prediabetes (33.9% of the adult US population) • 65 years or older : 23.1 million adults aged 65 years or older have prediabetes www.cdc.gov/diabetes 8/2017 9

ESTIMATED COSTS OF DIABETES IN US, 2014 Total Cost: $245 billion • Direct Medical Costs: $176 billion • Average medical expenditures among people with diagnosed diabetes were 2.3 times higher than people without diabetes • Indirect Costs: $69 billion • Disability, work loss, premature deaths American Diabetes Association. (2015): “The Cost of Diabetes.” Retrieved from: http://www.diabetes.org/advocacy/news-events/cost-of- diabetes.html

P REVALENCE OF D IABETES IN W YOMING 8.4% 8.7% 12.2% 5.9% 10.0% 6.2% 6.6% 18.1% 4.3% 8.5% 7.6% 5.0% 9.7% 9.5% 13.2% 5.1% 7.7% 9.4% 5.1% 9.2% 9.0% 4.6% 10.6% 10.5% 11 Source: 2011-2015 Wyoming BRFSS, retrieved from https://health.wyo.gov/publichealth/prevention/chronicdisease/data/

DIABETES PREVALENCE BY RACE AND ETHNICITY IN WYOMING Wyoming Diabetes Prevalence by Race and Ethnicity (BRFSS, 2011-2014) White 7.7% Hispanic 10.4% American Indian 17.8% • These data demonstrate a statistically significant difference in diabetes prevalence among White and American Indian populations 12 2014 Behavioral Risk Factor Surveillance System (BRFSS); www.cdc.gov/diabetes/wyoming

DIABETES PREVALENCE BY AGE IN WYOMING Ages <18 18-44 45-64 65-74 >75 Lower Upper Lower Upper Lower Upper Lower Upper Range Range Range Range Range Range Range Range Not 2.1% 4.6% 8.6% 12.4% 15.2% 20.4% 15.6% 21.1% Avail. 13 2014 Behavioral Risk Factor Surveillance System (BRFSS); www.cdc.gov/diabetes/wyoming CDC: Prevalence by age

AGE-ADJUSTED PREVALENCE OF OBESITY AND DIAGNOSED DIABETES AMONG US ADULTS Obesity (BMI ≥30 kg/m 2 ) 2000 2013 1994 No Data <14.0% 14.0% – 17.9% 18.0% – 21.9% 22.0% – 25.9% > 26.0% 2013 Diabetes 1994 2000 No Data <4.5% 4.5% – 5.9% 6.0% – 7.4% 7.5% – 8.9% >9.0% 14 CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

WHAT IS DIABETES Metabolic disorder • Blood glucose levels are above normal • Normal = fasting below 100 mg/dl • Most food is digested and converted to glucose (sugar) and used for energy • The pancreas makes insulin, a hormone • Insulin helps transport glucose from blood to the cells • With diabetes: • Insufficient insulin • Inefficient use of insulin • Excess glucose in your blood Standards of Medical Care in Diabetes” https://www.diabetes.org 15 was originally approved in 1988. Most recent review/revision: December 2017

TYPES OF DIABETES • Type 1 Diabetes – Autoimmune destruction of beta cells to make insulin, insulin required • Type 2 Diabetes - Insulin resistant • Gestational Diabetes – Hyperglycemia from the hormonal changes during pregnancy • Up to 60% develop diabetes in their lifetime • Secondary - Impaired fasting glucose and impaired glucose tolerances. 16 CDC: November 2016; https://www.cdc.gove/diabetes

PATHOPHYSIOLOGIC CHANGES IN DIABETIC PATIENT • Pancreas • Adipose tissue •  Beta cell function •  Cytokines •  alpha cell stimulation (communicators) •  hepatic glucose •  Inflammatory mediators production •  Free fatty acids • Brain •  Adinopectin • Impaired satiety •  Dopamine • Peripheral Tissue •  GLUT-4 • Kidney •  Glucose reabsorption • GI tract • Incretin deficiency and/or resistance Defronzo, R.A. (2009). From the triumvirate to the ominous octet: A new paradign from the treatment of type 2 diabetes mellitus. Diabetes, 58 (4), 773-795. doi: 10.2337/db09-9028

ROLE OF THE PANCREAS Role of the Pancreas Beta Cells – Amylin • Anabolic hormone • Secreted in 1:1 ratio with insulin • Helps store glucose as glycogen in muscle and • Satiety liver • Lowers post-prandial • Secreted in response to glucagon response elevated glucose • Slows gastric • Halts breakdown of emptying glycogen in liver • Type 1 = make non • Increases protein • Type 2 make less synthesis, fat storage than usual amount • Powerful hypoglycemic 18 An Overview of the Pancreas - Understanding Insulin and Diabetes https://www.endocrineweb.com/endocrinology/overview-pancreas