Osvrt na Prvi dijabetološki kongres FBiHMostar, Bosna i Hercegovina, Novembar 16 - 18. 2012.

Autor: Vildana Bilić

Ciljevi prezentacije

• Kratki pregled sadržaja Kongresa

• Važne poruke

Statistika

• Učestalost dijabetes melitusa u svijetu u 2011. g.- 8,3 %

• Učestalost dijabetes melitusa u Evropi 2011. g.- 8,1 %

• Predviđanje za 2030. g. – 51,0 %

Statistika

• Tri puta veći troškovi za tretman komplikacija u odnosu na bazično liječenje DM-a

• Troškovi neupućivanja jednog pacijenta na dijalizu “pokrivaju” troškove prevencije za cijelu populaciju

• Dvanaest puta veci troškovi za regulisanje stanja hiper i hipoglikemije u odnosu na troškove za nabavku inzulinskih pumpi

• 10% zdravstvenog dinara u susjednoj Hrvatskoj otpada na pacijente sa dijabetesom

• Samo 10% oboljelih od dijabetesa ima dobro kontroliranu bolest

Statistika

Izabrani slajdovi iz prezentacije prof. Izeta Aganovica

7 | Structured Testing | November, 2012 | Prof. Izet Aganovic

Basal glucoselevel

HbA1c

PPGPeak glucose level

HbA1c = glycated hemoglobinFPG = fasting plasma glucose PPG = postprandial plasma glucose

FPGAverage long-term

glucose level

‘Glucose triad’ of diabetes management

8 | Structured Testing | November 2012Prof. Izet Aganovic

Poor glycemic control compared with other cardiovascular risk factors

41%59%

43%57%

16%

84%

Hypertension Hyperlipidemia Type 2 diabetes

Uncontrolled Uncontrolled Uncontrolled

Controlled Controlled Controlled

Source: NHANES IIIhttp://www.cdc.gov/nchs/about/major/nhanes/nh3data.htm. Last accessed 25 January 2007

9 | Structured Testing | November 2012 | Prof. Izet Aganovic

+ +

Diet &exercise

Oral monotherapy

Oral combination

Oral plus insulin

Insulin

+

Adapted from Williams G. Lancet 1994; 343: 95-100.

Stepwise Management of Type 2 Diabetes

10 | Structured Testing | November 2012 | Prof. Izet Aganovic

10

Adju

sted

inci

denc

e pe

r 100

per

son

year

s (%

)

Prob

abili

ty

Updated mean HbA1c concentration (%) Glycosylated hemoglobin (%)

UKPDSBMJ 2000, 321: 405-412

DCCTDiabetes 1996: 45: 1289-1298

Every 1 point drop in HbA1c reduces the risk of microvascular complications up to 40%

Source: DCCT, 1993; UKPDS, 1998

11 | Structured Testing | November 2012 | Prof. Izet Aganovic

Diabetes is a progressive disease that requires on-going therapy adjustment

1111

Diabetes

Normal Blood Glucose

Normal Insulin

Years

Fasting Glucose

Postprandial Glucose

IGTInsulin/Hormone

Secretion

Insulin Sensitivity

Independent Risk for CVD

AvgDx 9-12yrs*

Source: Modified from Ramlo-Halsted & Edelman SV. Prim Care. 1999.Harris MI, Klein R et al. Diabetes Care 1992;15:815-819.

12 | Structured Testing | November 2012 | Prof. Izet Aganovic

HbA1Cs are not created equalThe same values are based on different

bG values

12

300

250

200

150

100

50Breakfast Lunch Supper Over Night

A1C = 7.8

BG

300

250

200

150

100

50Breakfast Lunch Supper Over Night

A1C = 7.8

BG

13

300

250

200

150

100

50Breakfast Lunch Supper Over Night

A1C = 7.8300

250

200

150

100

50Breakfast Lunch Supper Over Night

A1C = 7.8

BG

There is a variable relationship between fasting glucose, postprandial glucose and HbA1C

Source: Diabetes Care, Bonora yr:2001 vol:24 iss:12 pg:2023 -2029

Hb Hb

13 | Structured Testing | November 2012Prof. Izet Aganovic

What the HbA1c doesn’t tell you …SMBG does

• Identifies hypoglycemic events•Dynamic relationship between insulin, carbohydrates, physical activity and resulting glucose level

•Effects of different meals and snacks•Effects of physical activity•Effects of medicationsThere is a variable relationship between fasting glucose, postprandial

glucose and HbA1c

14 | Structured Testing | November 2012 | Prof. Izet Aganovic

The Lower the HbA1c…the more it is impacted by postprandial glucose levels

Cont

ributi

on (%

)

100

80

60

40

20

0 <7.3 7.3-8.4 8.5-9.2 9.3-10.2 >10.2

PostprandialFasting

• HbA1c Ranges

30%40%50% 60%55%50%70% 30% 70%45%

Source: Adapted from Monnier et al. Diabetes Care 2003;26:881-885.

15 | Structured Testing | November 2012Prof. Izet Aganovic

Glycemic excursions can be kept under control by bG monitoring

• Diabetes management remains suboptimal for many

• Improvements in HbA1c reduce complications

• Type 2 diabetes is a progressive disease – so therapy needs to change over time

Postprandial hyperglycemia is an important marker for complications

Looking at HbA1c levels is not enough

There is a variable relationship between fasting glucose, postprandial glucose and HbA1c

Structured bG monitoring and systematic data analysis can help people with diabetes make lifestyle changes and inform therapeutic decision-making

What We Know … What We are Beginning to Understand …

16 | Structured Testing | November 2012 | Prof. Izet Aganovic

Prevention = Diagnose + Treat + Monitor

The Diabetes Management Equation• Diabetes is a serious condition for the individual and society. Its

rapidly increasing global prevalence is a significant cause for concern.

• Only a systematic diabetes management with guidelines and reimbursement will allow to efficiently manage scarce resources

• Any HbA1c reduction below 9% is considered to be cost saving.

Source: Diabetes Care 20:1847-53; 19978.

17 | Structured Testing | November 2012Prof. Izet Aganovic

EVERY 1% reduction in HbA1c

REDUCED RISK*

1%

Deaths from diabetes 21%

Heart attacks 14%

Micro-vascular complications 37%

Peripheral vascular disorders 43%

*p<0.0001

Lessons from UKPDS = Better control means fewer complications

Source: UKPDS 35. BMJ 2000

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