ADULT ONSET DIABETES MELLITUS

MANAGEMENT OPTIONS

DR MUHAMMAD ISRAR UL HAQ

 Diabetes Mellitus

The name “diabetes mellitus means sweet

urine. It stems from ancient times when
physicians would taste a patients urine as a
part of a diagnosis.
Diabetes Mellitus :
a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production,
insulin action, or both

• 20.8 million in US ( 7% of population)

• estimated 14.6 million diagnosed (only 2/3)
• Consists of 3 types:
1) Type 1 diabetes
2) Type 2 diabetes
3) Gestational diabetes

 Complications :
- Stroke
- Heart attack
- Kidney disease
- Eye Disease
- Nerve Damage
Diabetes Mellitus
• Type 1 Diabetes • Type 2 Diabetes
- cells that produce - blood glucose levels rise due to
insulin are destroyed 1) Lack of insulin production
- results in insulin 2) Insufficient insulin action
dependence
(resistant cells)
- commonly detected
before 30 - commonly detected after 40
- effects > 90%

- eventually leads to β-cell failure

(resulting in insulin dependence)

Gestational Diabetes
3-5% of pregnant women in the US
develop gestational diabetes
 Criteria for the diagnosis of diabetes
1. Symptoms of diabetes and a casual plasma glucose ≥200
mg/dl (11.1 mmol/l). Casual is defined as any time of day
without regard to time since last meal. The classic
symptoms of diabetes include polyuria, polydipsia, and
unexplained weight loss.
OR
2. FPG ≥126 mg/dl (7.0 mmol/l). Fasting is defined as no
caloric intake for at least 8 hours
Criteria for the diagnosis of diabetes (con’t)

3. 2-h PG ≥ 200 mg/dl (11.1 mmol/l)

during an OGTT. The test should be
performed as described by the World
Health Organization, using a glucose
load containing the equivalent of 75
g anhydrous glucose dissolved in
water.
Criteria for testing for diabetes in asymptomatic adult individuals (con’t)

 Are members of a high-risk ethnic population (e.g., African-

American, Latino, Native American, Asian-American, Pacific
Islander)
 Are hypertensive (≥ 140/90 mmHg)
 Have HDL cholesterol level ≤35 mg/dl (0.90 mmol/l) and/or a
triglyceride level
≥ 250mg/dl (2.82 mmol/l)
 On a previous testing, had IGT or IFG
 Have other clinical conditions associated with insulin resistance
(e.g., PCOS or acanthosis nigricans)
 HbA1c

 Best determinant of glycemic exposure

 Mean is a quality indicator

% HbA1c Average Glucose (mg/dL)

4 60
5 90
6 120
7 150
8 180
9 210
10 240
11 270
12 300
Facts on Type 2

•Type 2 diabetes is a disease that generally develops over a

period of years.
• People who will eventually develop this disease are insulin
resistant several years before their blood sugars become
abnormal.
•Their bodies try to make up for the higher insulin needs
created by insulin resistance by producing more insulin.
Facts on Type 2
• But in Type 2 diabetes, the body ends up producing
abnormally high levels of insulin over the years
eventually begins to have a negative effect.
• The pancreas gradually begins to lose its ability to
produce the extra insulin needed to overcome
insulin resistance. As body insulin levels fall, blood
sugars begin to rise.
 Type 2 diabetes and the insulin resistance that causes it have a strong
genetic basis and are made worse by environmental factors, including
inactivity, weight gain, and stress.

 Most people are overweight at the time their Type 2 diabetes is

discovered. Being more active or losing weight may help prevent or
delay the development of diabetes.

 Type 2 diabetes was once called "Adult-onset Diabetes" but this term
is no longer used because it is inaccurate. Type 2 diabetes is on the
increase in all age groups, even among children of high school and
grade school age.
Who gets Type 2 Diabetes?
Most people are lead to believe that they’re to blame
for the disease. However, this disease can also be
inherited by genes as well. Not everyone that eats a
lot of sugar and is overweight have the disease. But
there are higher risks for people developing type 2
diabetes. Here are some facts on how it is people
obtain this disease:
•People who are overweight
•Have a parent or sibling with diabetes
•Are 40 years of age
•Have high blood pressure
•Are African America, Latino, or Native American
•Had diabetes during pregnancy
•Have the stress of an illness or injury
•Had a baby that weighed more than 9 pounds at birth.
Symptoms of Diabetes
Type 2 diabetes is often without symptoms in its early stages.
That’s the reason there are 40% of people with Type 2 diabetes
are unaware of their disease. When there are symptoms, they
may occur gradually. If present, they usually are:

