T2D Prevention

Question 1

Impact of Diabetes on the Individual and

Healthcare System

Answer 1

• People with diabetes (compared to those without
diabetes) during 1 year…
– Visit their family physician 2 times more frequently
– See a specialist 2-3 times more frequently
– Are 3 times more likely to be hospitalized
• If hospitalized, stay 4-6 days longer
• Other diabetes-related complications
– Neuropathy (neuropathic pain, gastroparesis, cardiac
autonomic neuropathy)
– Anxiety & depression (occur 2 times more often compared to people without chronic conditions)
– Erectile dysfunction
– Foot ulcers

Question 2

Cause of Death

Among People with Diabetes

Answer 2

Heart Disease & Stroke are the leading cause of death
• Risk of cardiovascular disease is
2-3 times higher compared to those without diabetes
• Consequences of cardiovascular
disease (mortality risk, severity, complications like heart failure) are significantly higher compared to those without diabetes
• Life expectancy is approximately 6 years shorter compared to those without diabetes

Question 3

Even People with Pre-Diabetes are at

Increased Risk of Death

Answer 3

see slide 9

Question 4

ominous octet
2 core defects
6 additional defects

newer mechanisms

Answer 4

• Core Defects
1. Insulin resistance in the muscle and liver
2. Impaired insulin secretion from pancreatic �-cells
• Additional Defects
3. ↑ hepatic glucose production
4. ↓ glucagon-like peptide 1 (GLP1) secretion from the small intestine
5. ↑ lipolysis ⇒ ↑ plasma free fatty acid levels
6. ↑ glucagon secretion from pancreatic �-cells
7. ↑ renal glucose reabsorption by sodium/glucose co-transporter 2
8. Neurotransmitter dysfunction & resistance to the appetitesuppressive effects of insulin, GLP1, and other neurotransmitters
• Newer mechanisms
9. Inflammation
10.Vascular insulin resistance

Question 5

Risk Factors for Type 2 Diabetes

canrisk

Answer 5

Reminder – 1 in 3 people with diabetes will not know
they have it!
• Community pharmacists are in an ideal position to
educate the public and raise awareness of diabetes r

over 45, male. BMI 25 or higher, waist circumference, physical activity, fruits and vegetables, high bp, high bg, high bg from pregnancy, given birth to large baby, relatives with diabetes, ethic groups , lvl of education

Question 6

what does weight loss improve?

Answer 6

insulin sensitivity

Question 7

Lifestyle Intervention

pros and cons

Answer 7

First and ongoing step in type 2 diabetes
management
• Reduces progression to diabetes by 58% in
patients with impaired glucose tolerance (IGT)
• Weight loss can improve insulin sensitivity,
lower blood glucose, and improve lipids and
blood pressure
• However, long term adherence is poor and most
patients will require pharmacotherapy within a
few years of diagnosis

Question 8

Strategies to Sustain Weight Loss

name 3, which is most effective

Answer 8

self-directed
interactive technology
personal contact

all the same in phase 1, in phase 2 weight increases the least with personal contacty, then interactive technology, self-directed