Diabetic Microvascular Disease: The Role of Glycemic Control and the Impact on Public Health Robert E. Ratner, MD MedStar Research Institute Georgetown.

Slides:

Advertisements

Similar presentations

Importance of early glycemic control in management of type 2 diabetes

Advertisements

What to do when basal bolus therapy fails in Type 2 Diabetes [insert name] UKHMG00596a February 2012 Prescribing information can be found on the last slide.

Aggressive Hyperglycemia Management. Significant hospital hyperglycemia requires close follow-up Previously diagnosed diabetes and elevated A1C Without.

Canadian Diabetes Association Clinical Practice Guidelines Chronic Kidney Disease in Diabetes Chapter 29 Phil McFarlane, Richard E. Gilbert, Lori MacCallum,

1 Prediabetes Comorbidities and Complications. 2 Common Comorbidities of Prediabetes Obesity CVD Dyslipidemia Hypertension Renal failure Cancer Sleep.

Benefits of intensive multiple risk factor intervention.

Diabetes: The Numbers Michigan Diabetes Partners in Action and Michigan Department of Community Health Diabetes: The Numbers Adapted from the National.

UKPDS Paper 36 Slides © University of Oxford Diabetes Trials Unit UKPDS slides are copyright and remain the property of the University of Oxford Diabetes.

UKPDS Paper 35 Slides © University of Oxford Diabetes Trials Unit

UKPDS Paper 81 Slides © University of Oxford Diabetes Trials Unit UKPDS slides are copyright and remain the property of the University of Oxford Diabetes.

BEDTIME INSULIN IN TYPE 2 DIABETES J. Robin Conway M.D. Diabetes Clinic, Smiths Falls,ON

Diabetes Mellitus Type 2

Facts and Fiction about Type 2 Diabetes Michael L. Parchman, MD Department of Family & Community Medicine September 2004.

Canadian Diabetes Association 2013 Clinical Practice Guidelines Targets for Glycemic Control Chapter 8 S. Ali Imran, Rémi Rabasa-Lhoret, Stuart Ross.

Diabetes – A 21 st Century Epidemic Diagnosis and what is it A common disease An expensive disease A serious disease A treatable disease A preventable.

Achieving Diabetes Targets Where are we, and how can we do better? Robert E. Ratner, MD MedStar Research Institute Georgetown University Medical School.

The Burden of Diabetes 1. Prevalence of Diabetes and Prediabetes in the United States 2 1. CDC. National diabetes fact sheet, 2008.

National Diabetes Education Program NDEP ( ) A joint program of NIH and CDC Diabetes: The Numbers Revised.

Diabetes: The Numbers The National Diabetes Education Program A joint program of NIH and CDC January 2007 Diabetes: The Numbers The National.

The Burden of Diabetes.

1 Prediabetes Burden. 2 Epidemiology: Health Performance Gaps Prevalence Risk factors –Metabolic syndrome –Obesity Clinical risks of prediabetes –Progression.

Prediabetes Burden.

Early Detection and Prevention of Renal Failure Linda Fried, MD, MPH.

ACCORD - Action to Control Cardiovascular Risk in Diabetes ADVANCE - Action in Diabetes to Prevent Vascular Disease VADT - Veterans Administration Diabetes.

Building a Diabetes Alliance: The Role of Provider Education Robert E. Jones, MD, FACP, FACE Professor of Medicine University of Utah School of Medicine.

Diabetes Mellitus Ibrahim Sales, Pharm.D. Assistant Professor of Clinical Pharmacy King Saud University

Translating Clinical Trials Into Clinical Practice Cliff Bailey on behalf of the Global Partnership for Effective Diabetes Management This slideset was.

Blood glucose: is lower better for diabetic patients?

These slides were sponsored by Janssen and developed in conjunction with the BRS CKD Strategy Group, following an advisory board that was organised by.

Joint Effects of Routine Blood Pressure Lowering and Intensive Glucose Control ADVANCE Adapted from EASD 2008.

Glycemic Control in Type 2 Diabetes: How Tight is Too Tight? Frederick L. Brancati, MD, MHS Professor of Medicine & Epidemiology Director, Division of.

