EPC of DM Flashcards
Drivers of Diabetes Epidemic?
- Demographic Change - Falling Birth Rates and Low Death Rates
- Disease Burden Change - Infection change to chronic diseases
- Urbanisation (rural to urban)
- Nutritional Transition (high income now eating more meat, low/middle income eating more carbs
- Occupational Transition (sedentary)
Risk factors for diabetes?
- Family History
- Lack of Exercise
- Unhealthy Eating
- Overweight, Metabolic Syndrome
Ethnicity Trend in DM?
Higher in Asian (Middle East + Pacific Islands) + Indigenous Communities in West
In Singapore, Indians > Malays > Chinese
5 methods to reduce DM?
- Prevent (primary)
- Control (tertiary)
- Screen (Secondary)
- Understand (primary)
- Do your part (primary) (stakeholder engagement)
‘Please Stop Un-Curing Diabetics’
Discuss Primary Prevention of DM.
High Risk Strategy vs Population Based Strategy
- HRS: Helps those at high risk but does not change overall population risk profile
- PBS: Shifts entire population risk lesser but is difficult to mount and sustain
E.g. of PBS:
1. Exercise (150min/week; 20min of vigorous activity 3x/week)
2. My Healthy Plate
3. Public Health Framework ‘4 Es’
- Engineer = healthier foods; walking instead of driving (cycling paths)
- Enforce = ban on smoking; ‘fat’ tax
- Encourage = healthier food in supermarket rows at eye level; make it less convenient to drive; incentives; disincentives
- Educate
Discuss Secondary PRevention of DM.
Screening for all 40 and above + any age for those with risk factors
- overweight
- family history
- high risk ethnicity
- gestational DM
- HTN
- HyperL
Do HbA1c, OGTT, Fasting Glucose
Subsidize screening
Repeat screening every 3 years for normal results, annually for those with IFG/IGT
5 qns for diabetes risk assessment.
- DOB
- Gender
- BMI
- Family History of DM
- History of HTN