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Diabetes is a long-term condition in which the amount of sugar (glucose) in the blood is too high so that the body’s cells cannot use glucose properly. Type 1, which occurs mostly in childhood and young adulthood and is due to the failure of the pancreas to secrete insulin (the hormone which allow the cells to use glucose) and nearly always has to be treated with insulin injections. Type 2 occurs when the body cannot make enough insulin or when the insulin cannot work properly. Diabetes leads to significant damage to the lining of blood vessels throughout the body leading to a variety of problems such as kidney failure, blindness, gangrene, loss of sensation and ulceration of the feet (see note 1), and to an increased risk of heart attack and an increased risk of dying from heart attack. As diabetes can be asymptomatic it is difficult to estimate an exact prevalence in the borough. The proportion of people with diabetes has risen over the years and is higher in Enfield than in London or England (Quality and Outcomes Framework, QOF). Comparisons between the predicted and recorded number of people living with diabetes in Enfield indicates that the gap between the diagnosed and estimated levels of diabetes may equate to as many as 2,688 undiagnosed cases of diabetes (14% of all expected cases). The proportion of people in Enfield with diabetes (diagnosed and undiagnosed) is predicted to rise by about 30% (5,700 people) by the year 2030 (Yorkshire and Humberside Public Health Observatory).
Death rates from diabetes have been falling, with death rates in Enfield being similar to those in London and in England (Health and Social Care Information Centre). When diabetes is uncontrolled, the person may go into a diabetic coma and need emergency admission to hospital. Lack of physical activity - it is estimated that if all the adult population met recommended levels of physical activity prevalence of diabetes in Enfield would be 14% less (1822 cases) (Health Impact of Physical Inactivity; Association of Public Health Observatories). A substantial number of the Enfield population are in higher-risk age bands (some 13,900 people aged 55-64 years, some 9,500 people aged 65-74 years and some 7,400 people aged 75 years and over). Many of the complications of diabetes can be prevented by a regime of treatment which keeps the blood sugar at the level it should be.
People with diabetes can play a large part in looking after themselves and making decisions about their own care. A National Diabetes Audit helps to monitor quality of diabetes care, and 22 out of 53 Enfield practices (41.5%) participate in this audit. The rate of complications of diabetes in Enfield is higher than that for people with diabetes in England and Wales overall and this suggests that diabetes control is not as good as it might be. In a large number of patients in Enfield, diabetic control was good as shown by blood glucose (indicated by HbA1C), cholesterol and blood pressure. Data for all people with diabetes in Enfield (including patients of practices not taking part in the National Diabetes Audit) is available from Quality Outcome Framework (QOF) (see note 17). In Enfield there is a specialist nurse diabetes team, which supports patients with diabetes and helps general practices to deliver diabetes care.
There is a marked gap between observed and expected prevalence of diabetes; there is likely to be a group of residents currently undiagnosed and therefore would not benefit from advice and treatment.
Diabetes is a common condition currently affecting about 19,000 people in Enfield of whom over 3,100 may be undiagnosed and are thus not being treated. The risk of developing diabetes increases with age, and above the age of 64 years, 1 in 7 people are likely to have diabetes. The complication rate for people with diabetes in Enfield is similar to the overall complication rate for England.
General medical practice plays a very large part in management of people with diabetes and this is often shared with hospital care.
The National Institute for Health and Care Excellence (NICE) has issued a very wide range of guidance on that management of diabetes over the years, including nine checks which should be carried out regularly on all patients with diabetes (NICE Guidance). The proportion of people with diabetes who are well controlled in Enfield is similar to the proportion nationally. Encourage and enable people to eat healthily and to have adequate levels of physical activity. Continue to improve and support diabetes care in general practice and in hospitals in order to increase the proportion of people receiving all nine recommended checks each year.
Further develop and encourage shared care between hospital diabetologists and primary care. Monitor diabetes prevalence in Black, Asian and minority ethnic groups for which data is currently inadequately available with a view to identifying other high-risk groups. Note 1: Larger blood vessels have their own blood supply, that is small blood vessels that supply their walls and linings.
Enfield Council uses cookies to improve your experience of our websites.To find out more about the cookies we use and how to delete them, see our cookie policy. The randomized, controlled OpT2mise study was sponsored by Medtronic and conducted with participation from 331 patients, ranging in age from 30 to 75 years. Study findings showed that MiniMed insulin pumps safely provided significant, sustainable and reproducible improvements in glucose control in comparison to MDI.
