The science diabetes control
Download
1 / 31

The Science: Diabetes Control - PowerPoint PPT Presentation


  • 329 Views
  • Updated On :

The Science: Diabetes Control. The National Diabetes Education Program Changing the Way Diabetes is Treated. What is Diabetes?. Diabetes is a group of diseases characterized by high levels of blood glucose (blood sugar) Diabetes can lead to serious health problems and premature death

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'The Science: Diabetes Control' - kris


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
The science diabetes control l.jpg
The Science: Diabetes Control

The National Diabetes Education ProgramChanging the Way Diabetes is Treated.


What is diabetes l.jpg
What is Diabetes?

Diabetes is a group of diseases characterized by high levels of blood glucose (blood sugar)

Diabetes can lead to serious health problems and premature death

About 24 million Americans have diabetes

NIDDK, National Diabetes Statistics 2007. www.diabetes.niddk.nih.gov/dm/pubs/statistics/


Common types of diabetes l.jpg
Common Types of Diabetes

Type 1 diabetes

  • 5% to 10% of diagnosed cases of diabetes

    Type 2 diabetes

  • 90% to 95% diagnosed cases of diabetes

NIDDK, National Diabetes Statistics 2007.

www.diabetes.niddk.nih.gov/dm/pubs/statistics/


Common types of diabetes4 l.jpg
Common Types of Diabetes

  • Gestational Diabetes occurs during pregnancy

    • 5 to 10 % of women with gestational diabetes are found to have type 2 diabetes

    • Increased lifelong risk for mother and child for developing type 2 diabetes

    • 40-60 % women with gestational diabetes will develop diabetes in the next 5 to 10 years

NIDDK, National Diabetes Statistics 2007.

www.diabetes.niddk.nih.gov/dm/pubs/statistics/


Risk factors for diabetes l.jpg
Risk Factors for Diabetes

  • Age 45 and older

  • Overweight (BMI ≥ 25)

  • Hypertension

  • Abnormal lipid levels

  • Family history of diabetes

  • Race/ethnicity

  • History of gestational diabetes

  • History of vascular disease

  • Signs of insulin resistance

    • (such as PCOS or acanthosis nigricans)

  • IGT or IFG on previous test

  • Inactive lifestyle

American Diabetes Association. Diabetes Care 2008; 31;(Suppl.1):S12-54.


Diabetes and cardiovascular disease l.jpg
Diabetes and Cardiovascular Disease

  • Cardiovascular disease is the leading cause of death for people with diabetes

  • In adults with diabetes:

    • 68% die of heart disease or stroke

    • the risk for stroke is two to four times higher

    • 75% have high blood pressure

    • smoking doubles the risk for heart disease

NIDDK, National Diabetes Statistics 2007.

www.diabetes.niddk.nih.gov/dm/pubs/statistics/


Diabetes complications l.jpg
Diabetes Complications

  • Diabetes is the leading cause of:

    • kidney failure

    • new cases of adult blindness

    • nontraumatic lower-limb amputations

  • In adults with diabetes:

    • the risk of periodontal (gum) disease is two to three times higher

    • 60 to 70 % have mild to severe nervous system damage

NIDDK, National Diabetes Statistics 2007. www.diabetes.niddk.nih.gov/dm/pubs/statistics/


Diabetes control and complications trial dcct l.jpg
Diabetes Control and Complications Trial (DCCT)

Compared effects of two diabetes treatment regimens – standard therapy and intensive control – on the complications of diabetes in people with type 1 diabetes

DCCT. New England Journal of Medicine, 329(14), September 30, 1993.


Slide9 l.jpg

DCCT Findings

Glucose control is key to preventing or delaying complications of diabetes

Any sustained lowering of blood glucose helps, even if the person has a history of poor control

DCCT. New England Journal of Medicine, 329(14), September 30, 1993.


Dcct findings l.jpg
DCCT Findings

Lowering blood glucose reduced risk of:

  • Eye disease by 76%

  • Kidney disease by 50%

  • Nerve disease by 60%

DCCT. New England Journal of Medicine, 329(14), September 30, 1993.


United kingdom prospective diabetes study ukpds l.jpg
United Kingdom Prospective Diabetes Study (UKPDS)

Clinical Trial

Looked at intensive management of blood glucose levels and long term risk-factors for diabetes complications in type 2 diabetes

UKPDS. BMJ. 2000; 321:405-412.


Slide12 l.jpg

UKPDS Findings

Mirrored the findings of DCCT in people with type 2 diabetes—better glucose control reduced development of microvascular complications

Demonstrated the need for management of high blood pressure and cholesterol as well as blood glucose levels (the ABCs of diabetes)

UKPDS. BMJ. 2000; 321:405-412.


Ukpds findings l.jpg

12%

14%

16%

19%

37%

43%

Micro-vascular Disease

PVD

MI

Stroke

Heart Failure

Cataract Extraction

UKPDS Findings

Risk reduction with 1% decline in annual mean A1C

P <.0001

P = .035

P = .021

P = .0001

0%

15%

30%

45%

Stratton IM, et al. BMJ. 2000;321:405-412.


Epidemiology of diabetes interventions and complications study edic l.jpg
Epidemiology of Diabetes Interventions and Complications Study (EDIC)

Observational study

DCCT participants (type 1 diabetes)

Looked at risk factors for long-term complications

DCCT/EDIC N Engl J Med 2005: 353:2643-2653.