• feeling tired and weak

• passing large volumes of urine, especially during the night
• having frequent infections
• having blurred eyesight
• Weight-loss
• Excessive hunger and thirst
RISK FACTORS!
If left untreated this, Diabetes can cause many life threatening
complications:
• Blindness
• Chronic Renal Failure= kidney failure
• Atherosclerosis= heart attacks and stroke
• Diabetic Neuropathy= numbness and pain to hands and feet
• Foot Ulcers
• Autonomic Neuropathy= diarrhea, rapid heart beat, and low blood
pressure
 Type 2 Diabetes Mellitus
• Constitutes 90-95% of DM diagnosis
• Age of onset usually >30 yo -MODY
• Signs and symptoms usually mild or absent at time of
diagnosis (ADA criteria)
• Occurs due to defects in insulin function
• Insulin resistance/not islet cell antibodies
• Decreased insulin secretion (rarely DKA)
• Hepatic glucose overproduction
• May be multifactoral
Type 2 causes and treatments

• Suspected causes
• Genetic predisposition-90% with family hx
• Strongly associated with obesity (80-90%)
• Strongly associated with sedentary lifestyle
• IRS/Syndrome X association
• Treatments
• Diet (80% of pt will need wt loss)
• Exercise
• Medications
Management components of DM

• Education
• Nutrition
• Exercise
• Monitoring
• Medications
Educating the patient with DM
• Learner assessment
• Health hx of patient and family
• Personal characteristics
• Lifestyle
• Psychosocial issues
• Current DM knowledge
• Values/beliefs
• Teaching plan
• Must include the learner
• Goals-short and long term
• Objectives-determined by methods of teaching
• Outcomes-determine future goals and objectives
• Utilizes the nursing process
Meal Planning
With type 2 Diabetes you have to eat healthy in order to
keep your sugar levels well maintained. That means:
o Fruits and vegetables (apples, bananas, broccoli,
spinach, etc.)
o Whole grain, cereals ,and bread. (Wheat, barley, rice
and bran.)
o Dairy products (yogurt, skim milk, cream)
o Meat: fish, poultry, eggs, dried beans
Nutrition
• Basic concepts
• Macronutrients - caloric
• Micronutrients – non-caloric
• Diet Prescription Determinants
• BG goals
• Comorbidities
• Weight goals
• Lifestyle-acquire diet hx, wt, and ht.
• Type of DM
• Food Classification Systems
• Exchange List
• Food Guide Pyramid
• Glycemic Index
• BG control and Nutrition
• Primary goal is euglycemia
• Education must focus on how foods affect BG
• Activity must be considered
• Comorbidities and Nutrition
• Must always consider other nutritional needs in
addition to BG control
• Comorbidity considerations
• HTN
• CHF
• Nephropathy
• Osteoporosis
• GI problems – diverticulosis and constipation
• Food allergies/intolerances
Weight-loss
 Obesity increases insulin resistance and can lead to
many other cardiovascular health problems.

 However the diabetic that carries the disease and

loses weight, will see a decrease in blood glucose levels
and a decrease in taking oral medication
• Weight Management and DM
• Cornerstone of Type 2 management in 80% of
cases
• IBW calculations vs reasonable body weight goals
– must be patient determined if possible
• Obesity is defined as 20% above IBW
• 10-15lbs of wt loss can improve IGT
• 10% total body wt loss may significantly improve
glycemic control
• Key is calorie control initially with careful
monitoring of BG
Exercise
• Exercise can take glucose out of the blood and for
energy during or after exercise, which lowers the glucose
level.
• Helps delay large blood vessel clots, which lead to
Cardiovascular heart Disease
• All people with diabetes should exercise to control their
blood sugar level, to maintain
• Lifestyle Considerations for Nutrition and DM
• Cultural/Religious practices
• Daily routine
• School
• Work (type)
• Activity
• Financial concerns
• Self-care ability
• Shopping
• Cooking
• feeding
Food Classification Systems
• System is determined by assessment
• 3 main systems to consider
• Exchange List
• Groups foods according to macronutrient value
• Assists patient in balancing total CHOs, calories, and
varieties of foods
• Important for patients CHO counting
• Food Guide Pyramid
• Simple for patients unable to grasp skills needed to use
Exchange list
• Not very useful for CHO counting
• Glycemic Index
• Source of debate as to significance
 ADA Exchange List Summary
Food Group CHO grams Protein Fat grams Calories
grams

