1 / 13

New Insulins and Insulin Delivery Systems

New Insulins and Insulin Delivery Systems. Bruce W. Bode, MD, FACE Atlanta Diabetes Associates Atlanta, Georgia Part 1. Methods For Managing Persons with Diabetes. Take Diabetes out of the equation. Control glucose!!!. Prevalence of Glycemic Abnormalities in the United States.

laurenjohnson
Download Presentation

New Insulins and Insulin Delivery Systems

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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. New Insulins and Insulin Delivery Systems Bruce W. Bode, MD, FACE Atlanta Diabetes Associates Atlanta, Georgia Part 1

  2. Methods For Managing Persons with Diabetes Take Diabetes out of the equation. Control glucose!!!

  3. Prevalence of Glycemic Abnormalities in the United States US Population: 275 Million in 2000 Undiagnosed diabetes ~5.2 million Diagnosed type 1 diabetes ~1.0 million Additional 25 -35 million with Prediabetes Diagnosed type 2 diabetes ~12 million Centers for Disease Control. Available at: http://www.cdc.gov/diabetes/pubs/estimates.htm; Harris MI. In: National Diabetes Data Group. Diabetes in America. 2nd ed. Bethesda, Md: NIDDK; 1995:15-36; U.S. Census Bureau Statistical Abstract of the U.S.; 2001 3

  4. Diagnostic Criteria Associated with Glucose Abnormalities FPG 2-Hour PG on OGTT Diabetes Mellitus Diabetes Mellitus 126 mg/dL 7.0 mmol/L 200 mg/dL 11.1 mmol/L Impaired Glucose Tolerance Prediabetes 100 mg/dL 5.6 mmol/L 140 mg/dL 7.8 mmol/L Normal Normal Adapted from The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2001;24(Suppl 1):S5-S20.

  5. Relative Risk of Progression of Diabetes Complications (DCCT) RELATIVE RISK Mean A1C • DCCT Research Group, N Engl J Med 1993, 329:977-986.

  6. Lifetime Benefits ofIntensive Therapy (DCCT) • Gain of15.3 yearsof complication free living compared to conventional therapy • Gain of 5.1 years of life compared to conventional therapy • DCCT Study Group, JAMA 1996,276:1409-1415.

  7. 60 50 5.5% 40 6.5% 7.5% 30 8.5% 9.5% 20 10.5% 10 0 Myocardial Infarction Microvasc Disease Effect of A1C On Complications in the UKPDS Study Stratton IM et al. BMJ 2000;321:405 A1C

  8. Lessons from the DCCT and UKPDS:Sustained Intensification of Therapy is Difficult DCCT EDIC (Type 1) UKPDS (Type 2),Insulin Group 10 8 9.0 8.1 7.9 8 A1C (%) 7.3 A1C (%) 7 Baseline 6 Normal 6 4 0 0 6.5 + 4 + 6 yrs 0 2 4 6 8 10 yrs EDIC DCCT DCCT/EDIC Research Group. New Engl J Med 2000; 342:381-389 Steffes M et al. Diabetes 2001; 50 (suppl 2):A63 UK Prospective Diabetes Study Group (UKPDS) 33 Lancet 1998; 352:837-853

  9. Specific Goals in Management of Diabetes • Fasting < 110 mg/dL • Post-meal < 140 mg/dL • A1C < 6.5% • Blood Pressure < 130/80 • LDL < 100 mg/dL; HDL > 45 mg/dL • Triglycerides < 150 mg/dL

  10. Primary Objectives of Effective Management lGæde P, Vedel P, Larsen N, Jensen GVH, Parving H-H,Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348:383-393. Diagnosis 9 A1C % 8 7 Reduction of both micro- and macro- vascular event rates …by 75%! SBP mm Hg 145 130 LDL mg/dL 140 100 45 50 55 60 65 75 80 85 90 70 Patient Age

  11. Mortality of DM Patients Undergoing CABG Furnary et al J Thorac Cardiovasc Surg 2003;123:1007-21

  12. Surgical ICU Mortality Effect of Average BG Van den Berghe et al (Crit Care Med 2003; 31:359-366) P=0.0009 BG>150 110<BG<150 P=0.026 BG<110

  13. Hyperglycemia and Hospital Mortality 1826 consecutive ICU patients 10/99 thru 4/02, Stamford CT Krinsley JS: Mayo Clin Proc 78: 1471-1478, 2003

More Related