Collection of glands that secrete hormones directly into the bloodstream.

› Adrenal glands, parathyroid glands, pancreas, pineal gland, pituitary gland, ovaries, testes, thymus gland, thyroid gland

(Hormone.org, 2012)

(Zelman, Tompary, Raymond, Holdaway, Mulvhill, 2010)

TSH T3 T4

Disruption of hormones› Hyperthyroidism› Hypothyroidism

(NIDDK, 2006)

Exophthalmos Profuse perspiration Hand tremors Goiter Weight loss Nervousness/excitability Rapid pulse Polydipsia Diarrhea Insomnia

Most common type: Grave’s Disease

Most common type of hypothyroidism› Hashimoto’s Disease

› The thyroid doesn’t make enough thyroid hormone

› Symptoms: Fatigue, mental depression, feeling cold,

weight gain, dry skin and hair, constipation, menstrual irregularities

Most people have no symptoms

4 types:› Papillary – slow growing – easily treated –

rarely fatal› Follicular – again slow growing – rarely fatal› Medullary – less common – more aggressive› Anaplastic – least common – most

aggressive

Adrenal Insufficiency› Adrenal glands

cannot produce enough cortisol

OR

› Pituitary gland fails to produce enough adrenocorticotropin (ACTH)

Symptoms:› Chronic, worsening

fatigue› Muscle weakness› Loss of appetite› Weight loss› Nausea/vomiting› Diarrhea› Craving for salty

foods› Low blood glucose› Headache

Caused by prolonged exposure of the body’s tissues to high levels of the hormone cortisol.

Relatively rare but risk factors:› Obesity› Type 2 diabetes› High blood pressure

Signs & Symptoms:› Rounded face› Upper body obesity› Increased neck fat› Bruise easily / poor

healing› Weakened bones› Fatigue› Increased

thirst/urination› Irritability / anxiety /

depression

(NIDDK, 2006)

Medication

Radioactive Iodine

Surgery

Prevention??

In diabetes, blood glucose builds up for several possible reasons…

High Blood Glucose (Hyperglycemia)

Too little insulin is made

Liver releases too much glucose

Cells can’t use insulin well

American Diabetes Association

Type 1› Pancreas makes

too little or no insulin

Pre-diabetes

Gestational Diabetes

Type 2› Cells do not use

insulin well (insulin resistant)

› Ability for pancreas to make insulin decreases over time

Number of Americans withNumber of Americans withDiagnosed Diabetes, 1980-2009Diagnosed Diabetes, 1980-2009

www.cdc.gov

Currently affects about 29.1 million Americans of all ages.› About 9.3% of the population (U.S.)

› Estimated 8 million undiagnosed

› Hispanics/Latinos – about 13% diagnosed› African Americans – about 13% diagnosed› Asian Americans – about 9% diagnosed

(CDC, 2014)

(Oregon.gov, 2006)

Increased thirst Increased urination Blurry vision Fatigue Weight loss Nausea and vomiting More frequent infections

A leading cause of blindness Leading cause of non-accident

amputations Kidney disease Nerve damage (peripheral neuropathy) Heart attack / stroke

Oralmedication

only58%

No medicatio

n 16%

Insulin only 12%

Insulin and oral

medication

14%

Treatment of DiabetesTreatment of Diabetes

National Diabetes Information Clearinghouse. National Diabetes Statistics, 2011. Available at: http://diabetes.niddk.nih.gov/dm/pubs/statistics/

“The best time to plant a tree is 20 years ago. The second best time is now.”

Chinese Proverb

Good news with diabetes prevention› Small steps matter

Active interventions (vs placebo) would:

Cost-Effectiveness of Lifestyle Cost-Effectiveness of Lifestyle Modification or Metformin: DPPModification or Metformin: DPP

Herman WH, et al for the Diabetes Prevention Program Research Group.Ann Intern Med. 2005:142:323-332.

Intensive Lifestyle

Metformin

Delay onset oftype 2 diabetes by

11.1 years 3.4 years

Reduce incidence oftype 2 diabetes by

20% 8%

Increase life expectancy by

0.5 years 0.2 years

Cost per QALY $1,124 $31,286

QALY = Quality Adjusted Life Years