Slide15 l.jpg

EDIC Findings: Intensive Therapy and Diabetes Complications Study (EDIC)

  • Participants continue to benefit years later from period ofintense glucose control

  • Years after intensive therapy:

    • Lasting benefits for eye, nerve, and kidney disease

    • Reduces CVD events by more than half

DCCT/EDIC N Engl J Med 2005: 353:2643-2653.


Slide16 l.jpg

EDIC Findings: Cardiovascular Events Study (EDIC)

Cumulative Incidence of First of Any Event

0.12

0.10

Risk reduction 42%

95% CI: 9% to 63%

P = 0.02

Conventional

0.08

Cumulative Incidence

0.06

0.04

Intensive

0.02

0.00

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Years from Study Entry

DCCT/EDIC N Engl J Med 2005: 353:2643-2653.


Slide17 l.jpg

EDIC Findings: Cardiovascular Events Study (EDIC)

Non-Fatal MI, Stroke, or CVD Death

0.12

0.10

Risk reduction 57%

95% CI: 12% to 79%

P = 0.02

0.08

Cumulative Incidence

0.06

Conventional

0.04

0.02

Intensive

0.00

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21

Years from Study Entry

DCCT/EDIC N Engl J Med 2005: 353:2643-2653.


Ukpds 10 yr follow up study insulin sulfonylurea group l.jpg
UKPDS 10 yr Follow-Up Study- Study (EDIC)insulin/sulfonylurea group

Differences in A1C between intensive & standard glycemic control treatment groups were lost after one year

Relative risk reductions at 10 yr in intensive insulin/sulfonylurea group:

  • 9% for any diabetes end point (P=0.04)

  • 24% microvascular disease (P=0.001)

  • 15% myocardial infarction (P=0.01)

  • 13% death from any cause (P=0.007)

N Engl J Med 2008; 359


Ukpds 10 yr follow up study metformin group l.jpg
UKPDS 10 yr Follow-Up Study- Study (EDIC)metformin group

Differences in A1C between intensive & standard glycemic control treatment groups were lost after one year

Relative risk reductions at 10 yr in intensive

metformin group:

  • 21% for any diabetes end point (P=0.01)

  • 33% myocardial infarction (P=0.005)

  • 21% death from any cause (P=0.002)

N Engl J Med 2008; 359


Ukpds 10 yr follow up study blood pressure findings l.jpg
UKPDS 10 yr Follow-Up Study- Blood Pressure findings Study (EDIC)

Between group differences lost within 2 yrs

Significant relative risk reductions in tight control group were not maintained

Benefits of BP control do not extend beyond intensive therapy period & ongoing treatment is essential

N Engl J Med 2008; 359


Recent clinical trial findings l.jpg
Recent Clinical Trial Findings: Study (EDIC)

Intensive glucose control in type 2 diabetes:

  • lowers risk of new or worsening microvascular complications (ADVANCE)

  • was associated with increased mortality in patients with longstanding DM and known CVD (ACCORD)

  • increases risk of severe hypoglycemia (ADVANCE, ACCORD and VADT)

ACCORD: N Engl J Med 2008; 358(24):2545-59

ADVANCE: N Engl J Med 2008; 358 (24): 2560-72

VADT: J Diabetes Complications 2003; 17 (6): 314-22


Key points of recent findings l.jpg
Key points of recent findings: Study (EDIC)

  • Intensive glucose control in newly diagnosed type 1 or type 2 diabetes has benefits during intensive therapy AND a legacy effect for later micro- and macrovascular benefits

  • Optimal glucose management should start as early as possible & continue as long as possible

  • While the A1C goal for the general population is <7%, treatment must be individualized.

N Engl J Med 2008; 359


Search for diabetes in youth study l.jpg
SEARCH Study (EDIC)For Diabetes in Youth Study

Observational study

Physician-diagnosed diabetes in youth ages 0-19

Data will help researchers better understand and treat diabetes in young people

(SEARCH). Diabetes Care 2006 29(8): 1891-6.


Search findings l.jpg
SEARCH Findings Study (EDIC)

Determine prevalence and correlates of selected CVD risk factors among youth with diabetes

21% of young people with diabetes had at least two CVD risk factors

Prevalence of CVD risk factors was higher among youth aged 10-19 years and among girls

(SEARCH). Diabetes Care 2006 29(8): 1891-6.


Search findings25 l.jpg
SEARCH Findings Study (EDIC)

In young people with type 2 diabetes:

  • 92% had at least two CVD risk factors

    In young people with type 1 diabetes:

  • 14% had at least two CVD risk factors

(SEARCH). Diabetes Care 2006 29(8): 1891-6.




Diabetes control health care professionals l.jpg

Diabetes Control: Study (EDIC)Health Care Professionals


Ndep websites l.jpg
NDEP Websites Study (EDIC)


Other ndep campaign tools at www yourdiabetesinfo org l.jpg
Other NDEP Campaign Tools Study (EDIC)at www.YourDiabetesInfo.org

  • TV, radio, and print PSAs

  • Sample feature articles

  • Sample press releases and media advisories

  • Fact sheets

  • Web buttons/blurbs

  • NDEP logos and banners


Slide31 l.jpg

For more information about NDEP and to order or download free materials:

Call 1-888-693-NDEP

or

Visit www.YourDiabetesInfo.org

The U.S. Department of Health and Human Services’ National Diabetes Education Program is jointly sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention with the support of more than 200 partner organizations.


ad