Download - Diabesity with Sharon Weinstein
Sharon M Weinstein MS RN CRNIreg FACW FAAN
ID Wellness December 3 2010
Discuss incidence of Diabesity and pandemic nature
State healthcare projections and cost factors associated with disease
Identify key dietary and pharmacological factors in managing disease process
Describe US and European approaches to management
An Epidemic
bull US newborn today has a 1 in 3 chance of developing diabetes
bull For Hispanics and African-Americans the risk is 1 in 2
Centers for Disease Control and Prevention (CDC)
A term coined by former US Surgeon General C Everett Koop
Raises awareness of the health effects of obesity
Diabesityreg is a registered trademark of Shape Up America (wwwshapeuporg)
Provides interactive information and guidance on weight management healthy eating physical activity childhood obesity and other topics related to the prevention and treatment of obesity
Is the terror within left unchecked could have a greater impact than 911
Dr Richard Carmona (former surgeon general)
Overweight kids become overweight adults
Robert Wood Johnson Foundation ndashspending at least $500 million over the next 5 years to reduce childhood obesity
Incidence of diabetes 800000 casesyear
Prevalence of diabetes 16 million total (includes ~ 8 million undiagnosed)
Number will double or triple by 2050 (1 in 3 adults)
$ 44 billion direct medical costs $ 138 billion in direct and indirect costs Medical costs are 3-8x higher for
Diabetic vs non-Diabetic In patient hospital costs are 5 ndash 9x higher
($7153 vs $1222) 60 ndash65 high blood pressure Leading cause of blindness Common cause of ESRD
50 reduction in sick days and no comp cases between 1997 and 2003
Expanded program to asthma and hypertension
Midwest Business Group on Health (Pactiv City of Naperville Jewish Federation of Chicago)
Rolled out in Milwaukee Pittsburgh and Los Angeles
Payment for medications and consultation Valued at $2000 per yearemployee
Usually diagnosed in children and young adults
Previously known as juvenile diabetes
The body does not produce insulin
Either the body does not produce enough insulin or the cells ignore the insulin
When glucose builds up in the blood instead of going into cellshellip
- your cells may be starved for energy
- high blood glucose levels affect vital organs
Emergence in children is one of the obesity epidemicrsquos most eye-opening symptoms
The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score
Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703
Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese
Depends on administrative data
Health risk appraisal (HRA)
Lab
Pharmacy
Claims
Yields only 15 of high risk cohort
Physician engagement
Practice level reports
Dietary and pharmacological factors
Peer comparisons
Performance-based incentives
Moving toward real-time reporting
Promoting utilization of services
Better patient compliance
Improved outcomes
A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Discuss incidence of Diabesity and pandemic nature
State healthcare projections and cost factors associated with disease
Identify key dietary and pharmacological factors in managing disease process
Describe US and European approaches to management
An Epidemic
bull US newborn today has a 1 in 3 chance of developing diabetes
bull For Hispanics and African-Americans the risk is 1 in 2
Centers for Disease Control and Prevention (CDC)
A term coined by former US Surgeon General C Everett Koop
Raises awareness of the health effects of obesity
Diabesityreg is a registered trademark of Shape Up America (wwwshapeuporg)
Provides interactive information and guidance on weight management healthy eating physical activity childhood obesity and other topics related to the prevention and treatment of obesity
Is the terror within left unchecked could have a greater impact than 911
Dr Richard Carmona (former surgeon general)
Overweight kids become overweight adults
Robert Wood Johnson Foundation ndashspending at least $500 million over the next 5 years to reduce childhood obesity
Incidence of diabetes 800000 casesyear
Prevalence of diabetes 16 million total (includes ~ 8 million undiagnosed)
Number will double or triple by 2050 (1 in 3 adults)
$ 44 billion direct medical costs $ 138 billion in direct and indirect costs Medical costs are 3-8x higher for
Diabetic vs non-Diabetic In patient hospital costs are 5 ndash 9x higher
($7153 vs $1222) 60 ndash65 high blood pressure Leading cause of blindness Common cause of ESRD
50 reduction in sick days and no comp cases between 1997 and 2003
Expanded program to asthma and hypertension
Midwest Business Group on Health (Pactiv City of Naperville Jewish Federation of Chicago)
Rolled out in Milwaukee Pittsburgh and Los Angeles
Payment for medications and consultation Valued at $2000 per yearemployee
Usually diagnosed in children and young adults
Previously known as juvenile diabetes
The body does not produce insulin
Either the body does not produce enough insulin or the cells ignore the insulin
When glucose builds up in the blood instead of going into cellshellip
- your cells may be starved for energy
- high blood glucose levels affect vital organs
Emergence in children is one of the obesity epidemicrsquos most eye-opening symptoms
The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score
Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703
Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese
Depends on administrative data
