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1. ID Wellness
December 3, 2010
Sharon M. Weinstein, MS, RN, CRNI®, FACW, FAAN

2.  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

3. An Epidemic
• U.S. newborn today has a 1 in
3 chance of developing
diabetes
• For Hispanics and African-
Americans, the risk is 1 in 2
Centers for Disease Control and Prevention (CDC)

4.  A term coined by former US Surgeon General
C. Everett Koop
 Raises awareness of the health effects of
obesity
 Diabesity® is a registered trademark of Shape
Up America! (www.shapeup.org)

5.  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

6.  Is the terror within; left unchecked, could
have a greater impact than 9/11
Dr. Richard Carmona (former surgeon general)
 Overweight kids become overweight adults
 Robert Wood Johnson Foundation –
spending at least $500 million over the
next 5 years to reduce childhood obesity

7.  Incidence of diabetes: 800,000 cases/year
 Prevalence of diabetes: 16 million total
(includes ~ 8 million undiagnosed)
 Number will double or triple by 2050 (1 in 3
adults)

8.  $ 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 – 9x higher
($7153 vs. $1222)
 60 –65% high blood pressure
 Leading cause of blindness
 Common cause of ESRD

9.  50% reduction in sick days and no comp
cases between 1997 and 2003
 Expanded program to asthma and
hypertension

10.  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 year/employee

11.  Usually diagnosed in children and young
adults
 Previously known as juvenile diabetes
 The body does not produce insulin

12.  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 cells…
- your cells may be starved for energy
- high blood glucose levels affect vital
organs

13.  Emergence in children is one of the obesity
epidemic’s most eye-opening symptoms

14.  The terms ―overweight‖ and ―obese‖ have
precise meanings within medicine - tied to
a person’s Body Mass Index score
 Determined by dividing a person’s 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‖

15.  Depends on administrative data
 Health risk appraisal (HRA)
 Lab
 Pharmacy
 Claims
Yields only 15% of high risk cohort

16.  Physician engagement
 Practice level reports
 Dietary and pharmacological factors
 Peer comparisons
 Performance-based incentives
 Moving toward real-time reporting

17.  Promoting utilization of services
 Better patient compliance
 Improved outcomes

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

19.  Promotes a disease management approach
 Identifying other co-morbidities present in
this same population, such as eye, heart,
kidney and clinical depression

20.  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

21.  Retinopathy
 Renal
 Cardiovascular
 Lower extremity
 Clinical Depression
 Hg A1c
 Blood pressure

22.  Safety related
 Disease control
 Health promotion
 Higher levels of self-care

23. Diabetic Nephropathy
40% of new cases of end-
stage renal disease (ESRD) are Incidence of ESRD
attributed to diabetes Resulting from Primary
Diseases (1998)
In 2001, 41,312 people with
diabetes began ESRD 19%
treatment
In 2001, it cost $22.8 billion in 3%
43%
public and private funds to 12%
treat patients with kidney
failure
23% Diabetes
Minorities experience higher Hypertension
than average rates of Glomerulonephritis
nephropathy and kidney Cystic Kidney
disease Other Causes

24. • The most common cause of new
cases of blindness among adults 20-
74 years of age
• Between 12,000 to 24,000 people
lose their sight because of diabetes
annually
• Nearly all patients with type 1
diabetes and over 60% of patients
with type 2 diabetes have retinopathy
in first 20 years of disease

25. Diabetes
Cardiovascular Renal Disease Eye Disease Lower Extremity Depression
Disease
Angina, MI,CABG, Poor Self-
Dialysis Blindness Amputation
Angioplasty Care

26.  Abdominal obesity (excessive fat tissue in
and around the abdomen)
 Atherogenic dyslipidemia (blood fat
disorders — high triglycerides, low HDL
cholesterol and high LDL cholesterol —
that foster plaque buildups in artery
walls)
 Elevated blood pressure

27.  Insulin resistance or glucose intolerance
(the body can’t properly use insulin or
blood sugar)
 Prothrombotic state (e.g., high fibrinogen or
plasminogen activator inhibitor–1 in the
blood)
 Proinflammatory state (e.g., elevated C-
reactive protein in the blood)

28.  Elevated waist circumference:
Men — Equal to or greater than 40 inches
(102 cm)
Women — Equal to or greater than 35 inches
(88 cm)
 Elevated triglycerides:
Equal to or greater than 150 mg/dL

29.  Reduced HDL (―good‖) cholesterol:
Men — Less than 40 mg/dL
Women — Less than 50 mg/dL
 Elevated blood pressure:
Equal to or greater than 130/85 mm Hg
 Elevated fasting glucose:
Equal to or greater than 100 mg/dL

30.  Weight loss to achieve a desirable weight
(BMI less than 25 kg/m2)
 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

31. 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

32.  75% readmitted
 5-9% will die while hospitalized
 19% require nursing home placement
 Electric scooter $2000-$5000
 BK prosthesis $2000-$7000/yr
 Cost = $10 billion /yr or 20% of total
diabetes cost

35.  Peripheral Vascular Disease
 Peripheral Neuropathy

36.  Great American diet
 Nutritional goals
 Improving metabolic function

37.  Glucose disposal
 Current pharmaceuticals
 Effect on kidney function

38.  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

39.  Evidence base
 Smoking, drinking, overeating
 Shape Up America
 Neurocircuitry of weight control

40.  Common and often disabling
complication of diabetes
mellitus
Impaired sensation or
pain in the feet or hands

41.  Conduction is required for nervous system
function

42.  Weintraub study
- Annals of Rehabilitation Medicine, April 2003

43.  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)
-

44. 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

45.  Intervention: nerve conduction and or
quantified sensory testing performed
serially
 Outcome Measures:
- Daily visual analog scale scores for
numbness or tingling/burning and QOL
issues tabulated over 4 months
- Secondary measures included nerve
conduction changes, role of placebo and
safety issues

46.  Statistically significant reductions, during
the 3rd and 4th months in burning (mean
change for magnet treatment -12
%; for sham -3%;P < .05)
 Numbness and tingling (magnet -10%;
sham + 1%; P <.05)
 Exercise-induced foot pain (magnet, -12%;
sham -4%; P<.05)

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

48.  High percentage of population screened
 Reduction in lower extremity amputations
 Reduction in hospital admissions
 Reduction in hospital length of stay

49.  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.

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

51.  Diabesityknows no borders…that
is why we all need to be a part of
the solution!

52. sharonw@corelimited.com
www.corelimited.com
www.gedinfp.com
www.ihfglobal.com
www.mynikken.net/corewellness