Starches 15 3 <1 80

Fruits 15 - - 60

Milks 12 8 0-8 80-150

Desserts 15 varies varies varies

Veggies 5 2 - 25

Meats - 7 0-8 35-100

Fats - - 5 45
Food Guide Pyramid
• Fats/Sugars
• Milk, Eggs, Cheese/Meats
• Vegetables/Fruits
• Starches

• Based on dietary recommendations of obtaining 50-

60% of calories from CHOs, 20-30% from fats, and
20% from protein
• Suggest a range of servings in each group w/o
serving size recommendations specified
Glycemic Index System
• Based on the ability of foods to raise blood glucose
levels
• Simple sugars raise BG quickly
• Complex CHOs raise BG more slowly – higher fiber
content is major determinant
• Not universally accepted as significant when patients
are counting total CHO content for meals and snacks
 Exercise
• Benefits
• Lowers BG – readily available and stored
• Lowers BP
• Improves Lipids
• Raises HDL
• Lowers triglycerides
• Lowers total cholesterol
• Enhances insulin sensitivity
• Contributes to weight loss
• Strengthens cardiac health
• Contributes to reduction in medication use
• Improves overall well-being
Periodic Medical Exams
• Routine check-ups with health care provider
• Physical exam
• Ht, wt, BP
• Foot exam (microfilament and vibratory testing)
• Multi-system review and exam
• Diagnostic Exams
• Laboratory /Screenings
• Hgb A1C quarterly to biannually
• Annual lipids, TSH, urine for microalbuminuria, and BMP
• Testing of other functions depends on medications, new
• GXT or other cardiac work-up
• Specialist
• Ophthalmologist annually
• Podiatrist
• Nephrologist
• Endocrinologist
 TZDs Sulfonylureas
Biguanides and
Decreased
Decrease Hepatic Nonsulfonylurea
Thiazolidinedinones Lipolysis
Glucose Secretagogues
(TZDs) Production
Increase Glucose Increase Insulin
Adipose Tissue Secretion
Uptake TZDs
Increased Lipolysis
Liver
Increased Glucose
Production

Skeletal Muscle Pancreatic

Decreased Increased Beta Cells
Glucose Uptake Lipotoxicity Free Fatty Lipotoxicity Decreased Insulin
Acids Secretion

Insulin Defective Insulin

Resistance Glucotoxicity Secretion

a-Glucosidase
Inhibitors
Delay Intestinal
Carbohydrate
Absorption
Hyperglycemia
Small Intestine
Carbohydrate
Absorption
 Options for monotherapy

Sulfonylureas

Meglitinides

Biguanides

Thiazolidinediones

Alpha-glucosidase
inhibitors
 Target Population

Sulfonylureas
Meglitinides
•Recent type 2 Biguanides
DM diagnosis
•Type 2 DM < 5 Thiazolidinediones
years’ duration
Alpha-glucosidase
inhibitors
 Target Population

Sulfonylureas
Meglitinides
•Recent type 2 Biguanides
DM diagnosis
•Elevated PPG Thiazolidinediones

Alpha-glucosidase
inhibitors
 Target Population

Sulfonylureas
Meglitinides
•Overweight/ Biguanides
obese
•Insulin Thiazolidinediones
resistant
Alpha-glucosidase
inhibitors
 Target Population

Sulfonylureas
Meglitinides
•Insulin Biguanides
resistant
•Overweight/ Thiazolidinediones
obese
Alpha-glucosidase
inhibitors
 Target Population

Sulfonylureas
Meglitinides
•Elevated PPG Biguanides
•Contraindications
to other agents Thiazolidinediones

Alpha-glucosidase
inhibitors
 Advantages

Sulfonylureas
Meglitinides
•Rapid FPG Biguanides
reduction
•Low cost Thiazolidinediones

Alpha-glucosidase
inhibitors
 Advantages

Sulfonylureas
Meglitinides
•↓Risk of Biguanides
hypoglycemia
•Short-acting Thiazolidinediones
•Meal-adjusted
dosing
Alpha-glucosidase
inhibitors
 Advantages

