The bad news - type 2 diabetes is the seventh leading cause of death in the United States. If you are in your 40s or 50s, it might shorten your life by as much as five to 10 years. It may cause blindness, heart attacks, stroke, or kidney failure. Approximately 16 million Americans have diabetes, and half of them don't even know they have it.

The good news - according to a recent Finnish study, over 50 percent of those at risk for diabetes may be able to prevent it from occurring. And the University of Iowa Health Care REACH program can help. REACH stands for Reaching Euglycemia and Comprehensive Health. The program teaches people who are at risk of developing type 2 diabetes, or who have recently developed type 2 diabetes, how to normalize blood sugar levels and develop a healthier lifestyle.

What is type 2 diabetes? Diabetes is a metabolism disorder - your body doesn't properly convert food into energy. Type 1 diabetes appears suddenly, progresses quickly, and the patient nearly always requires insulin injections. In type 2 diabetes, the pancreas produces insufficient insulin, or the body has trouble delivering blood sugar (glucose) from the blood to the cells for fuel. Type 2 is gradual, and can generally be controlled through diet and exercise. About 95 percent of all people with diabetes have type 2.

REACH helps people understand diabetes. How does it affect your life? What can you do to help control it? How can you prevent complications? The program also helps people who have not yet developed type 2 diabetes but have impaired glucose tolerance (IGT), a forerunner of type 2 diabetes, to normalize blood sugar levels and forestall the onset of type 2 diabetes.

REACH gives these people the tools and strategies to make the changes necessary for a healthier life. The program provides a physical exam, counseling, exercise evaluation, and exercise sessions. "Our primary aim is to reduce the barriers to good health. Even when people know what they need to do, they often have difficulty putting the knowledge into a lasting practice," says Rhonda Barr, P.T. coordinator of REACH.

The REACH team includes a dietitian, a mental health counselor, a diabetes nurse educator, a physician assistant, and a diabetes physician.

For information about upcoming REACH program sessions, call the Rehabilitation Therapies at 356-2663.To schedule a free fasting-blood glucose and lipid test, call UI Health Access (800-777-8442 or 384-8442) and ask for REACH Screening.

If you have a health-related question, or to make an appointment, call UI Health Access - 800- 777-8442 or 384-8442.

More information:

• www.idi.org.au/

Listed above are several Web sites that offer additional information on this topic. University of Iowa Health Care does not sponsor or endorse these sites, or guarantee the accuracy of the information contained on these sites. These links are here for general information only, and should not be used for personal diagnosis or treatment. If you have any questions, please contact UI Health Access.

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Impaired Glucose Tolerance (IGT)

Impaired Glucose Tolerance (IGT), which has also been called borderline or chemical diabetes, is defined as having a fasting blood glucose level of 110-125 mg percent or having blood glucose levels greater than 140 mg percent after consuming 75-100 grams of glucose. IGT is a common condition. In the United States there are now more than 20 million people with IGT, and this number is increasing at epidemic proportions. Individuals with a higher risk of developing IGT include those who are overweight, especially if they have an increased waist/hip ratio, a family history of diabetes, gestational diabetes (i.e. diabetes only when pregnant), steroid induced hyperglycemia, having a baby weighing more than 4500 grams, being of Native American, Hispanic, African American or Pacific Island descent or having hypertension or abnormal lipid profile (Figure 1). These are the same individuals who are at increased risk for developing diabetes. In fact, most individuals who develop type 2 diabetes, which represents approximately 93 percent of all individuals with diabetes, are felt to go through a period where they have IGT before developing type 2 diabetes (Figure 2).

There are two major medical concerns regarding IGT. First, individuals with IGT are at increased risk of having a myocardial infarction (heart attack) and second, people with IGT have an increased risk of developing type 2 diabetes. In the United States, as many as 50 percent of people with IGT go on to develop diabetes. The National Institutes of Health (NIH) is presently conducting a study in which they have identified 4000 people with IGT and are treating them with metformin or diet and exercise in hopes of delaying or preventing the onset of diabetes. Although the ongoing NIH trial is the largest prospective study of IGT, there are several smaller studies that have indicated that the subsequent development of diabetes can be at least delayed by treatment with diet and exercise, or treatment with several antidiabetic medications.

