Taking the Fear out of Diabetes and Insulin

Taking the Fear out of Diabetes and Insulin By: Carly Arena, Crystal Rose, Megan Schulz

What is Diabetes Mellitus Type II? �Heterogeneous disorder �Defined by high levels of plasma glucose �Insulin resistance �Beta cell failure �Diagnosed when: �A patient has a fasting glucose >126 mg/d. L �Random plasma glucose >200 mg/d. L �Two hour post glucose load (75 g) plasma glucose >200 mg/d. L

What can happen? �Neuropathy �Retinopathy �Ulcers �Impotence �Gum disease � 65% of patients that die from diabetes die from heart complications and strokes �#1 cause of renal failure �#1 cause of lower limb amputations

Interesting Facts � 246 million people world wide have diabetes �India is the diabetes capitol in the world, 40 million people currently have diabetes � 6 deaths every minute �Worldwide, $215 -375 billion is spent annually on diabetes �$174 billion alone is spent in the U. S. �Every 21 seconds someone is diagnosed with diabetes � 90% of patients with diabetes type II are obese

Who gets diabetes in the U. S. ? �DM increased from 4. 9% to 7. 9% from 1990 -2001 �In 2008, more than 19 million Americans are affected �A national survey from 2004 -2006 found that: � 6. 6% of non-Hispanic whites � 7. 5% of Asian Americans � 11. 8% of non-Hispanic blacks � 10. 4% of Hispanics have diabetes. � Among Hispanics, Puerto Ricans in the US have the highest rate of DM at 12. 6%. http: //www. nodeathtax. org/blog

Demographics in CT �Prevalence of DM is 6. 2% from 2003 -2005 �A total of 233, 000 residents with diagnosed and undiagnosed DM. �In Connecticut: �Black adults have a significantly higher incidence (10%) �Residents with an income below poverty level have a 13. 2% incidence of DM. http: //www. jud. ct. gov /directory/maps/Juv/

Objectives 1. Establish cultural stigma and reluctance to start and abide by insulin therapy in a Hispanic prevalent population 2. Identify patients’ thoughts, feelings, and fears about insulin therapy 3. Identify correlations between Hgb A 1 C and compliance and fears of insulin, and complications of DM 4. Assess differences in attitudes regarding insulin therapy between patients with an A 1 C >9. 0% and <9. 0%

Objectives continued…. 5. Determine how useful diabetic patients found the diabetic information that was previously given to them by Optimus Health Care 6. Develop a guide for diabetic patients that simplifies what they can and cannot eat and how to lose weight without a gym membership 7. Develop a step wise model for other providers in the clinic to assist patients in making lifestyle changes.

Methods �A sample group of patients seen from January to June 2010 at Optimus Park City Healthcare clinic with an A 1 C lab value >9. 0% was comprised. �A sample group of patients with diabetes and an A 1 C <9. 0% was comprised from diabetic patients. �A Chart review was conducted �A short survey was developed to assess patients’ feelings about and use of insulin

Methods continued…. �The results of the survey were compiled analyzed to: �Analysis of the demographics and patient information to yield information regarding age, sex, ethnicity/race, immigration status, and average height / weight / BMI / A 1 C level. �Determine the main fears and barriers to insulin use and patients’ understanding of the complications of diabetes. �Assess the level of patient education of their disease, their compliance to treatment, and their fears or barriers to treatment.

Methods continued…. �A survey was developed to assess patient satisfaction with previously supplied diabetic health maintenance information. �A culturally competent information pamphlet was created to inform patients of healthy eating habits and simple methods of weight loss. �The pamphlet was developed with the consideration of the patient population ethnicity and income level. �A step-wise process of educating patients on diet and exercise and implementing changes in their routines was produced for implementation by healthcare providers at Optimus Healthcare Park City Clinic. �All materials that were created and provided to the patients and medical staff were developed in an English and Spanish version.

Optimus Park City Ethnicity of Patients with Diabetes for 2009

Demographics at Optimus Park City �Prevalence of DM in the adult population was 7. 5% in 2005 and has risen to 8. 1% in 2007. �Demographics of patients that were used in the study are broken down by ethnicity, immigration status and sex in the following slides. http: //www. optimushealthcare. org/locations. htm

Ethnicity

Immigration Status

Sex

Percentage of Patients with DM Complications

Average BMI

Average Number of Times Patients Report Checking Blood Glucose

Percent of Patients with DM Who Report…

What Patients Report about Insulin

Families impact on insulin use

Reasons Patients with DM are Afraid to take insulin or begin insulin therapy Needles Sign that health is deteriorating Inconvenience Injection Pain

Other findings � 90% of patients with A 1 C < 9 reported receiving information from their provider about insulin and diabetes; this was opposed to 80% of those with A 1 C>9. �Only 1/45 patients reported that their family was opposed to them taking insulin. This was due to the financial burden.