Sulfonylureas
Meglitinides
•No weight Biguanides
gain
•↓ Risk of Thiazolidinediones
hypoglycemia
Alpha-glucosidase
inhibitors
 Advantages

Sulfonylureas

Meglitinides
•↓Amount of Biguanides
insulin
•↓Risk
Thiazolidinediones
hypoglycemia
Alpha-glucosidase
inhibitors
 Advantages

Sulfonylureas
Meglitinides
Biguanides
•↓ Risk of hypoglycemia
•Non systemic action Thiazolidinediones

Alpha-glucosidase
inhibitors
 Disadvantages

Sulfonylureas
Meglitinides
•Weight gain Biguanides
•↑ Risk of
hypoglycemia Thiazolidinediones

Alpha-glucosidase
inhibitors
 Disadvantages

Sulfonylureas
Meglitinides
•↓High costs Biguanides
•Frequent dosing
Thiazolidinediones

Alpha-glucosidase
inhibitors
 Disadvantages

Sulfonylureas
Meglitinides
•GI side Biguanides
effects
•High costs Thiazolidinediones
•Rare lactic
acidosis
Alpha-glucosidase
inhibitors
 Disadvantages

Sulfonylureas
Meglitinides
•High cost Biguanides
•Weight gain
Thiazolidinediones
•Slow onset of action
•Issue of liver toxicity Alpha-glucosidase
inhibitors
 Disadvantages

Sulfonylureas
Meglitinides
•High cost Biguanides
•GI side
effects Thiazolidinediones

Alpha-glucosidase
inhibitors
Total daily dose (mg) & dosing interval

Sulfonylureas

Meglitinides
•Glyburide 1.25 to 20 QD or BID
Biguanides
•Glyburide, micronized 0.75 to 12 QD or BID
•Glipzide 2.5 to 40 QD orThiazolidinediones
BID
•Glipizide, extended-release 2.5 to 20 QD
•Glimepiride 1 to 8 QD
Alpha-glucosidase
inhibitors
 Total daily dose (mg) & dosing interval

Sulfonylureas

Meglitinides
Biguanides
•Nateglinide 180 to 360 TID
•Repaglinide 1.5 to 16 TID or QID
Thiazolidinediones

Alpha-glucosidase
inhibitors
 Total daily dose (mg) & dosing interval

Sulfonylureas

Meglitinides
Biguanides
•Metformin HCI 1,000 to 2,550 BID or TID
Thiazolidinediones
•Metformin, extended-release 1,000 to 2,000 QD or BID
Alpha-glucosidase
inhibitors
 Total daily dose (mg) & dosing interval

Sulfonylureas

Meglitinides
•Rosiglitazone maleate 4 to 8 QD or BID
Biguanides
•Pioglitazone HCI 15 to 45 QD

Thiazolidinediones

Alpha-glucosidase
inhibitors
 Total daily dose (mg) & dosing interval

Sulfonylureas

Meglitinides
•Acarbose 150 to 300 TID
Biguanides
•Miglitol 150 to 300 TID
Thiazolidinediones

Alpha-glucosidase
inhibitors
 Sulfonylureas Meglitinides Biguanides α-glucosidase Thiazolidine-
inhibitor diones

Hypoglycemia + ±
BW gain + ± +
GI upset + +
Lactic acidosis +
Hepatotoxicity +
Increased plasma +
volume

Contraindication Significant Significant Cr (M) >1.5, Gastroparesis Active liver

liver/kidney liver (F) >1.4 m/dl IBD disease or
dysfunction dysfunction Acidosis GPT >2.5 UNL
CHF CHF
Hypoxia
Radiocontrast

 relative Short & rapid

onset
 relative
Monotherapy Pearls
• All drugs except AGIs and nateglinide equally reduce
HbA1c
• Metformin usually best for obese- no weight gain
• Non-SU secretagogues may be useful for irregular meals
• Metformin and TZDs avoid hypoglycemia
Clinical Efficacy of Oral Hypoglycemic Agents

Class of hypoglycemic agents Reduction in HbA1c (%) Reduction in FPG (mg

per dl)

Sulfonylureas 0.8 to 2.0 60 to 70

Meglitinides 0.5 to 2.0 65 to 75
Biguanides 1.5 to 2.0 50 to 70
Thiazolidinediones 0.5 to 1.5 25 to 50
Alpha-glucosidase inhibitors 0.7 to 1.0 35 to 40
 Options for combination therapy