Health risk appraisal (HRA)
Lab
Pharmacy
Claims
Yields only 15 of high risk cohort
Physician engagement
Practice level reports
Dietary and pharmacological factors
Peer comparisons
Performance-based incentives
Moving toward real-time reporting
Promoting utilization of services
Better patient compliance
Improved outcomes
A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
An Epidemic
bull US newborn today has a 1 in 3 chance of developing diabetes
bull For Hispanics and African-Americans the risk is 1 in 2
Centers for Disease Control and Prevention (CDC)
A term coined by former US Surgeon General C Everett Koop
Raises awareness of the health effects of obesity
Diabesityreg is a registered trademark of Shape Up America (wwwshapeuporg)
Provides interactive information and guidance on weight management healthy eating physical activity childhood obesity and other topics related to the prevention and treatment of obesity
Is the terror within left unchecked could have a greater impact than 911
Dr Richard Carmona (former surgeon general)
Overweight kids become overweight adults
Robert Wood Johnson Foundation ndashspending at least $500 million over the next 5 years to reduce childhood obesity
Incidence of diabetes 800000 casesyear
Prevalence of diabetes 16 million total (includes ~ 8 million undiagnosed)
Number will double or triple by 2050 (1 in 3 adults)
$ 44 billion direct medical costs $ 138 billion in direct and indirect costs Medical costs are 3-8x higher for
Diabetic vs non-Diabetic In patient hospital costs are 5 ndash 9x higher
($7153 vs $1222) 60 ndash65 high blood pressure Leading cause of blindness Common cause of ESRD
50 reduction in sick days and no comp cases between 1997 and 2003
Expanded program to asthma and hypertension
Midwest Business Group on Health (Pactiv City of Naperville Jewish Federation of Chicago)
Rolled out in Milwaukee Pittsburgh and Los Angeles
Payment for medications and consultation Valued at $2000 per yearemployee
Usually diagnosed in children and young adults
Previously known as juvenile diabetes
The body does not produce insulin
Either the body does not produce enough insulin or the cells ignore the insulin
When glucose builds up in the blood instead of going into cellshellip
- your cells may be starved for energy
- high blood glucose levels affect vital organs
Emergence in children is one of the obesity epidemicrsquos most eye-opening symptoms
The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score
Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703
Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese
Depends on administrative data
Health risk appraisal (HRA)
Lab
Pharmacy
Claims
Yields only 15 of high risk cohort
Physician engagement
Practice level reports
Dietary and pharmacological factors
Peer comparisons
Performance-based incentives
Moving toward real-time reporting
Promoting utilization of services
Better patient compliance
Improved outcomes
A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
A term coined by former US Surgeon General C Everett Koop
Raises awareness of the health effects of obesity
Diabesityreg is a registered trademark of Shape Up America (wwwshapeuporg)
Provides interactive information and guidance on weight management healthy eating physical activity childhood obesity and other topics related to the prevention and treatment of obesity
Is the terror within left unchecked could have a greater impact than 911
Dr Richard Carmona (former surgeon general)
Overweight kids become overweight adults
Robert Wood Johnson Foundation ndashspending at least $500 million over the next 5 years to reduce childhood obesity
Incidence of diabetes 800000 casesyear
Prevalence of diabetes 16 million total (includes ~ 8 million undiagnosed)
Number will double or triple by 2050 (1 in 3 adults)
$ 44 billion direct medical costs $ 138 billion in direct and indirect costs Medical costs are 3-8x higher for
Diabetic vs non-Diabetic In patient hospital costs are 5 ndash 9x higher
($7153 vs $1222) 60 ndash65 high blood pressure Leading cause of blindness Common cause of ESRD
50 reduction in sick days and no comp cases between 1997 and 2003
Expanded program to asthma and hypertension
Midwest Business Group on Health (Pactiv City of Naperville Jewish Federation of Chicago)
Rolled out in Milwaukee Pittsburgh and Los Angeles
Payment for medications and consultation Valued at $2000 per yearemployee
Usually diagnosed in children and young adults
Previously known as juvenile diabetes
The body does not produce insulin
Either the body does not produce enough insulin or the cells ignore the insulin
When glucose builds up in the blood instead of going into cellshellip
- your cells may be starved for energy
- high blood glucose levels affect vital organs
Emergence in children is one of the obesity epidemicrsquos most eye-opening symptoms
The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score
Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703
Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese
Depends on administrative data
Health risk appraisal (HRA)
Lab
Pharmacy
Claims
Yields only 15 of high risk cohort
Physician engagement
Practice level reports
Dietary and pharmacological factors
Peer comparisons
Performance-based incentives
Moving toward real-time reporting
Promoting utilization of services
Better patient compliance
Improved outcomes
