Prevention of Disease

- Tertiary Prevention
Tertiary Prevention of Diabetes
Prevention of Disease -
Tertiary Prevention
 aim to improve the quality of life for people
with various diseases by limiting
complications and disabilities, reducing
the severity and progression of disease,
and providing rehabilitation (therapy to
restore functionality and self-sufficiency).
(cont.) Prevention of Disease
- Tertiary Prevention
 Unlike primary and secondary prevention,
tertiary prevention involves actual
treatment for the disease and is
conducted primarily by health care
practitioners, rather than public health
agencies.
(cont.) Prevention of Disease
- Tertiary Prevention

 Tertiary prevention efforts have demonstrated

that it is possible to slow the natural course of
some progressive diseases and prevent or delay
many of the complications associated with
chronic diseases such as arthritis (inflammation
of the joints that causes pain, swelling, and
stiffness), asthma (inflammation and obstruction
of the airways that makes breathing difficult),
heart disease, and diabetes.
Tertiary Prevention of
Diabetes
 Insulin is a hormone produced by the pancreas
to control the amount of glucose (sugar) in the
blood.
 Diabetes mellitus is a disease in which high
blood glucose levels result from insufficient
insulin production or action.
 When there is not enough insulin produced, the
body is unable to metabolize (use, regulate, and
store) glucose, and it remains in the blood.
(cont.) Tertiary Prevention of
Diabetes
 Type 1 diabetes mellitus (also called insulin-
dependent diabetes or juvenile-onset diabetes)
occurs when pancreatic beta cells, the cells that
make insulin, are destroyed by the body's own
immune system. It usually develops in children
and young adults.
 Because people with diabetes do not have
enough insulin, they must be injected or inject
themselves with insulin several times a day or
receive insulin via a pump.
 About 5 to 10 percent of all diagnosed cases of
diabetes are type 1.
(cont.) Tertiary Prevention of
Diabetes
 Approximately 90 to 95 percent of all diagnosed
cases of diabetes are type 2 diabetes mellitus
(also called non–insulin-dependent diabetes or
adult-onset diabetes). Type 2 diabetes occurs
when the body becomes resistant to insulin.
 As a result of the cells being unable to use
insulin effectively, the amount of glucose they
can take up is sharply reduced and high levels
of glucose accumulate in the blood.
(cont.) Tertiary Prevention of
Diabetes

 People who are older than age forty,

overweight, have a family history of
diabetes, and are physically inactive are at
greater risk of developing type 2 diabetes.
African-Americans, Hispanic/Latino
Americans, Native Americans, and some
Asian Americans and Pacific Islanders are
at greater risk for type 2 diabetes.
(cont.) Tertiary Prevention of
Diabetes

 Approximately 1.3 million new cases of

diabetes were diagnosed among
Americans aged twenty years and older in
2002, and the incidence of type 2 diabetes
is increasing among people of all ages,
including children.
Prevalence of diabetes in
people aged 20 years or
older, by age group, 2002
 2 diabetes are able to control their blood sugar
by losing excess weight, maintaining proper
nutrition, and exercising regularly. Others require
insulin injections or orally administered (taken by
mouth) drugs to lower their blood sugar.
 Other types of diabetes can occur as a result of
pregnancy (gestational diabetes) or physiologic
stress such as surgery, trauma, malnutrition,
infections, and other illnesses. These types of
diabetes account for about 5 percent of all
diagnosed cases of the disease.
COMPLICATIONS OF
DIABETES
 People with diabetes are about twice more likely
to die at any given time than people without the
disease, but the risk of death from diabetes is
even greater for young adults than older adults.
 Persons with diabetes who are age twenty-five
to forty-four are at 3.6 times greater risk than
those age sixty-five to seventy-five (who are at
1.5 times greater risk than people in the same
age group without diabetes).
 In 2001 diabetes was the seventh leading cause
of death among all age groups.
PREVENTING
COMPLICATIONS OF
DIABETES
 Early detection and treatment of diabetic eye
disease can reduce the possibility of blindness
or serious loss of vision by about 50 percent.
 Early detection and treatment of kidney
disease sharply reduces the risk of developing
kidney failure
 Careful attention to foot care reduces the risk
of amputation by as much as 85 percent.
(cont.) PREVENTING
COMPLICATIONS OF
DIABETES
 To help increase early detection of diabetes (secondary
prevention) and reduce the morbidity (illnesses) and mortality
(deaths) associated with it (tertiary prevention), the CDC and
National Institute of Diabetes and Digestive and Kidney Diseases
of the NIH launched the National Diabetes Education Program
(NDEP) in 1998.
 Increase public awareness of diabetes, improve self-management
of people with diabetes, enhance health care providers'
knowledge and treatment of diabetes, and promote health policies
that improve access, availability, and quality of diabetes care.
 To meet these educational objectives, the NDEP, working with a
variety of other health organizations, develops and distributes
teaching tools and resources.
(cont.) PREVENTING
COMPLICATIONS OF
DIABETES
 Print advertising and patient education materials
developed by the NDEP focus on personal
responsibility for self-management of diabetes.
 For example, one 1999 print advertisement was
translated from Spanish into English after it proved
tremendously successful in Hispanic/Latino
communities.
 Featured a photograph of a lightning bolt next to the
heading: "There are many things in life that can't be
controlled. Fortunately diabetes isn't one of them."
(cont.) PREVENTING
COMPLICATIONS OF
DIABETES
 The 148-page NDEP patient information book also emphasizes
the importance of self-care in the prevention of complications of
diabetes.
 E.g. the section on foot care explains, "There's a lot you can to do
prevent problems with your feet. Controlling your blood glucose
and not smoking or using tobacco can help protect your feet. You
can also take some simple safeguards each day to care for and
protect your feet."
 Goes on to explain the importance of self-care habits such as
having one's feet checked, washing them carefully, trimming toe-
nails, taking care of corns and calluses, protecting feet from heat
and cold, wearing shoes and socks, and remaining physically
active.
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