Patient’s Responses to “What do you think having Diabetes means? ” Normal Disease, whole family has it Family Died from it. Take care of Self. Might lose part of self. Pancreas isn’t working correct. Es la Cosa Mas Mala Bad. Can 200 toistake good. Knows it’s Die. important Cautious ofenough sweets. sugar. Can kill you. Not Medication to live longer

Patients’ Response to: “What do you think having diabetes means? ” � “Don’t know” �“Es mal” �“Life goes on. Keep living” �“That my pancreas is not producing enough insulin” �“Body not producing enough sugar” �“Another Sickness, Checking your sugar, Taking medicine” �“Stay away from sugar and white things like rice and potatoes” �“I’m being unhealthy” �“I’m sick, got to take care of myself”

Patient’s Response to “What do you think needing Insulin means? ” Your F*ck For Life. Doctors didn’t togood. dofrom insluin. Es muya importante para Need lot want offeel help Wouldn’t I told doctors I wanted. Sentir bien. Your family. Feels normal not to have To take it.

Patients’ Response to: “What do you think needing insulin means? ” �“Es la vida” �“Not enough from pancreas” �“Don’t know” �“Doctor tells me to take it” �“Keeps sugar level controlled” �“Pass the point of doing it on own” �“When system not functioning properly need insulin” �“That my body needs it to absorb my food” �“You have to give yourself needles everyday” �“Mejorar la diabetes” �“If they need it they should take it” �“If you go from the pill to insulin there’s a problem” �“Diabetes is bad” �“Sugar is down”

Diet and Exercise

Typical Hispanic Diet �Common ingredients: �Fried food �Grease �Salt �Foods: �Tortillas �Rice �Beans �Beef �Potatoes http: //static. howstuffworks. com/gif/potatoes-1. jpg

http: //hispanic-marketing. com/blog/wp-content/uploads/2009/09/399 Latin. Diet. Pyramid_1000 px-882 x 1024. jpg

American Cuisine http: //www. healthytipsforabetterlife. com/resources/new_food_pyramid_DRH 500. gif

Why is it hard for Hispanic patients to change their diet? ? �Food is the center of the Hispanic culture �Cooking and eating meals together is a family affair �The “bad” food is cheap and easy �Lack of education �Tradition

References � "Glycemic Index Food Chart. " South Beach Diet for Beginner. 2008. Web. 06 Aug. 2010. <http: //www. southbeach-dietplan. com/glycemicfoodchart. htm>. � "Diabetes Statistics - American Diabetes Association. " Diabetes Basics. American Diabetes Association, 2010. Web. 06 Aug. 2010. <http: //www. diabetes. org/diabetes-basics/diabetes-statistics/>. � Riddle, Matthew C. MD, and Saul Genuth, MD, FACP. "II Type 2 Diabetes Mellitus. " ACP Medicine (2010). STAT!Ref Online Medical Database. BC Decker Inc. Web. 06 Aug. 2010. <http: //online. statref. com/Document. aspx? doc. Address=VEd. Y 7 QZbygnf 6 l 0 l. Ih. VFbg==&Scroll=1&Index=0 &Session. Id=12 C 9 CF 0 KLQJUYWJE>. � Mitchell, Braxton D. "Hispanic and Latino Diet. " Dieting and Weight Loss - Diet. com. Diet Health Inc. Web. 06 Aug. 2010. <http: //www. diet. com/g/hispanic-and-latino-diet>. � Hynes, Margaret M. Ph. D MPH, and Betty C. Jung, RN, MPH, CHES. "The Burden of Diabetes in Connecticut. " Connecticut Department of Public Health. State of Connecticut, Dec. 2006. Web. 6 Aug. 2010. <http: //www. ct. gov/dph/LIB/dph/hisr/pdf/Diabetes_surveillance_2006 CT. pdf>. � "Poverty in the United States. " National Poverty Center | University of Michigan, 2008. Web. 06 Aug. 2010. <http: //www. npc. umich. edu/poverty/>. � "Diabetes Prevalence in Connecticut, 2006 -2008. " Connecticut Government. Health Information Systems & Reporting Section, May 2009. Web. 6 Aug. 2010. <http: //www. ct. gov/dph/lib/dph/hisr/pdf/diabetesprevalence_2008. pdf>. � Weller, Susan C. Ph. D, Roberta D. Baer, Ph. D, and Lee M. Pachter, DO. et. al. "Latino Beliefs About Diabetes. " Diabetes Care 22. 5 (1999): 722 -28. American Diabetes Association. Weller and Associates. Web. 06 Aug. 2010. <http: //care. diabetesjournals. org/content/22/5/722. full. pdf html>. � Asche, Carl, Ph. D V. "Health Econnomics and Compliance of Vials/Syringes versus Pen Devices: A Review of the Evidence. " Diabetes Technology & Therapeutics 12. 1 (2010): 101 -07. Print.