IGT tends to be associated with several other risk factors for coronary artery disease, including hypertension, dyslipidemia, and increased visceral adiposity. Because of this association individuals with IGT should be evaluated with frequent blood pressure measurements, a fasting lipid profile and assessment of waist to hip ratio. These conditions should be treated even before someone with IGT develops diabetes. The lifestyle changes recommended for IGT will also improve hypertension and dyslipidemia.

A major goal of any of the treatments for IGT is to delay or prevent the development of diabetes. Diabetes is defined as having a fasting blood sugar greater than 125 mg percent. In addition to having an elevated blood sugar (hyperglycemia), diabetes is associated with a group of chronic complications that affect the eyes (retinopathy), kidneys (nephropathy), nerves (neuropathy) and larger blood vessels with atherosclerosis. Development of these complications is directly related to the degree of hyperglycemia and the duration of the diabetes. Therefore, with diabetes, a major goal of therapy is to keep the blood sugar as close to normal as possible. In the United States approximately 16 million people have diabetes. Despite efforts to control blood sugars in patients with diabetes, the disease and its complications exact major morbidity and mortality on our society. Diabetes, in the adult population, is the leading cause of blindness, kidney failure, amputations, and is a major cause of myocardial infarctions (heart attacks) and strokes. It is because of the likely development of diabetes that we put such an emphasis on identifying and treating IGT with the hope of preventing diabetes.

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Impaired Glucose Tolerance (IGT)

Impaired Glucose Tolerance (IGT), which has also been called borderline or chemical diabetes, is defined as having a fasting blood glucose level of 110-125 mg percent or having blood glucose levels greater than 140 mg percent after consuming 75-100 grams of glucose.

IGT is a common condition. In the United States there are now more than 20 million people with IGT, and this number is increasing at epidemic proportions. Individuals with a higher risk of developing IGT include:

• Those who are overweight, especially if they have an increased waist/hip ratio
• A family history of diabetes
• Gestational diabetes (i.e. diabetes only when pregnant)
• Steroid induced hyperglycemia
• Having a baby weighing more than 4500 grams
• Being of Native American, Hispanic, African American or Pacific Island descent or
• Having hypertension or abnormal lipid profile.

These are the same individuals who are at increased risk for developing diabetes. In fact, most individuals who develop type 2 diabetes, which represents approximately 93 percent of all individuals with diabetes, are felt to go through a period where they have IGT before developing type 2 diabetes.

There are two major medical concerns regarding IGT:

1. Individuals with IGT are at increased risk of having a myocardial infarction (heart attack).
2. People with IGT have an increased risk of developing type 2 diabetes.

In the United States, as many as 50 percent of people with IGT go on to develop diabetes. The National Institutes of Health (NIH) is presently conducting a study in which they have identified 4,000 people with IGT and are treating them with metformin or diet and exercise in hopes of delaying or preventing the onset of diabetes. Although the ongoing NIH trial is the largest prospective study of IGT, there are several smaller studies that have indicated that the subsequent development of diabetes can be at least delayed by treatment with diet and exercise, or treatment with several antidiabetic medications.

IGT tends to be associated with several other risk factors for coronary artery disease, including hypertension, dyslipidemia, and increased visceral adiposity. Because of this association individuals with IGT should be evaluated with frequent blood pressure measurements, a fasting lipid profile and assessment of waist to hip ratio. These conditions should be treated even before someone with IGT develops diabetes. The lifestyle changes recommended for IGT will also improve hypertension and dyslipidemia.

A major goal of any of the treatments for IGT is to delay or prevent the development of diabetes.