Session II: Glycemic control, when the lower is not the better Strict glycemic control and cardiovascular diseases Stefano Genovese Diabetologia e Malattie.

1 NHLBI/NEI National Institutes of Health NHLBI/NEI National Institutes of Health.

FDA Endocrinologic and Metabolic Drugs Advisory Committee 1st June 2008 Rury Holman Clinical outcomes with anti-diabetic drugs: What we already know.

Lifetime Benefits and Costs of DCCT Intensive Therapy DCCT References: Diabetes Care, : JAMA, :

Lower the better; the case for glucose Professor Taner DAMCI Istanbul University Cerrahpaşa Medical School, TURKEY.

Proteinuria as a surrogate outcome in CKD UKPDS Rudy Bilous Middlesbrough, UK.

Consider testing if person is: – Overweight or obese with additional risk factor for diabetes – Age 45 or older Obtain: A1C or FPG or 2-hour plasma glucose.

The ADVANCE trial: update and new results Jean-François Gautier Saint Louis Hospital, Paris 12 th Meeting of the Mediterranean Group for the Study of Diabetes.

Glycemic Control: When the Lower is Not the “Better”?

Healthy People 2010 Focus Area 4

Diabetes and the Eye Karen B. Saland, M.D. August 18, 2008.

Individualization Strategies for Older Patients with Diabetes Elbert S. Huang, MD MPH FACP University of Chicago.

Diabetes Update Division of Endocrinology Department of Medicine Wayne State University Medical School Detroit, Michigan Part 1 of 3.

Diabetes Mellitus 101 for Cardiologists (and Alike): 2015

UKHDS (UKPDS): UK Hypertension in Diabetes Study Purpose To determine whether tight control of blood pressure (aiming for BP

Impatto della terapia ipoglicemizzante sulla retinopatia diabetica Raffaele Napoli Dipartimento di Scienze Mediche Traslazionali Università Federico II.

Burden of Type 1 Diabetes

Impact of Diabetes on Cardiovascular Risk C.Richard Conti M.D. MACC Oct 16,2004 GWICC Beijing, PRC.

Diabetes Mellitus 101 for Cardiologists (and Alike): 2015

Part 3. Diabetes Report Card: HbA 1c Levels in the United States Hoerger TJ, et al. Diabetes Care. 2008;31: Patients (%) HbA 1c (%)

Updates in Diabetic Nephropathy Rodica Pop-Busui, M.D., Ph.D Division of Metabolism, Endocrinology and Diabetes Michigan Comprehensive Diabetes Center.

Diabetes Mellitus A Unique Opportunity to Integrate Specialty and Primary Care to Attain Therapeutic Goals with Cost Reduction.

Diabetes type 2 Landmark Outcomes Trials

Pathophysiology and Prevention of Heart Disease in Diabetes Mellitus

Insulin Delivery Systems Atlanta Diabetes Associates

HbA1c as a Marker of Glycaemic Control in Diabetes Care

Macrovascular Complications Microvascular Complications

366 میلیون نفر در جهان مبتلا به دیابت هستند.

Incidence of CV Events in Subjects With T2D vs the Nondiabetic CAD Population

Need to Know! Screening and Diagnosis of Kidney Disease in Diabetes

The Future Use of Technology in Outpatient Care Using the Computerized Patient Record to Implement Principles of Disease Management: Focus on the.

Prediabetes Burden.

Endocrinologist faculty of Mazandaran university

Incidence of CV Events in Subjects With T2D vs the Nondiabetic CAD Population

Glycemic control for macrovascular disease in type II diabetes: Evidence and insights from recent trials Sanjay Rajagopalan Journal of Indian College.

The Clock is ticking for the world’s leaders

Schematic overview of diabetes-associated microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular (cerebrovascular, coronary artery,

The Burden of Diabetes.

Hazard ratios, with 95% confidence intervals as floating absolute risks, as estimate of association between category of updated mean haemoglobin A1c concentration.