Sulfonylureas
+ Biguanide
Biguanide +
Or Alpha-
Thiazolidinedione Biguanide
Or + glucosidase
Alpha-glucosidase meglitinide inhibitor
inhibitor
Biguanides Triple combination therapy
+ Sulfonylurea + biguanide
Thiazolidinediones + Thiazolidinedione
or
Sulfonylurea + biguanide
+ alpha-glucosidase inhibitor

If therapeutic goals are not met using the above combinations;

switch to insulin +/- oral agent
Insulin Therapy in Type 2 DM

 Not 1st line, except initially in some

 50% need eventually
 ↓ gluconeogenesis and ↑ glucose uptake
 Can be combined with oral agents
 Diabetes - Insulin
• Discovered in 1921 by Banting and
Best
• Consist of A & B chains linked by 2
disulfide bonds
(plus additional disulfide in A)

~
A = 21amino acids B = 30 amino acids
 Diabetes – Insulin
(synthesis, storage, secretion)
• Produced within the pancreas by β cells  islets of Langerhans
• insulin mRNA is translated as a single chain precursor called preproinsulin
• removal of signal peptide during insertion into the endoplasmic reticulum generates proinsulin
• Within the endoplasmic reticulum, proinsulin is exposed to several specific endopeptidases which excise the C peptide, thereby
generating the mature form of insulin

• Stored as β granules

Zn

This light micrograph of a section of the

human pancreas shows one of the islets of
Langerhans, center, a group of modified
glandular cells. These cells secrete insulin,
a hormone that helps the body metabolize
sugars, fats, and starches. The blue and
white lines in the islets of Langerhans are
blood vessels that carry the insulin to the
rest of the body.
Diabetes – Insulin
(Biochemical Role)

-Tyrosine Kinase
receptors are the locks
in which the insulin
key fits
- Involved in signal
transduction
(insulin hormone being 1st messenger)
 Insulin is a small protein consisting of an A
A chain chain of 21 amino acids linked by two disulfide
(S—S) bridges to a B chain of 30 amino acids.

Beta cells have channels in their plasma

membrane that serve as glucose
detectors. Beta cells secrete insulin in
response to a rising level of circulating
glucose.
B chain
Insulin affects many organs:

amino acids protein

• It stimulates skeletal muscle fibers.
uptake synthesis
• It stimulates liver cells.

• It acts on fat cells glycogen

glucose
synthesis
• It inhibits production of certain enzyme.
uptake

In each case, insulin triggers

fat
these effects by binding to the
synthesis
insulin receptor.

enzyme glycogen
production breaking
Insulin Options:
Long and Intermediate

NPH
Lente
Ultralente
Glargine
Short-acting Insulin Options

Regular
Lispro
Aspartine
Combination Insulin Options

• 70 NPH/30 Reg premixture

• 50 NPH/50 Reg premixture
• 75 lispro protamine/25 lispro
IDC Insulin Staged Regimens

OA – O – O – N
R/N – O – R/N – O
R/N – O – R – N
R – R – R – N
BID Insulin Division

AM PM
Distribution 2/3 1/3
R/N Ratio 1:2 1:1

Premix: Best for drawing impaired

Insulin Therapy Profiles
• Variable absorption of NPH, Lente, Ultralente
• Peak effect late with regular
• Split/mixed insulin hypoglycemia
• Lantus more predictable absorption
• Humalog/Novolog more rapid peak/fall
Multiple Dose Insulin Intensive Therapy

 Basal dose suppresses hepatic glucose output

 Bolus dose enhances postprandial glucose uptake
 Basal dose about 50%
 Bolus doses 10-20% before meals
Premeal Humalog or Novolog Insulin
• CHOgm intake/carbohydrate insulin ratio (CIR)
• CIR= 500
TDD
• TDD (total daily dose) = BW (lb)
4
• Common ratio: 1u/5-15 gms CHO
• Correction Dose = 1800 /TDD = 1u ↓ of BG mg/dl
• Ideal BG rise post meal is 30 – 60 mg
• Out of Target adjustment range 1 u/30-50 BG mg/dl
 Diabetes Self-Management Skills
Medical Nutrition Therapy, Activity
Patient Education, Glucose Monitoring