A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Provides interactive information and guidance on weight management healthy eating physical activity childhood obesity and other topics related to the prevention and treatment of obesity
Is the terror within left unchecked could have a greater impact than 911
Dr Richard Carmona (former surgeon general)
Overweight kids become overweight adults
Robert Wood Johnson Foundation ndashspending at least $500 million over the next 5 years to reduce childhood obesity
Incidence of diabetes 800000 casesyear
Prevalence of diabetes 16 million total (includes ~ 8 million undiagnosed)
Number will double or triple by 2050 (1 in 3 adults)
$ 44 billion direct medical costs $ 138 billion in direct and indirect costs Medical costs are 3-8x higher for
Diabetic vs non-Diabetic In patient hospital costs are 5 ndash 9x higher
($7153 vs $1222) 60 ndash65 high blood pressure Leading cause of blindness Common cause of ESRD
50 reduction in sick days and no comp cases between 1997 and 2003
Expanded program to asthma and hypertension
Midwest Business Group on Health (Pactiv City of Naperville Jewish Federation of Chicago)
Rolled out in Milwaukee Pittsburgh and Los Angeles
Payment for medications and consultation Valued at $2000 per yearemployee
Usually diagnosed in children and young adults
Previously known as juvenile diabetes
The body does not produce insulin
Either the body does not produce enough insulin or the cells ignore the insulin
When glucose builds up in the blood instead of going into cellshellip
- your cells may be starved for energy
- high blood glucose levels affect vital organs
Emergence in children is one of the obesity epidemicrsquos most eye-opening symptoms
The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score
Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703
Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese
Depends on administrative data
Health risk appraisal (HRA)
Lab
Pharmacy
Claims
Yields only 15 of high risk cohort
Physician engagement
Practice level reports
Dietary and pharmacological factors
Peer comparisons
Performance-based incentives
Moving toward real-time reporting
Promoting utilization of services
Better patient compliance
Improved outcomes
A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Is the terror within left unchecked could have a greater impact than 911
Dr Richard Carmona (former surgeon general)
Overweight kids become overweight adults
Robert Wood Johnson Foundation ndashspending at least $500 million over the next 5 years to reduce childhood obesity
Incidence of diabetes 800000 casesyear
Prevalence of diabetes 16 million total (includes ~ 8 million undiagnosed)
Number will double or triple by 2050 (1 in 3 adults)
$ 44 billion direct medical costs $ 138 billion in direct and indirect costs Medical costs are 3-8x higher for
Diabetic vs non-Diabetic In patient hospital costs are 5 ndash 9x higher
($7153 vs $1222) 60 ndash65 high blood pressure Leading cause of blindness Common cause of ESRD
50 reduction in sick days and no comp cases between 1997 and 2003
Expanded program to asthma and hypertension
Midwest Business Group on Health (Pactiv City of Naperville Jewish Federation of Chicago)
Rolled out in Milwaukee Pittsburgh and Los Angeles
Payment for medications and consultation Valued at $2000 per yearemployee
Usually diagnosed in children and young adults
Previously known as juvenile diabetes
The body does not produce insulin
Either the body does not produce enough insulin or the cells ignore the insulin
When glucose builds up in the blood instead of going into cellshellip
- your cells may be starved for energy
- high blood glucose levels affect vital organs
Emergence in children is one of the obesity epidemicrsquos most eye-opening symptoms
The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score
Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703
Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese
Depends on administrative data
Health risk appraisal (HRA)
Lab
Pharmacy
Claims
Yields only 15 of high risk cohort
Physician engagement
Practice level reports
Dietary and pharmacological factors
Peer comparisons
Performance-based incentives
Moving toward real-time reporting
Promoting utilization of services
Better patient compliance
Improved outcomes
A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Incidence of diabetes 800000 casesyear
Prevalence of diabetes 16 million total (includes ~ 8 million undiagnosed)
Number will double or triple by 2050 (1 in 3 adults)
$ 44 billion direct medical costs $ 138 billion in direct and indirect costs Medical costs are 3-8x higher for
Diabetic vs non-Diabetic In patient hospital costs are 5 ndash 9x higher
($7153 vs $1222) 60 ndash65 high blood pressure Leading cause of blindness Common cause of ESRD
50 reduction in sick days and no comp cases between 1997 and 2003
Expanded program to asthma and hypertension
Midwest Business Group on Health (Pactiv City of Naperville Jewish Federation of Chicago)
Rolled out in Milwaukee Pittsburgh and Los Angeles
Payment for medications and consultation Valued at $2000 per yearemployee
Usually diagnosed in children and young adults
Previously known as juvenile diabetes
The body does not produce insulin
Either the body does not produce enough insulin or the cells ignore the insulin
When glucose builds up in the blood instead of going into cellshellip
- your cells may be starved for energy
- high blood glucose levels affect vital organs
Emergence in children is one of the obesity epidemicrsquos most eye-opening symptoms