Initial results of OpT2mise showed that after six months, people with insulin-requiring type 2 diabetes who used insulin pumps achieved better glucose control than those using MDI.
The Diabetes Media Foundation is a 501(c)(3) tax-exempt nonprofit media organization devoted to informing, educating, and generating community around living a healthy life with diabetes. As man crosses the prime sexual period, 30 years in many cases, the male organ undergoes some significant changes. As men age, the testosterone level falls, and when this hormone level falls in the body, it takes more time to achieve erection and orgasm. Oh my gosh, are you seriously teaching something medical when you don’t even know about the foreskin? When i was child then i don’t know disadvantage of Hand Practice, I do so much hand practice, Now my penis goes down and it is bent towards left, It is not straight, Veins also appears on my penis, Please tell me how can i see it in straight form. I agree to Shutterstock's Website Terms, Privacy Policy, Licensing Terms and to receive emails that I can opt out of at any time.
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All plans come as a Standard license, and can be upgraded to an Enhanced license at any time. Since the 1970a€™s, academic studies have been pointing out the alarming growth of obesity in the US. Reports from numerous fields depict an alarming situation: the rise in obesity puts our children at serious risk of contracting life-threatening diseases that were previously associated only with older age, such as type-2 diabetes or hepatic steatosis. A 2009 study shows that Obesity has overtaken cigarette-smoking as the leading cause of preventable deaths in the US. General Motors (GM) pays an estimated $1,500 per car produced, in health-care coverage costs to employees and retirees. In 2000, the total cost of obesity in the US was estimated as $117 billion, with $61 billion towards medical costs. More than 25% of the rise in medical costs, between 1987 and 2001, is attributable to obesity. US health-care costs in 2007 ($2.2 trillion) was over 3x higher than in 1990 (3x higher in 17 years), and more than 8x higher than in 1980 (8x higher in 27 years).


Obesity-related and overweight-related diseases cause more than 100,000 preventable deaths each year.
Ethnic-specific studies suggest that overweight and obesity may afflict up to 30-40% of children and youth from minority populations.
By as early as age 3, Latino children in the US are more likely to be obese than Black or White children. The body mass index (BMI) or Quetelet Index is a measure of body weight, the weight of a person scaled according to height.
Generally, a BMI chart displays calculated BMI as a function of weight (horizontal axis) and height (vertical axis) using “contour lines” for different values of BMI or colors for different BMI categories. A frequent use of the BMI is to assess how much an individual's body weight departs from what is normal or desirable for a person of his or her height.
Human bodies rank along the index from around 15 (near starvation) to over 40 (morbidly obese). Body mass index calculations are not just for adults—they can also be used to identify the growing number of overweight children.
These recommended distinctions along the linear scale may vary from time to time and country to country, making global, longitudinal surveys problematic.
For Asians,the new cut-off BMI index for obesity is 27.5 compared with the traditional WHO figure of 30. The Body Mass Index is generally used as a means of correlation between groups related by general mass and can serve as a basic means of estimating adiposity. This general correlation is particularly useful for consensus data regarding obesity or various other conditions because it can be used to build a semi-accurate representation from which a solution can be stipulated, or the RDA for a group can be calculated. Despite this, BMI categories are generally regarded as a satisfactory tool for measuring whether sedentary individuals are "underweight," "overweight" or "obese." It has been used by the WHO as the standard for recording obesity statistics since the early 1980s. In all cases, methods for actually measuring body fat percentage are always preferable to BMI for measuring healthy body size. As a general rule, developed muscle contributes more to weight than fat and the BMI does not account for this. Another issue is that competitive athletes often know very accurately what their actual height and weight are, while the general public has tendencies toward over-estimating their height, and under-estimating their weight. One more problem is that men, in general, tend to over-estimate the amount of of muscle mass that they have. Patient hosted Gastric Bypass radio show features interviews with top gastric bypass surgeons that talk extensively about Body Mass Index.
It used to be called ‘maturity-onset diabetes’ because it was normally only seen in people in their late 50s and 60s. The predicted rise in Enfield is greater than that for England overall because the proportion of older people in the general population of Enfield is rising, as well as the number of people in ethnic groups with higher diabetes risk. Mortality rates fluctuate widely due to the small number of deaths and differences are not statistically significant. As stated above these include heart disease, stroke, blindness, peripheral neuropathy and kidney disease, each of which has significant health and financial implications.
