diabetes management: lessons from around the globe – … · diabetes management: lessons from...
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Diabetes management: lessons from around the globe – Romania
S. Popa (Romania)
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DIABETES MANAGEMENT: LESSONS FROM AROUND THE GLOBE – ROMANIA
SG Popa, M Mota, E Mota, A Mitrea
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Agenda
• Premises: diabetes as a huge and growing problem • PREDATORR Study • Children with diabetes in Romania • Therapy in type 2 diabetes (CEGEDIM data) • Conclusions • Acknowledgements
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Premises
Diabetes (DM) and related comorbidities are major public health problems in the new millennium in most countries
Recent studies of the prevalence of DM and prediabetes were furnished only for few countries
The prevalence of DM, prediabetes and other metabolic diseases has not undergone until present a rigorous scientific evaluation in Romania.
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2014
Diabetes is a huge and growing problem…
2035
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… and the costs to society are high and escalating Diabetes is a human and economic burden
4.9 million deaths per year
50% of deaths under 60 years of age
Intersects with all dimensions of development
US$612 billion
11% of worldwide healthcare expenditure
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Agenda
• Premises: diabetes as a huge and growing problem • PREDATORR Study • Children with diabetes in Romania • Therapy in type 2 diabetes (CEGEDIM data) • Conclusions • Acknowledgements
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• Protocol number SRDCEB/2012/001; • Eudra CT Number: 2012-004803-12 • Beneficiaries: - Romanian Society of Diabetes, Nutrition and Metabolic
Diseases (RSDNMD) - Romanian Society of Nephrology (RSN) • Investigators: 101 General physician • CRO: CEBIS International (www.cebis-int.com) • Central Laboratory for the analysis of the study: Synevo
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PREDATORR – Primary goals
Estimating the prevalence of DM and pre diabetes in the adult population of Romania
Estimating the prevalence of overweight and obesity in the adult population of Romania
Estimating the prevalence of the chronic kidney disease in the adult population of Romania
Note: Prevalence distribution of the pre-specified subgroups (eg age groups etc) is also expected.
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PREDATORR – Secondary goals
Estimating the prevalence of DLP in Romania Estimating the prevalence of Hyperuricemia in Romania Estimating the prevalence of Metabolic Syndrome in
the population of Romania. Estimating the prevalence of HTN in Romania CVR assessment in the population of Romania: SCORE
diagram for the high-risk areas Metabolic risk evaluation through FINDRISC score
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PREDATORR – Subject inclusion
Inclusion criteria Exclusion criteria
Subjects aged 20-79 years Born and with residence in
Romania Living for the past 10 years
mainly in Romania Included on the list of a GP
affiliated with CNAS Signing the I.C.
Subjects aged <20 and >79 years Born outside Romania Living for the past 10 years
mostly outside Romania Refuse or can not sign the
informed consent Pregnant or breastfeeding
women
Subjects were randomly assigned for screening from the list of each GP via a random number generator
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ROMANIA at a glance - PREDATORR 2013
NGT 71.9%
Prediabetes 16.5%
Diabetes
11.6%
Known diabetes 9.2%
Unknown diabetes 2.4%
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ROMANIA at a glance - PREDATORR 2013 DIABETES
Diabetes in Romania (20-79 years)) Adult Romanian population (20-79 years)
15097473
Number of people with diabetes 1752000
Age- and sex-adjusted prevalence of diabetes
11.6%