The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score
Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703
Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese
Depends on administrative data
Health risk appraisal (HRA)
Lab
Pharmacy
Claims
Yields only 15 of high risk cohort
Physician engagement
Practice level reports
Dietary and pharmacological factors
Peer comparisons
Performance-based incentives
Moving toward real-time reporting
Promoting utilization of services
Better patient compliance
Improved outcomes
A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
$ 44 billion direct medical costs $ 138 billion in direct and indirect costs Medical costs are 3-8x higher for
Diabetic vs non-Diabetic In patient hospital costs are 5 ndash 9x higher
($7153 vs $1222) 60 ndash65 high blood pressure Leading cause of blindness Common cause of ESRD
50 reduction in sick days and no comp cases between 1997 and 2003
Expanded program to asthma and hypertension
Midwest Business Group on Health (Pactiv City of Naperville Jewish Federation of Chicago)
Rolled out in Milwaukee Pittsburgh and Los Angeles
Payment for medications and consultation Valued at $2000 per yearemployee
Usually diagnosed in children and young adults
Previously known as juvenile diabetes
The body does not produce insulin
Either the body does not produce enough insulin or the cells ignore the insulin
When glucose builds up in the blood instead of going into cellshellip
- your cells may be starved for energy
- high blood glucose levels affect vital organs
Emergence in children is one of the obesity epidemicrsquos most eye-opening symptoms
The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score
Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703
Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese
Depends on administrative data
Health risk appraisal (HRA)
Lab
Pharmacy
Claims
Yields only 15 of high risk cohort
Physician engagement
Practice level reports
Dietary and pharmacological factors
Peer comparisons
Performance-based incentives
Moving toward real-time reporting
Promoting utilization of services
Better patient compliance
Improved outcomes
A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
50 reduction in sick days and no comp cases between 1997 and 2003
Expanded program to asthma and hypertension
Midwest Business Group on Health (Pactiv City of Naperville Jewish Federation of Chicago)
Rolled out in Milwaukee Pittsburgh and Los Angeles
Payment for medications and consultation Valued at $2000 per yearemployee
Usually diagnosed in children and young adults
Previously known as juvenile diabetes
The body does not produce insulin
Either the body does not produce enough insulin or the cells ignore the insulin
When glucose builds up in the blood instead of going into cellshellip
- your cells may be starved for energy
- high blood glucose levels affect vital organs
Emergence in children is one of the obesity epidemicrsquos most eye-opening symptoms
The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score
Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703
Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese
Depends on administrative data
Health risk appraisal (HRA)
Lab
Pharmacy
Claims
Yields only 15 of high risk cohort
Physician engagement
Practice level reports
Dietary and pharmacological factors
Peer comparisons
Performance-based incentives
Moving toward real-time reporting
Promoting utilization of services
Better patient compliance
Improved outcomes
A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Midwest Business Group on Health (Pactiv City of Naperville Jewish Federation of Chicago)
Rolled out in Milwaukee Pittsburgh and Los Angeles
Payment for medications and consultation Valued at $2000 per yearemployee
Usually diagnosed in children and young adults
Previously known as juvenile diabetes
The body does not produce insulin
Either the body does not produce enough insulin or the cells ignore the insulin
When glucose builds up in the blood instead of going into cellshellip
- your cells may be starved for energy
- high blood glucose levels affect vital organs
Emergence in children is one of the obesity epidemicrsquos most eye-opening symptoms
The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score
Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703
Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese
Depends on administrative data
Health risk appraisal (HRA)
Lab
Pharmacy
Claims
Yields only 15 of high risk cohort
Physician engagement
Practice level reports
Dietary and pharmacological factors
Peer comparisons
Performance-based incentives
Moving toward real-time reporting
Promoting utilization of services
Better patient compliance
Improved outcomes
A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Usually diagnosed in children and young adults
Previously known as juvenile diabetes
The body does not produce insulin
Either the body does not produce enough insulin or the cells ignore the insulin
When glucose builds up in the blood instead of going into cellshellip
- your cells may be starved for energy
- high blood glucose levels affect vital organs
Emergence in children is one of the obesity epidemicrsquos most eye-opening symptoms
The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score
Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703
Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese
Depends on administrative data
Health risk appraisal (HRA)
Lab
Pharmacy
Claims