Hyperglycemia Hypertension Other Components

Insulin Resistance of Care

Lipid Disorders Micro vascular

Complications

Hemoglobin A1c
(2 – 4 times per year)
Target ≤ 7.0%
SMBG 80-140 mg/dL (-50% of readings)
Combination RX
Insulin Therapy
Insulin Sensitizers
 Diabetes Self-Management Skills
Medical Nutrition Therapy, Activity
Patient Education, Glucose Monitoring

Hyperglycemia Hypertension Other Components

Insulin Resistance of Care

Lipid Disorders Micro vascular

Complications

GOALS
LDL < 100 mg/dL
Annual Lipid Profile Trigs < 150 mg/dL
HDL > 45 mg/dL♂
Statin Therapy > 55 mg/dL♀
Fibrate Therapy
? Glitazones
Clinical Approaches to the Treatment of Dyslipidemia in Patients with Diabetes

TG < 150 mg/dl TG 150-400 mg/dl TG >400 mg/dl

(Optimal) (Elevated) (Markedly Elevated)

LDL-C <100 Emphasize glycemic Fibrate therapy Fibrate therapy

mg/dl control Pioglitazone Glitazone
(Optimal)

LDL-C > Statin Statin Statin + fibrate

100mg/dl Fenofibrate Fenofibrate
Statin +Fibrate Niacin
Statin + pioglitazone Statin + pioglitazone
Niacin
 Diabetes Self-Management Skills
Medical Nutrition Therapy, Activity
Patient Education, Glucose Monitoring

Hyperglycemia Hypertension Other Components

Insulin Resistance of Care

Lipid Disorders Micro vascular

Complications

Blood Pressure
(every visit)

Dx and Rx + 130/80 mm Hg

ACEI-Based Therapy Combination Rx

 Blood Pressure Management
(every visit)
Diagnosis and Rx Target < 130/80 mm Hg

Nonpharmacologic Therapies
Weight management Physical activity Sodium restriction Smoking cessation

Normal BP Hypertension Hypertension with

↑ CVD Risk Nephropathy

ACE Inhibitor ACE Inhibitor or ARB ACE Inhibitor or ARB

Target BP < 130/80 mm Hg Target BP < 130/80 mm Hg Target BP < 125/75 mm Hg

Consider multidrug therapy (required in up to 60% of patients)

Ca++ Channel
Thiazide Β-Blocker
Blocker Other Agents
Low cost Effective post-MI
Systolic HTN Systolic HTN Consider cost
Avoid if severe
Elderly patients ? Non DHP Use in combination
hypoglycemia
Use in combination
 Diabetes Self-Management Skills
Medical Nutrition Therapy, Activity
Patient Education, Glucose Monitoring

Hyperglycemia Hypertension Other Components

Insulin Resistance of Care

Lipid Disorders Micro vascular

Complications

Annual Screening
Nephropathy
Microalbuminuria screening
Retinopathy
Dilated retinal exam
Neuropathy
Comprehensive foot exam
 Diabetes Self-Management Skills
Medical Nutrition Therapy, Activity
Patient Education, Glucose Monitoring

Hyperglycemia Hypertension Other Components

Insulin Resistance of Care

Lipid Disorders Micro vascular

Complications

Aspirin Use
ACE Inhibitor
Foot Care
Tobacco Cessation
Flu Shot + Pneumococcal Vaccination
Psychosocial Support
QOL: Patient Satisfaction
OTHER CLINICAL PEARLS –
TYPE 2 DM

• Early Dx/Rx ↓ cardiovascular risks

• Elderly ↑ risk of hypoglycemia- careful aggressive Rx
• Prevention by lifestyle changes in obese and sedentary
• Educational interventions cause clinical improvements
• Most diabetics die of cardiovascular disease
OTHER CLINICAL PEARLS –
TYPE 2 DM
• Audit or computer enhanced monitoring system improves
outcomes
• Continuity of care improves quality of care
• HOPE and LIFE trials - ↓ DM with ACE & ARB use
• Dietary fiber high intake improves BS & lipids
• Gap exists between guidelines and care
Conclusions
The rate of people being diagnosed with Type 2 DM is
on the rise
New Treatments and even cures are continuously being
explored
Early detection and intervention hold the key to delaying
or even avoiding the development of DM
DM management is crucial to preventing complications
Prevention???
Researchers attribute obesity to Type 2 Diabetes

 Maintain a healthy body weight

 Eat a healthy diet
(fruits, vegetables, bread, milk)
 Exercise at least 30 minutes for 4-5 days a week.
(swimming, walking, basketball, running)