Diabetes Complications

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1 Managing Diabetes: It s s Not Easy But It s s Worth It Presenter Disclosures W. Lee Ball, Jr., OD, FAAO (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months: No relationships to disclose The National Diabetes Education Program Changing the Way Diabetes is Treated W. Lee Ball, Jr., OD, FAAO The National Diabetes Education Program wwwyourdiabetesinfo.org NDEP A joint program of NIH and CDC What is Diabetes? Diabetes is a group of diseases resulting from problems with insulin production, insulin action, or both Diabetes can lead to serious health problems and premature death About 24 million Americans have diabetes 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 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 % women with gestational diabetes will develop diabetes in the next 5 to 10 years 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 American Diabetes Association. Diabetes Care 2008; 31;(Suppl.1):S

2 Risk Factors for 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):S 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 Diabetes Complications Diabetes is the leading cause of: kidney failure new cases of adult blindness nontraumatic lower-limb 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 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, 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 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, DCCT. New England Journal of Medicine, 329(14), September 30,

3 United Kingdom Prospective Diabetes Study (UKPDS) 20 Year Clinical Trial Looked at intensive management of blood glucose levels and long term risk-factors for diabetes complications in type 2 diabetes 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: UKPDS. BMJ. 2000; 321: % 15% 30% 45% Microvascular PVD Disease Stratton IM, et al. BMJ. 2000;321: UKPDS Findings Risk reduction with 1% decline in annual mean A1C 37% P <.0001 P =.035 P =.021 P = % 14% MI 12% Stroke 16% Heart Failure 19% Cataract Extraction Epidemiology of Diabetes Interventions and Complications Study (EDIC) Ongoing Observational study DCCT participants (type 1 diabetes) Looked at risk factors for long-term incidence of cardiovascular disease DCCT/EDIC N Engl J Med 2005: 353: EDIC Findings: Intensive Therapy and Diabetes Complications Participants continue to benefit years later from period of intense 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: Cumulative Incidence EDIC Findings: Cardiovascular Events Cumulative Incidence of Any Event Risk reduction 42% 95% CI: 9% to 63% P = Years from Study Entry DCCT/EDIC N Engl J Med 2005: 353: Conventional Intensive 3

4 UKPDS 10 yr Follow-Up Study- 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) UKPDS 10 yr Follow-Up Study- 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) UKPDS 10 yr Follow-Up Study- Blood Pressure findings 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 Recent Clinical Trial Findings: 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): ADVANCE: N Engl J Med 2008; 358 (24): VADT: J Diabetes Complications 2003; 17 (6): Key points of recent findings: 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. SEARCH For Diabetes in Youth Study Observational study funded by CDC and NIH Physician-diagnosed diabetes in youth ages Data will help researchers better understand and treat diabetes in young people (SEARCH). Diabetes Care (8):

5 SEARCH Findings 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 years and among girls (SEARCH). Diabetes Care (8): SEARCH Findings 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 (8): National Diabetes Education Program Materials Diabetes Control: Patient Materials Diabetes Control: Health Care Professionals NDEP Websites 5

6 Other NDEP Campaign Tools at TV, radio, and print PSAs Sample feature articles Sample press releases and media advisories Fact sheets Web buttons/blurbs NDEP logos and banners For more information about NDEP and to order or download free materials: Call NDEP or Visit 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. Thank You! W. Lee Ball, Jr., OD, FAAO The National Diabetes Education Program wwwyourdiabetesinfo.org NDEP A joint program of NIH and CDC 6

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