Yields only 15 of high risk cohort
Physician engagement
Practice level reports
Dietary and pharmacological factors
Peer comparisons
Performance-based incentives
Moving toward real-time reporting
Promoting utilization of services
Better patient compliance
Improved outcomes
A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Either the body does not produce enough insulin or the cells ignore the insulin
When glucose builds up in the blood instead of going into cellshellip
- your cells may be starved for energy
- high blood glucose levels affect vital organs
Emergence in children is one of the obesity epidemicrsquos most eye-opening symptoms
The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score
Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703
Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese
Depends on administrative data
Health risk appraisal (HRA)
Lab
Pharmacy
Claims
Yields only 15 of high risk cohort
Physician engagement
Practice level reports
Dietary and pharmacological factors
Peer comparisons
Performance-based incentives
Moving toward real-time reporting
Promoting utilization of services
Better patient compliance
Improved outcomes
A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Emergence in children is one of the obesity epidemicrsquos most eye-opening symptoms
The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score
Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703
Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese
Depends on administrative data
Health risk appraisal (HRA)
Lab
Pharmacy
Claims
Yields only 15 of high risk cohort
Physician engagement
Practice level reports
Dietary and pharmacological factors
Peer comparisons
Performance-based incentives
Moving toward real-time reporting
Promoting utilization of services
Better patient compliance
Improved outcomes
A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
The terms ―overweight and ―obese have precise meanings within medicine - tied to a personrsquos Body Mass Index score
Determined by dividing a personrsquos weight by the square of his or her height then multiplying that number by 703
Scores between 25 and 29 are ―overweight while those with scores 30 and above are ―obese
Depends on administrative data
Health risk appraisal (HRA)
Lab
Pharmacy
Claims
Yields only 15 of high risk cohort
Physician engagement
Practice level reports
Dietary and pharmacological factors
Peer comparisons
Performance-based incentives
Moving toward real-time reporting
Promoting utilization of services
Better patient compliance
Improved outcomes
A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Depends on administrative data
Health risk appraisal (HRA)
Lab
Pharmacy
Claims
Yields only 15 of high risk cohort
Physician engagement
Practice level reports
Dietary and pharmacological factors
Peer comparisons
Performance-based incentives
Moving toward real-time reporting
Promoting utilization of services
Better patient compliance
Improved outcomes
A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Physician engagement
Practice level reports
Dietary and pharmacological factors
Peer comparisons
Performance-based incentives
Moving toward real-time reporting
Promoting utilization of services
Better patient compliance
Improved outcomes
A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Promoting utilization of services
Better patient compliance
Improved outcomes
A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
A Disease Management Approach targets each co-morbidity and takes a proactive approach to prevention and education to patients and physicians
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Promotes a disease management approach
Identifying other co-morbidities present in this same population such as eye heart kidney and clinical depression
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Identification of these complications enhances outcomes and patients are encouraged to utilize alternative methods of dealing with possible neuropathies
Implementation of a screening program expands the population base from the 10 of diabetics that have wounds to 100 of the population who may be candidates for ulcers and other lower extremity complications
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Retinopathy Renal Cardiovascular Lower extremity Clinical Depression Hg A1c Blood pressure
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Safety related
Disease control
Health promotion
Higher levels of self-care
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Diabetic Nephropathy40 of new cases of end-
stage renal disease (ESRD) are attributed to diabetes
In 2001 41312 people with diabetes began ESRD treatment
In 2001 it cost $228 billion in public and private funds to treat patients with kidney failure
Minorities experience higher than average rates of nephropathy and kidney disease
Incidence of ESRD
Resulting from Primary
Diseases (1998)
43
23
12
3
19
Diabetes
Hypertension
Glomerulonephritis
Cystic Kidney
Other Causes
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
bull The most common cause of new
cases of blindness among adults 20-
74 years of age
bull Between 12000 to 24000 people
lose their sight because of diabetes
annually
bull Nearly all patients with type 1
diabetes and over 60 of patients
with type 2 diabetes have retinopathy
in first 20 years of disease
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Diabetes
Cardiovascular Eye Disease Lower Extremity
Disease
Angina MICABG
