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Osvrt na Prvi dijabetološki kongres FBiH Mostar, 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 %
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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
Statistika • 10% zdravstvenog dinara u susjednoj Hrvatskoj otpada na pacijente sa dijabetesom • Samo 10% oboljelih od dijabetesa ima dobro kontroliranu bolest
‘Glucose triad’ of diabetes management PPG Peak glucose level FPG HbA1c Basal glucose level Average long-term glucose level HbA1c = glycated hemoglobin FPG = fasting plasma glucose PPG = postprandial plasma glucose 7 | Structured Testing | November, 2012 | Prof. Izet Aganovic
Poor glycemic control compared with other cardiovascular risk factors Type 2 diabetes Hyperlipidemia Hypertension Controlled Controlled Controlled Uncontrolled Uncontrolled Uncontrolled Source: NHANES IIIhttp://www.cdc.gov/nchs/about/major/nhanes/nh3data.htm. Last accessed 25 January 2007 8 | Structured Testing | November 2012Prof. Izet Aganovic
Stepwise Management of Type 2 Diabetes Insulin Oral plus insulin + + Oral combination + Oral monotherapy Diet & exercise 9 | Structured Testing | November 2012 | Prof. Izet Aganovic Adapted from Williams G. Lancet 1994; 343: 95-100.
Every 1 point drop in HbA1c reduces the risk of microvascular complications up to 40% Probability Adjusted incidence per 100 person years (%) Updated mean HbA1c concentration (%) Glycosylated hemoglobin (%) DCCT Diabetes 1996: 45: 1289-1298 UKPDS BMJ 2000, 321: 405-412 Source:DCCT, 1993; UKPDS, 1998 10 | Structured Testing | November 2012 | Prof. IzetAganovic 10
Diabetes is a progressive disease that requires on-going therapy adjustment Insulin/Hormone Secretion IGT Insulin Sensitivity Postprandial Glucose Fasting Glucose Diabetes Normal Insulin Independent Risk for CVD Normal Blood Glucose AvgDx 9-12yrs* Years Source:Modified from Ramlo-Halsted & Edelman SV. Prim Care. 1999. Harris MI, Klein R et al. Diabetes Care 1992;15:815-819. 11 | Structured Testing | November 2012 | Prof. Izet Aganovic 11 11
HbA1Cs are not created equalThe same values are based on different bG values Hb Hb 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 12 | Structured Testing | November 2012 | Prof. Izet Aganovic 12
What the HbA1c doesn’t tell you …SMBG does There is a variable relationship between fasting glucose, postprandial glucose and HbA1c • 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 medications 13 | Structured Testing | November 2012Prof. Izet Aganovic
The Lower the HbA1c…the more it is impacted by postprandial glucose levels 100 80 60 40 20 0 Postprandial Fasting Contribution (%) 70% 30% 50% 50% 45% 55% 40% 60% 30% 70% <7.3 7.3-8.4 8.5-9.2 9.3-10.2 >10.2 Source:Adapted from Monnier et al. Diabetes Care 2003;26:881-885. HbA1c Ranges 14 | Structured Testing | November 2012 | Prof. Izet Aganovic
Glycemic excursions can be kept under control by bG monitoring What We Know … What We are Beginning to Understand … 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 • 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 15 | Structured Testing | November 2012Prof. Izet Aganovic
Prevention = Diagnose + Treat + MonitorThe Diabetes Management Equation • Diabetes is a serious condition for the individual and society. Its rapidly increasing global prevalence is a significant cause for concern. • Any HbA1c reduction below 9% is considered to be cost saving. • Only a systematic diabetes management with guidelines and reimbursement will allow to efficiently manage scarce resources Source:Diabetes Care 20:1847-53; 19978. 16 | Structured Testing | November 2012 | Prof. Izet Aganovic
Lessons from UKPDS = Better control means fewer complications EVERY 1% reduction in HbA1c REDUCED RISK* 1% 21% Deaths from diabetes Heart attacks 14% Micro-vascular complications 37% Peripheral vascular disorders 43% *p<0.0001 Source:UKPDS 35. BMJ 2000 17 | Structured Testing | November 2012Prof. Izet Aganovic