L16 Chronic disease epidemiology - diabetes/obesity Flashcards
Health Problems caused by obesity
- Type _1_ diabetes
- ____2____ blood pressure
- Coronary heart disease and stroke
- Asthma
- ____3____ syndrome (a combination of diabetes, high blood pressure and obesity)
- Several types of cancer, including bowel cancer, breast cancer and womb cancer
- ____4____ fertility
- ____5____ (a condition involving pain and stiffness in your joints)
- Sleep ____6____ (a condition that causes interrupted breathing during sleep)
- Liver disease and kidney disease
- ____7____ complications, such as gestational diabetes or pre-eclampsia
- 2
- High
- Metabolic
- Reduced
- Osteoarthritis
- Apnoea
- Pregnancy
Complications caused by diabetes
If diabetes is not appropriately treated, high glucose levels can damage blood vessels, nerves and organs. Long-term damaging effects may include:
- Heart disease and ____1____ (risk ↑ x 5)
- Nerve damage
- Diabetic ____2____ (damage of the retina and impair sight)
- Kidney disease
- Foot problems (1 in 10 people with diabetes develop a foot ulcer, which can cause a serious infection)
- Sexual dysfunction
- ____3____ and stillbirth
- Decreased mean life expectancy by ____4____ years
- Stroke
- Retinopathy
- Miscarriage
- 10
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Main risk factors for Type 2 diabetes
- Genetic predisposition - especially 1st degree relative with T2D
- Ethnicity - South Asian, African-Caribbean or Middle Eastern descent
- Increasing age
- Overweight or obese - especially central obesity
- Energy dense diet
- Low physical activity
- Lower socio-economic position - especially urban deprivation
- Smoking
- Previous gestational diabetes
- Non-diabetic hyperglycaemia
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Disease prevention, Population v Individual
Given a preventable disease with risk factor(s) amenable to modification, where should we target interventions for primary prevention?
- Individuals at high risk?
- The whole population?
The Prevention Paradox: “A preventive measure that brings large benefits to the community offers little to each participating individual” Geoffrey Rose, The strategy of preventive medicine, 1992
2 Key observations:
- Risk of disease is rarely an all-or-nothing phenomenon - more usually risk changes gradually across a gradient of risk factor exposure.
- Levels of exposure to a risk factor are usually distributed within the population along a normal curve, with average exposure levels representing moderate levels of risk.
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Disease prevention, Population v Individual
Population Strategy - Strengths
- Radical - attacks root causes of health problems
- Powerful - small shifts in population mean result in large reductions in risk and adverse outcomes
- Appropriate - seeks to shift the cultural norms in lifestyle at a population level, rather than change ‘deviant’ individuals
Population Strategy - Weaknesses
- Acceptability - changing the cultural norms may not be easy
- Feasibility - even small shifts in behaviour are difficult to achieve in whole populations
- Costs and safety - since the benefit is small for each individual, this may be counterbalanced by increased risk
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Disease prevention, Population v Individual
High Risk Strategy - Strengths
- Intervention is appropriate to individuals
- Patient motivation - avoids interference with those not a special risk (but note negative effects of screening)
- Physician motivation - readily accommodated within medical care. Favourable benefit-to-risk ratio
High Risk Strategy - Weaknesses
- Difficulties identifying high-risk individuals - requires appropriate screening and identification techniques
- Temporary effect - success may be only palliative
- Behaviourally inappropriate - prevention becomes medicalized, constrained by cultural norms, patient expected to ‘deviate’ from norm
- Limited effect - contribution to overall control of disease (at population level) may be small
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The Diabetes Prevention Program Outcomes Study (DPPOS)
Long-term follow-up to a randomized clinical trial to prevent Type 2 Diabetes in persons at high risk
DPP Primary Goal: 1996-2002: To prevent or delay the development of type 2 diabetes in persons with impaired glucose tolerance (IGT)
DPPOS Primary Goal: 2002-2013: Prevention of diabetes complications such as kidney, eye and nerve problems, and heart disease
DPP Treatments:
- Lifestyle Goals – 7% weight loss – 150 minutes activity each week
- Metformin Goals – -850 mg twice daily
- Original Placebo group – HELP classes four times a year
- Original Metformin group – Metformin 850 mg twice daily – HELP classes four times a year
- Original Lifestyle group – HELP classes four times a year – Boost lifestyle classes twice a year
Keys to DPP Lifestyle Success:
- Weight loss was the key to diabetes prevention
- Every 2.2 pounds of weight loss decreased risk by 13%
- Reduction of total calories, especially fat calories
- At baseline, American Indians reported 37.5% calories from fat
- Achieving 150 minutes of activity each week
- DPP intervention was key to prevention
Diabetes Frequency After 10 years:
- 52% of Placebo participants have diabetes
- 47% of Metformin participants have diabetes
- 42% of Lifestyle participants have diabetes Cost Effectiveness:
- Over 10 years, metformin treatment reduced the costs of medical care by $1700 per person
- Over 10 years lifestyle treatment reduced the costs of medical care by $2600 per person
- Since lifestyle costs more to administer, the reductions make metformin treatment cost saving and lifestyle remains cost effective
What is NICE?
What does it do?
The National Institute for Health and Care Excellence (NICE).
NICE provides national guidance and advice to improve health and social care.