AngioplastyDialysis Blindness Amputation
Renal Disease Depression
Poor Self-
Care
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Abdominal obesity (excessive fat tissue in and around the abdomen)
Atherogenic dyslipidemia (blood fat disorders mdash high triglycerides low HDL cholesterol and high LDL cholesterol mdashthat foster plaque buildups in artery walls)
Elevated blood pressure
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Insulin resistance or glucose intolerance (the body canrsquot properly use insulin or blood sugar)
Prothrombotic state (eg high fibrinogen or plasminogen activator inhibitorndash1 in the blood)
Proinflammatory state (eg elevated C-reactive protein in the blood)
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Elevated waist circumferenceMen mdash Equal to or greater than 40 inches (102 cm)Women mdash Equal to or greater than 35 inches (88 cm)
Elevated triglyceridesEqual to or greater than 150 mgdL
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Reduced HDL (―good) cholesterolMen mdash Less than 40 mgdLWomen mdash Less than 50 mgdL
Elevated blood pressureEqual to or greater than 13085 mm Hg
Elevated fasting glucoseEqual to or greater than 100 mgdL
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Weight loss to achieve a desirable weight (BMI less than 25 kgm2)
Increased physical activity with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
Healthy eating habits that include reduced intake of saturated fat trans fat and cholesterol
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
17 X more likely to develop for gangrene
30 X more likely to require amputation
2nd amputation likely to occur within 2 yrs of first
Within 5 years 50 will die
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
75 readmitted 5-9 will die while hospitalized 19 require nursing home placement Electric scooter $2000-$5000 BK prosthesis $2000-$7000yr Cost = $10 billion yr or 20 of total
diabetes cost
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Peripheral Vascular Disease
Peripheral Neuropathy
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Great American diet
Nutritional goals
Improving metabolic function
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Glucose disposal
Current pharmaceuticals
Effect on kidney function
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Sulphonylureas stimulate insulin secretion
Metformin and troglitazone increase glucose disposal and decrease hepatic glucose output without causing hypoglycemia
Medical management generally improves blood glucose regulation in Type 2 diabetes patients
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Evidence base
Smoking drinking overeating
Shape Up America
Neurocircuitry of weight control
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Common and often disabling complication of diabetes mellitus
Impaired sensation or pain in the feet or hands
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Conduction is required for nervous system function
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Weintraub study- Annals of Rehabilitation Medicine April 2003
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Weintraub study- Objective to determine if constant wearing of multipolar static magnetic insoles can reduce neuropathic pain and quality of life scores in symptomatic diabetic peripheral neuropathy (DPN)-
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Design randomized placebo-controlled parallel study - Setting 48 centers in 27 states - Participants 375 subjects with DPN state II or III randomly assigned to wear insoles for 4 months placebo group wore a similar unmagnetized device
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Intervention nerve conduction and or quantified sensory testing performed serially
Outcome Measures - Daily visual analog scale scores for numbness or tinglingburning and QOL issues tabulated over 4 months - Secondary measures included nerve conduction changes role of placebo and safety issues
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Statistically significant reductions during the 3rd and 4th months in burning (mean change for magnet treatment -12 for sham -3P lt 05)
Numbness and tingling (magnet -10 sham + 1 P lt05)
Exercise-induced foot pain (magnet -12 sham -4 Plt05)
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Screen and assess the diabetic population for lower extremity disease that may lead to complications causing multiple hospitalizations multiple surgeries and ultimately amputation
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
High percentage of population screened
Reduction in lower extremity amputations
Reduction in hospital admissions
Reduction in hospital length of stay
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Identifying high-risk patients before the first acute event then using a primary prevention methodology to prevent the first acute event results in a significant reduction of human suffering
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
A collaborative approach to disease management using all healthcare disciplines as well as patient and family results in quality outcomes
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
Diabesity knows no bordershellipthat is why we all need to be a part of the solution
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness
sharonwcorelimitedcom
wwwcorelimitedcom
wwwgedinfpcom
wwwihfglobalcom
wwwmynikkennetcorewellness