Other non-modifiable risk factors include ethnicity (Black African, Asian) and some medical conditions such as pituitary disease. National data suggests that the prevalence of diabetes is about three times higher in people from India, Pakistan, Bangladesh and the Caribbean (Health Survey for England, 2004). In addition, a sizable proportion of the population come from ethnic groups with an increased risk of diabetes. Most hospital care for people with diabetes in Enfield is provided by the North Middlesex University Hospital NHS Trust or Barnet and Chase Farm Hospitals NHS Trust.
In Enfield, just over half of patients with diabetes (51.4%) cared for by practices participating in the National Diabetes Audit, had eight checks that they should have had in the past 15 months. The percentage of patients with good control was similar to that for the country generally.
These results appear slightly better than those recorded by the National Diabetes Audit, but these QOF data must be regarded as less reliable as practices that take part in the National Diabetes Audit may have better management of long-term conditions that those that do not. Enfield Diabetes Support Group, a branch of Diabetes UK, holds regular meetings for people with diabetes and their relatives at Chase Farm Hospital.
The risk of developing diabetes is also higher in people from India, Pakistan and Bangladesh as well as in Black Caribbean populations. Initial six-month study results comparing MiniMed insulin pump therapy to MDI were published in The Lancet in July 2014. The penis head gradually loses its color due to reduced blood flow, and pubic hair loss can be observed in some cases. One, the slow deposition of fatty substances (plaques) inside tiny arteries in the penis, which impairs blood flow to the organ.
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Once you have downloaded your image, you have life-long rights to use it under the terms of the license purchased. But it took 30 years before US Surgeon Generala€™s report in 2001 to declare obesity as a national health problem. It is used as a simple means of classifying sedentary individuals according to their body fat content. The weight excess or deficiency may, in part, be accounted for by body fat (adipose tissue) although other factors such as muscularity also affect BMI (see discussion below and overweight).
This statistical spread is usually described using categories: eg, severe underweight, underweight, optimum weight, pre-obese (or overweight), obese, morbidly obese.
National Health and Nutrition Examination Survey of 1994 indicates that 59% of American men and 49% of women have BMIs over 25.
BMI for children aged 2 to 20 years is calculated just as it is for adults, but it is classified differently. However, the duality of the Body Mass Index is that, whilst easy-to-use as a general calculation, it is limited in how accurate and pertinent the data obtained from it can be. Similarly, this is becoming more and more pertinent to the growth of children, due to the majority of their exercise habits. Obesity trends can be calculated from the difference between the child's BMI and the BMI on the chart.
However, BMI categories do not take into account factors such as frame size and muscularity. In the United States, BMI is also used as a measure of underweight, owing to advocacy on behalf of those suffering with eating disorders, such as anorexia nervosa and bulimia nervosa. Or to state the problem more accurately, the BMI measurements at which these people may be underweight, overweight or obese are different from for sedentary mesomorphs whose ages are between about 20 and 70.


Most professional athletes are "overweight" or "obese" according to their BMI[6] - unless the number at which they are considered "overweight" or "obese" is adjusted upward. But it is now seen in people of all ages and, most worryingly, in an increasing number of children. A further 3,100 (roughly1% of the registered population) may have undiagnosed diabetes equating to an overall prevalence of 8.6%. Whilst there has been a general downward trend in the mortality rate from diabetes in Enfield, it should be remembered that the DSR is based on diabetes as the underlying cause of death. The rate of complications of diabetes in Enfield is higher than that for people with diabetes in England and Wales overall and statistically significant differences were found for both angina and renal replacement therapy.
National Institute for Health and Care Excellence (NICE) has also published detailed guidance on different aspects of diabetes care for Type 1 diabetes (CG15), Type 2 diabetes (CG66), diabetic foot care (CG119), patient education models (TA60) and prevention (PH35) (NICE). The proportion of patients with diabetes receiving each check was similar to national figures. The group has also published a handbook “Living with Diabetes” (Enfield Diabetes Support Group, 2008), available at GP surgeries in Enfield in four languages (English, Turkish, Somali, Bengali).
Principally, because obesity is more common amongst people living in deprived areas, so too is diabetes. The OpT2mise study is the largest randomized controlled trial to compare the efficacy and safety of insulin pump therapy versus multiple daily injections (MDI) for poorly controlled type 2 patients. Whether single, married, healthy or unhealthy, a man’s body will eventually go through some changes.
