CHAPTER 9 Chronic Disease Prevention Tertiary prevention, to prevent complications B. Type 2 Diabetes Mellitus lished obesity, often involves pharmacotherapy for complications and bariatric surgery. The utility of In developed countries, about 95% of patients with surgery is well established. Pharmacotherapy for obesity is mellitus have type 2. Whereas type 1 diabetes is an to date, of limited utility and prone to unintended conse- mune disease resulting in destruction of the quences. The use of medications for the metabolic complica- producing beta cells of the islets of Langerhans, type 2 tions of obesity, such as prediabetes, is more clearly supported diabetes is overwhelmingly a lifestyle-related disease of pro ressive insulin resistance mediated largely by excess body Figure 19-2 shows the prevalence of obesity in low- fat. Type 2 diabetes mellitus, formerly called"adult-onset income U.S. children age 2 to 4 years diabetes, is usually preventable, both by treating the insulin See Figure 19-3 on studentconsult. com for obesity trends resistance that often precedes it and, more fundamentally, by U.S. adults. ( For USPSTF recommendations on obesit preventing the accumulation of excess visceral fat that is an see the Websites list at end of chapter. Important root if not the cause, in most patients. 7 The importance of preventing type 2 diabetes is reflected in its large contribution to current health care costs and LoW-Income Children Aged 2 to 4 Years of its fut that as many as one in three americans will have diabetes 圖口回■□ by the mid-2lst century if current trends persist, putting the fate of the U.S. health care system in doubt. Fortu nately, type 2 diabetes is overwhelmingly preventable by available interventions. A fasting glucose between 100 and 125 mg/dL is indicative of prediabetes, whereas a level of 126 mg/dL or greater indicates diabetes. The U.S.Preven tive Services Task Force(USPSTF) specifically recommends diabetes screening in patients with borderline or overt Risk factors for type 2 diabetes overlap substantially with risk factors for obesity. Rates of diabetes are considerably higher in some ethnic groups than others, and there is a known genetic predisposition. The principal driver of the epidemiology of type 2 diabetes, however, and its progression from a disease of adults into a disease of children and adults alike, is epidemic (or hyperendemic)obesity ● Inter Unbal concl ot Anmon●Sa o Navao Nation(AZ, NM, The epidemiology of obesity has changed drastically Viroin blands over recent decades; genes have not. In particular, central adiposity and the accumulation of excess visceral fat in the Figure 19-2 Obesity prevalence in early childhood, united States, liver are causally implicated. Diabetes can be prevented 2009. Among low-income children age 2 to 4 years by state. Insert, In with lifestyle interventions that foster moderate weight loss territories and Indian tribe organizations. ( From Division of Nutrition with pharmacotherapy; and with bariatric surgery. Medical Physical Activity and Obesity, National Center for Chronic Disease management of diabetes to prevent progression and compli Prevention and Health Promotion, Atlanta. 2009. uS Centers for Disease cations constitutes tertiary prevention Box 19-4 summarizes Control and Prevention.) Box 19-4 Summary of Type 2 Diabetes Risk Factors and Preventie Risk Factors Physical activity Nonmodifable Pharmacothera Genetics ity, in particular abdominal (visceral)adios Medical assessment for potential complications(e.g, eye and foot Primary Prevention Bariatric surgery Weight loss/management Weight loss/management Physical activity Pharmacotherapy Bariatric surgery Dietary management