1010thth Biennial Conference Biennial Conference

Management of Diabetes Management of Diabetes in Youthin Youth

Keystone, July 12-16, 2008Keystone, July 12-16, 2008

Barbara Davis Centerfor Childhood Diabetes

GoalsGoals

• Learn to serve better children and youth suffering from diabetes

• Meet colleagues, enjoy the mountains, have fun

Tradition

Professor Peter Chase, MD

BDC Clinical Director 1980-2000

Keystone Conference Program Director 1990-2006

CDF1977- present

SponsorsSponsors

Platinum: Abbott Diabetes Care

Novo NordiskGold: LifeScan; Roche Diagnostics; Smith Medical

Silver: Medtronic Diabetes, Pfizer, Sanofi-Aventis

Brass: Agamatrix; ADA; Animas Corp; BD Medical/DC; Cumberland Hospital; Eli Lilly & Co; Insulet Corp; Nipro Diabetes Systems

OrganizersOrganizers

Marijane Engel (CDF)Marijane Engel (CDF)

Linda Schneider (CDF)Linda Schneider (CDF)

Ariel Quigley (CDF)Ariel Quigley (CDF)

Volunteers (Guild)Volunteers (Guild)

Carissa Figal (BDC)Carissa Figal (BDC)

Ian Smith (BDC) - slidesIan Smith (BDC) - slides

Barbara Davis Center for Childhood DiabetesBarbara Davis Center for Childhood Diabeteswww.BarbaraDavisCenter.orgwww.BarbaraDavisCenter.org

1980-2005Since 2005

Pediatric Clinic: 3,500 T1D & T2D patientsYoung Adult Clinic: 1,800 T1D patientsEye Clinic, Laboratories

Tours of the BDCTours of the BDC

• Thursday 8-3

• 30 min- 1 hour

• Contact Carissa Figal to sign up

Diabetes in YouthDiabetes in Youthin the U.S.in the U.S.

170,000 patients younger than 20 y

1,500,000 patients with type 1 diabetes

all ages

Number of new patients annually has tripled in the past 20 years

0

10

20

30

40

50

60

70

1950 1960 1970 1980 1990 2000

Finland

Sweden

Colorado

Germany

T1D incidence is rising 3-5% per year Due to environmental cause(s)

Incidence /100,000/ yr in children aged 0-14

Technology

Where are We Today?Average A1c by Age, 2005-06

*11-18 yrs; ^the original 14 centers, unchanged compared to 1998

Age Intensive Rx Hvidoere N=1,295^

Sweden(80% of the nation)

Los AngelesN=1664

BDCDenverN=3910

DCCTN=195

EDICN=175

<6 

    7.5 8.0 7.8

6-12 

    7.9 7.8 8.2

13-18 8.1 8.4 8.6*^ 8.4 8.4* 8.6

>18 

7.1 7.9 8.0   7.8

T1D patients diagnosed in childhoodlive longer

NishmuraR, et al. Diabetes Care 2001

Duration of diabetes (yrs)

0.5

0.6

0.7

0.8

0.9

1

0 5 10 15 20 25 30 35

1975-1970-

1965-

Duration of diabetes (yrs)

0.5

0.6

0.7

0.8

0.9

1

0 5 10 15 20 25 30 35

1970-74

1965-69

1975-79

Incidence of microvascular complications is declining

Hovind P, et al. Diabetes Care 2003

1961-65

1966-70

1966-70

1971-751971-75

1976-80 1976-80

Diabetic nephropathyProliferative diabetic retinopathy1965-691965-69

1970-741970-74

1975-79

1975-79

1980-841980-84

30

20

10

40

Poor control of hypertension and dyslipidemia in young adult patients with T1D

7%

10%

30%

53%

Normal Treated, controlled

Treated, uncontrolled Untreated

6%11%

16%

67%

Hypertension DyslipidemiaMaahs D, Diabetes Care 2005 Wadwa P, Diabetes Care 2005

CME CreditsCME Credits

• Nurses must sign in dailyNurses must sign in daily

• All others need to sign in only onceAll others need to sign in only once

• The sheets are at the Conference The sheets are at the Conference Registration deskRegistration desk

• The American Dietetic Association may The American Dietetic Association may award additional credits. award additional credits.

Evaluation sheetsEvaluation sheets

• Sheets included with your materialsSheets included with your materials

• Please turn in on the last day at the Please turn in on the last day at the Conference Registration deskConference Registration desk

• Your feedback and suggestions for theYour feedback and suggestions for the future are important! future are important!

BooksBooks

• “Understanding Insulin Pumps & CGMs” by Peter Chase included in your backpack

• Additional copies as well as the “Pink Panther” books available for sale at the Registration desk

Dinner tonightDinner tonight

• Here, Longs Peak room, 5:45-6:45 Speaker: Dr. Robert Slover (BDC)

• Topic: “Closing the loop with insulin pumps and glucose sensors”

• Sponsored by: LifeScan, Medtronic Diabetes & Novo Nordisk

• Followed by “Meet with Counterparts”, here 6:45-8:00

Altitude sicknessAltitude sickness

• Headache• Poor appetite, nausea, vomiting • Fatigue or weakness • Dizziness or light-headedness• Insomnia• Pins and needles• Shortness of breath on exertion • Persistent rapid pulse • General malaise, drowsiness • Swelling of hands, feet & face)

Above 8000 ft - 20-30% of visitors from low altitude affected Keystone 9300 ft (2800 m) - 72% of the oxygen at sea levelMountains 12000-14000 ft (3650-4300 m) – 60-65% of the oxygen

Symptoms last usually 1-2 days only, if severe – seek help !

Prevent altitude sicknessPrevent altitude sickness

• Stay at low elevation• Do not exercise hard• Drink more water (avoid carbonated drinks)• Eat more carbs, less fat and less salt• Reduce alcohol and caffeine intake• Feeling worse? - seek help

• smoking, emphysema, asthma, anemia, diabetes, high blood pressure

• UV, lightning, cold, dehydration