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Diabetic Microvascular Disease: The Role of Glycemic Control and the Impact on Public Health

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. EVERY 24 HOURS. New Cases – 4,100

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Diabetic Microvascular Disease: The Role of Glycemic Control and the Impact on Public Health

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  1. 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

  2. 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.

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

  4. Prevalence of Visual Impairment per 100 Adults with Diabetes, by Age, United States, 1997–2003 Source: National Diabetes Surveillance System – CDC website (http://www.cdc.gov/diabetes/statistics/index.htm)

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

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

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

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

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

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

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

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

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

  14. Glucose Control Study Summary • The intensive glucose control policy maintained a lower HbA1c 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=0.029 • 25% for microvascular endpoints p=0.0099 • 21% for retinopathy at twelve years p=0.015 • 33% for albuminuria at twelve years p=0.000054

  15. 1 5 p<0.0001 1 0 Hazard ratio 1 37% decrease per 1% decrement in HbA1c 0 . 5 0 5 6 7 8 9 1 0 1 1 Updated mean HbA1c UKPDS 35. BMJ 2000; 321: 405-12 Microvascular Endpoints

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

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

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

  19. UKPDS: A1c as Predictor of Micro- and Macrovascular Disease 10 9 Microvascular 8 7 6 Est. Hazard Ratio 5 4 3 Myocardial infarction 2 1 - 5 6 7 8 9 10 11 Updated Mean A1c Stratton IM et al. BMJ. 2000; 321:405-412.

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

  21. Age-adjusted Mortality, age 35-74 yearsNHANES Gregg EW. Ann Int Med 147:149, 2007

  22. Age-adjusted Mortality, age 35-74 yearsNHANES Gregg EW. Ann Int Med 147:149, 2007

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