Prevalence is 8 11% of the population cca. 190 million patient

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1 Diabetes Mellitus The Silent Disease

2 Diabetes The risk Who is at risk of Diabetes Mellitus? Everybody The Silent Disease occurs without symptoms, pain or significant biomarker changes!

3 Diabetes The risk II. Risk Group Anybody! Unhealthy food intake Stress Physical inactivity sitting life style Obesity (the 80% of type II DM patients are overweight) Hypertension (at age between of men 40%, and women 27% has high systolic and 39%, 34% has high diastolic blood pressure, in Hungary) Family history

4 Diabetes in 2003 Prevalence is 8 11% of the population cca. 190 million patient

5 Spread of Diabetes in the World Europe up to 20% North America up to 50% South America up to 85% Asia up to 10 50% increase

6 Diabetes in 2025 Prevalence should as high as 11-14% cca. 330 million patient

7 Pre-Diabetes New research findings: A condition with increased blood glucose level Long term damage to the body especially heart & circulatory system already be occuring during this condition Manage the blood glucose level during pre- diabetes can delay or prevent developing type 2 DM

8 Pre - diabetes II. How serious is this condition: In the USA 54 million people has pre-diabetes The manifest DM in the USA effects 20,8 million people The diagnosed DM is only 14,6 million citizen

9 Types of Diabetes Types of Diabetes Insulin Dependent (Type I) 5-10% Non Insulin Dependent (Type II) 90-95% Gestation DM 45% 35% Dialysis Transplantation

10 Diabetes - The complications CVD, Stroke, Blindness, Renal damage, Neuropathy A DCCT investigation highlighted the fact, with early stage diagnosis and regular monitoring the END STAGE Complications can be reduced significantly!

11 Diabetes - Complications II. The most frequent cause of death is CVD (78% 78%) The most common complications are: Stroke TIA Nephropathy Neuropathy Rethinopathy

12 Diabetes The diagnosis At the time spot of diagnosis, the 50% of the patient has irreversible organ damage! According to international studies 50 80% of cases are uncovered! Diagnosis of DM the only suitable parameter is the serum and urine GLUCOSE TEST

13 Diabetes The diagnosis II. > 126 DIABETES > 200 > 100 PRE - DIABETES > 140 < 100 NORMO - GLYCEMIA < 140 FPG (fasting plasma glucose) Glucose level (mg/dl) OGTT (oral glucose tolerance test)

14 Glucose Method Sample type Sensitivity Linearity GOD-PAP Serum 1 mg/dl 400 mg/dl Hexokinase Serum, Urine 2 mg/dl 900 mg/dl Glucose Dehydrogenase Serum, Urine, CSF 2 mg/dl 1000 mg/dl

15 Diabetes The monitoring Blood glucose level short term (daily) Fructosamine medium term (2-3 weeks) HbA1c long term (6-8 weeks) While in the 70s, almost the 85% of the patients got new organ, until the 90s only 30% of them went through transplantation

16 Diabetes The monitoring II. Glucose the self testing is subjective, most of the laboratories are using GOD-PAP method instead the more accurate Hexokinase method Fructosamine not widely used parameter, however it is vital in GDM, therapeutic regime changes, in childhood monitoring, when the HbA1c can t be use HbA1c recommended by the NGSP, ADA, but gives unreliable results some conditions, like anemia, in Hb variants, in pregnancy

17 Diabetes The monitoring III. To predict and prevent End Stage Organ Damages and Fatal Consequence, the ADA recommends serious, complete and frequent monitoring: Creatinine/GFR calculation Cystatin C Microalbumin Hydroxybutyrate NEFA Lipid markers

18 Cystatin C Predictor of Renal Damage Clinical significance of the Cystatin C 1. Early diagnosis of renal failure in creatinin blind GFR range 2. The Cystatin C conc. doesn t altered by weight, sex, age or even inflammation 3. In diabetic GFR monitoring - can replace the unreliable creatinine method as well the expensive 51 Cr-EDTA or iohexol methods 4. In newborns - reliable GFR determination 5. Renal transplantation - rejection and function monitoring

19 Cystatin C The new hope? Importance of the Cystatin C 1. Kidney disease produces no symptoms until almost all function is gone 2. A marker to detect the progression from normoglycemia to pre-diabetes 3. Results suggested that elevated Cystatin-C level was associated with threefold excess risk of progression to prediabetes Diabetes Care online 24. April 2007; Diabetes Care 25 : , 2002

20 Microalbumine - Nephropathy 1. The most frequent cause of death in DM, either caused by CV or Renal disease 2. The most frequent complication in both types of DM, around 30% in Type I and around 25% in Type II 3. The microalbuminurea can t be detected by urine sticks 4. Development of nephropathy can be stopped by the early diagnosis in the stage of microalbuminurea Renal malfunction Microalbuminurea Macroalbuminurea ESRD Cystatin C Microalbumin Total protein Renal transplantattion, Dialysis

21 Microalbumine Could save lifes? Importance of the Microalbumine 1. Prognostic marker of kidney disease Diabetes Mellitus 2. Indicator of subclinical cardiovascular disease CVD 3. Predicts elevated risk for acute respiratory failure and multiple organ dysfunction Intensive Care

22 Hydroxybutyrate The marker of ketosis 1. The incidence of the ketoacidosis (DKA) in newly diagnosed cases can be as high as 20-25% 25% 2. The DKA can be the 1st sign of the type 1 diabetes 3. One of the most common complication of insulin pump treatment 4. In manifest diabetes the ketosis can be the marker of the insufficient insulin supply 5. Occurs in type 2 diabetes too 6. The mortality rate of lately diagnosed ketoacidosis is very high, 5-20%

23 Hydroxybutyrate The marker of ketosis Importance of the hydroxybutyrate 1. Does not effect by dehydration, the common condition in DKA patient 2. The urine stick is not enough sensitive, required fresh sample, can t perform together with urine glucose test 3. Notice earlier with 4,6h about normalized condition after DKA then urine stick test 4. Financial savings on a single patient: 22h of hospital stay 375 further laboratory tests USD on treatment cost

24 Conclusion The Saint Vincent Declaration Diagnosis & Monitoring HbA1c Fructosamine Microalbumine Creatinine T-Ch HDL-Ch Tg Additional tests recommended Cystatin C Hydroxybutyrate CO 2 NEFA Hs CRP Lp(a)

25 Conclusion Even a very strict glychemic control will not prevent the macro vascular complications The risk of CHD in diabetes is extremely high The diabetes therapy and the treatment of the complications represent the biggest direct healthcare expenditure Recently the World-wide direct cost of the DM is around billion USD Scientist prediction for 2025 will be raise as high as billion USD