Diabetes is defined as having a fasting blood sugar greater than 125 mg percent. In addition to having an elevated blood sugar (hyperglycemia), diabetes is associated with a group of chronic complications that affect the eyes (retinopathy), kidneys (nephropathy), nerves (neuropathy) and larger blood vessels with atherosclerosis. Development of these complications is directly related to the degree of hyperglycemia and the duration of the diabetes. Therefore, with diabetes, a major goal of therapy is to keep the blood sugar as close to normal as possible.

In the United States approximately 16 million people have diabetes. Despite efforts to control blood sugars in patients with diabetes, the disease and its complications exact major morbidity and mortality on our society. Diabetes, in the adult population, is the leading cause of blindness, kidney failure, amputations, and is a major cause of myocardial infarctions (heart attacks) and strokes.

It is because of the likely development of diabetes that we put such an emphasis on identifying and treating IGT with the hope of preventing diabetes.

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Diabetes Statistics*
(Figures for United States)

Number of Americans with diabetes (1995)

Eight million

Deaths annually (1997)

62,636

Cause of death ranking (1997)

Ranks seventh as cause of death in United States

Number of hospital discharges (1996)

503,000

Average length of hospital stay (1996)

6.3 days

Number of ambulatory care visits (1996)

18.9 million

*National Center for Health Statistics

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REACH: Reaching Euglycemia And Comprehensive Health

Program Description:

REACH is a multidisciplinary outpatient program for people at risk for developing type 2 diabetes, with impaired glucose tolerance (IGT) and newly diagnosed type 2 diabetes. The goal is to improve health by modifying lifestyle factors that increase the likelihood of developing type 2 diabetes and related complications.

REACH complements but does not replace the need for diabetes self-management education recommended for people already diagnosed with diabetes.

Program Goals:

1. Develop an individualized plan for risk management for each participant.
2. Support lifestyle changes of participants in order to lower risks of disease.
3. Increase knowledge of participants about diabetes, IGT, and available resources, treatment options and current research.
4. Promote long-term maintenance of lifestyle changes and quality of life achieved by participants.
5. Communicate program outcomes to participants and their health care providers.

Program Content/Schedule:

The program is offered in the Department of Rehabilitation Therapies, on Tuesdays and Thursdays from 5:30 to 7:30 p.m. to provide educational experiences that are informal, fun, and participatory while emphasizing life long changes in behavior. Each participant will receive a notebook with the program content, resources for further information, and diaries to help with translation of program activities into the home environment.

General Schedule:

5:30 - 6:30 p.m. Group education and/or support session

6:30 - 7:30 p.m. Group supervised exercise and individual education/counseling

Program Staff:

Rhonda N. Barr, P.T, MA, CCS, coordinator

Meg Bayless, R.N., CDE

Linda Snetselaar, RD, Ph.D.

John Kramer, LP, Ph.D.

Stephanie Rosenfeld, PA-C

Robert S. Bar, M.D., medical consultant

Exercise Education Topics:

These topics will be a focus during the group exercise sessions.

• Components of a healthy exercise session
• Walking: getting the most of each step
• REACH for flexibility
• REACH for strength
• Exercise for the foot and ankle
• Focus on hips and knees
• Care and maintenance of your back
• Benefits of exercise equipment: TM, bikes, ski, step
• The basics of water based exercise
• REACH for health at work: staying active on the job
• Exercise and the environment
• Nutrition for performance: hydration, substrate utilization
• Stress busters: massage, stretching, relaxation techniques
• Exploring community resources for fun and exercise

Program Cost:

The program cost is $190 for the eight weeks. Participants are responsible for determining if their insurance carrier will cover part or all of the cost. The entrance examination and evaluation with recommendations is required before participation and is a separate fee that is reimbursable by most insurance carriers.

For more information about REACH:

• Call 319-356-2663 and ask for the REACH coordinator, Rhonda Barr.
• Call UI Health Access, 1-800-777-8442, and ask for Rhonda Barr in the Department of Rehabilitation Therapies
• e-mail questions to rhonda-barr@uiowa.edu .

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REACH

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