This process, known as atherosclerosis, is the same one that contributes to blockages inside the coronary arteries — a leading cause of heart attack. As men reach 40, semen production start getting lower, and the erection quality also starts going down. If at any time you're unsatisfied with your experience with us, you can cancel your subscription.
This finally caught the attention of national media, and became the subject of numerous governmental and philanthropic efforts directed at controlling obesity.
As a rough guideline for adults a BMI of less than 20 implies underweight, over 25 is overweight, and over 30 is obese.
The reason height is squared rather than cubed or raised to some other power is simply that, taken over people of different height, the resulting index correlates reasonably well with degree of underweight or overweight. The exact index values used to determine weight categories vary from authority to authority, but in general a BMI less than 18.5 is underweight and may indicate malnutrition, an eating disorder, or other health problems, while a BMI greater than 25 is overweight and above 30 is considered obese. Instead of set thresholds for underweight and overweight, it is their BMI percentile compared with children of the same gender and age that is important [1]. Generally, the Index is suitable for recognising trends within sedentary or overweight individuals because there is a smaller margin for errors [3]. However, this method again falls prey to the obstacle of body composition: many children who are generally born, or grow as an endomorph, would be classed as obese despite body composition.
In children and the elderly, differences in bone density and, thus, in the proportion of bone to total weight can mean the number at which these people are considered underweight should be adjusted downward.
This can lead to athletes having a higher reported BMI than a lay person of the same height and weight.
For instance, many of the players in the NFL qualify as obese by BMI standards, when they actually fall on the far end of the curve for body size, and could not easily fit into the healthy categories, despite being very physically active and having normal body fat percentages.
That causes them to believe that their high BMI is not indicative of large fat stores, and to discount the usefulness of the BMI as a screening tool. Its principal cause is overweight and obesity and this is significant: as an increasing number of people become overweight and subsequently obese, we can expect an increasing number of people to develop diabetes. However, diabetes would have been an indirect cause in many more deaths by increasing the risk of other conditions such as heart attack, stroke and kidney failure. There is a mass of evidence that good diabetic care with good control of blood glucose levels better enables people with diabetes to live a normal enjoyable life and to avoid the serious complications of the disease.
Damage caused to the vasa nervorum, because of diabetes, itself damages peripheral nerves, especially in the feet. The MDI group, which switched to insulin pump therapy after six months, experienced a similar reduction in A1C to the results seen in the original insulin pump group. In many cases, the prostate enlarges which weakens the urine flow and may cause other complications. Despite a multitude of projects that were run on all levels, from national to local administrations, the rate of obesity-growth continues to be on the rise.
It is calculated by taking the weight of the individual in kilograms and dividing by the square of the height in metres.
There are differing opinions on the threshold for being underweight in females, doctors quote anything from 18.5 to 20 as being the lowest weight, the most frequently stated being 19. A BMI that is less than the 5th percentile is considered underweight and above the 95th percentile is overweight. Clinical professionals should take into account the child's body composition and defer to an appropriate technique such as densiometry.
This does not seem to protect them from health issues associated with obesity, such as increased risk of heart disease and diabetes. Studies indicate that the higher the BMI, the less likely it is to be a result of abundant muscle mass. Unfortunately, this is not achieved in a high proportion of diabetic populations leading to increased risk of complications. With, for example, a consequential loss of pain sensation minor damage to the feet goes unnoticed. Additionally, at the end of the continuation phase, participants who switched from MDI to insulin pump showed a 19.0% reduction in total daily insulin dose, making it equivalent in both treatment arms. There is nothing to worry about if you notice the reduction in the size, since it simply happens due to reduced blood flow. It was originally developed between 1830 and 1850 by the Belgian polymath, Adolphe Quetelet during the course of developing "social physics".
Children with a BMI between the 85th and 95th percentile are considered to be at risk of becoming overweight.
This had the effect of redefining approximately 30 million Americans, previously "technically healthy" to "technically overweight".
And because the blood supply to the feet is compromised by the effect of diabetes on blood vessels supplying the skin and underlying tissues, small areas of damage heal poorly, if at all, leading to ulceration and further tissue damage including ‘dry’ gangrene where large areas of tissues, such as whole toes, literally die and become black and mummified. Unfortunately, because the blood supply to the feet is damaged, this surgical procedure runs the risk of leading to poor healing and ulceration and it is often necessary to make an amputation at a relatively high level to ensure an adequate blood supply to ensure adequate healing.



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