Presentation transcript:

Diabetic Microvascular Disease: The Role of Glycemic Control and the Impact on Public Health Robert E. Ratner, MD MedStar Research Institute Georgetown University Medical School Washington, DC

Diabetes: The Numbers The National Diabetes Education Program A joint program of NIH and CDC December 2006 EVERY 24 HOURS New Cases – 4,100 Amputations – 230 (60% of non-traumatic amputations annually) Blindness – 55 (#1 cause) Kidney Failure – 120 (#1 cause) Derived from NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2005.

Adjusted ESRD incident rates of ESRD due to diabetes lla illi lla illi Incident ESRD patients; adjusted for age, gender, & race. USRDS, accessed July 13, 2007

Prevalence of Visual Impairment per 100 Adults with Diabetes, by Age, United States, 1997–2003 Source: National Diabetes Surveillance System – CDC website (

What Complications do People with Diabetes Get? Ramsey SD. Pharmacoeconomics 3:285, 1999

Cumulative Incidence of Proliferative Retinopathy: The Pittsburgh EDC Study Pambianco G. Diabetes 55:1463, 2006 Diagnosed between %

Cumulative Incidence of Overt Nephropathy: The Pittsburgh EDC Study Pambianco G. Diabetes 55:1463, 2006 Diagnosed between %

Cumulative Incidence of Autonomic Neuropathy: The Pittsburgh EDC Study Pambianco G. Diabetes 55:1463, 2006 Diagnosed between %

Cumulative Incidence of Peripheral Neuropathy: The Pittsburgh EDC Study % Diagnosed between Pambianco G. Diabetes 55:1463, 2006

Cumulative Incidence of Hard End-Points: The Pittsburgh EDC Study Renal Failure Total CAD Pambianco G. Diabetes 55:1463, 2006 % % %

Metabolic Pathways Leading to Microvascular Complications Brownlee M. Diabetes 54:1615, 2005

Metabolic Pathways Leading to Microvascular Complications Brownlee M. Diabetes 54:1615, 2005

Metabolic Pathways Leading to Microvascular Complications Brownlee M. Diabetes 54:1615, 2005

Prevalence of Retinopathy: The AusDiab Study Tapp RJ. Diabetes Res Clin Pract 73:315, 2006

Prevalence of Microalbuminuria: The AusDiab Study Tapp RJ. Diabetes Res Clin Pract 73:315, 2006

DCCT: Relationship between Glycemic Control and Retinopathy Progression Lachin J. Diabetes 57:995, 2008

DCCT: Microvascular Complications and Glycemic Control Lachin J. Diabetes 57:995, 2008

Microvascular Endpoints (cumulative) renal failure or death, vitreous haemorrhage or photocoagulation 346 of 3867 patients (9%)

Aggregate Clinical Endpoints

Glucose Control Study Summary The intensive glucose control policy maintained a lower HbA 1c by mean 0.9 % over a median follow up of 10 years from diagnosis of type 2 diabetes with reduction in risk of: 12%for any diabetes related endpoint p= %for microvascular endpoints p= %for retinopathy at twelve years p= %for albuminuria at twelve years p=

Microvascular Endpoints % decrease per 1% decrement in HbA1c p< Updated mean HbA 1c Hazard ratio UKPDS 35. BMJ 2000; 321:

Steno 2: Long-term Outcomes of Intensive Management Gaede P. NEJM 358:580, 2008

Steno 2: Long-term Outcomes of Intensive Management Gaede P. NEJM 358:580, 2008

Steno 2: Long-term Outcomes of Intensive Management Gaede P. NEJM 358:580, 2008

Steno 2: Long-term Outcomes of Intensive Management Gaede P. NEJM 358:580, 2008

UKPDS: A1c as Predictor of Micro- and Macrovascular Disease Microvascular Myocardial infarction Updated Mean A1c Est. Hazard Ratio Stratton IM et al. BMJ. 2000; 321:

Temporal Changes in Glycemic Control: NHANES Hoerger TJ. Diabetes Care 31:81, 2008

Age-adjusted Mortality, age years NHANES Gregg EW. Ann Int Med 147:149, 2007

Age-adjusted Mortality, age years NHANES Gregg EW. Ann Int Med 147:149, 2007

VADT: Correlation of Retinopathy with Coronary Calcium Scores Reaven P. Diabetes Care 31:952, 2008