Undiagnosed cases (unknown diabetes mellitus – UKDM)
362340
Age- and sex-adjusted prevalence of UKDM 2.4%
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Diabetes worldwide …
(Adults 20-79 years); Source: IDF Diabetes Atlas Sixth Edition 2014
Diabetes in Romania - PREDATORR 2013 …
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Top 10 countries/territories for prevalence (20-79 years) 2013 and 2035
Source: IDF Diabetes Atlas Sixth Edition 2013
Romania – PREDATORR 2013 11,6%
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EUROPE at a glance
Source: IDF Diabetes Atlas Sixth Edition 2014
Romania at glance PREDATORR 2013 …
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Diabetes surge in EUROPE
PREDATORR
Romania
1.752 million
11.6% Romania
(Adults 20-79 years) Source: IDF Diabetes Atlas Sixth Edition 2014
Spain 2012 – 13.8% Portugal 2010 – 11.7%
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Diagnosed and undiagnosed diabetes among people aged 20 years or older, United States, 2012
Source: 2009–2012 National Health and Nutrition Examination Survey estimates applied to 2012 U.S. Census data
Romania – PREDATORR 2013 1.752 million people have diabetes (11.6% of adult Romanian population)
3.623 million people have undiagnosed diabetes (20.69% of people of diabetes)
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11,5% 8,1%
35,5% 29,4%
50,4% 49,3%
ROMANIA at a glance - PREDATORR 2013 Prevalence of impaired glucose regulation by sex and age groups
Mota M. Prevalence of Diabetes Mellitus and Prediabetes in the Adult Romanian Population: PREDATORR Study. Journal of diabetes. 2015 in press (available at http://onlinelibrary.wiley.com/doi/10.1111/1753-0407.12297/abstract)
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2,7% 6,9%
10,1%
18,9% 17,7%
27,8%
0,2%
3,2%
4,3%
2.9%
ROMANIA at a glance - PREDATORR 2013 Prevalence of DIABETES and PREDIABETES by age groups
13.3%
22%
Mota M. Prevalence of Diabetes Mellitus and Prediabetes in the Adult Romanian Population: PREDATORR Study. Journal of diabetes. 2015 in press (available at http://onlinelibrary.wiley.com/doi/10.1111/1753-0407.12297/abstract)
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10,7%
16,3%
7,9%
16,7%
2,9%
1,9%
ROMANIA at a glance - PREDATORR 2013 Prevalence of DIABETES and PREDIABETES by sex
9.8%
13.6%
Mota M. Prevalence of Diabetes Mellitus and Prediabetes in the Adult Romanian Population: PREDATORR Study. Journal of diabetes. 2015 in press (available at http://onlinelibrary.wiley.com/doi/10.1111/1753-0407.12297/abstract)
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3,5% 1,9%
12,1% 8,4%
19,7% 15,9%
0 0,5%
4,9%
1,8%
4,6%
4,1%
ROMANIA at a glance - PREDATORR 2013 Prevalence of DIABETES by sex and age groups
3.5% 2.4%
17%
10.2%
24.3%
20%
Mota M. Prevalence of Diabetes Mellitus and Prediabetes in the Adult Romanian Population: PREDATORR Study. Journal of diabetes. 2015 in press (available at http://onlinelibrary.wiley.com/doi/10.1111/1753-0407.12297/abstract)
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Prevalence (%) of people with diabetes by age and sex, 2013
(Adults 20-79 years) Source: IDF Diabetes Atlas Sixth Edition 2013
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ROMANIA at a glance - PREDATORR 2013 PREDIABETES
Prediabetes in Romania (20-79 years)) Adult Romanian (20-79 years)
15097473
Number of people with prediabetes 2491083
Age- and sex-adjusted prevalence of prediabetes
16.5%
Mota M. Prevalence of Diabetes Mellitus and Prediabetes in the Adult Romanian Population: PREDATORR Study. Journal of diabetes. 2015 in press (available at http://onlinelibrary.wiley.com/doi/10.1111/1753-0407.12297/abstract)
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Prediabetes worldwide …
Study population Prediabetes prevalence
Observations
US; ≥20 years 37% Prediabetes Portuguese; 20-79 years 27% IFG and/or IGT Spanish; ≥18 years 14.8% IFG and/or IGT European; 20-79 years 9.2% IGT Romanian; 20-79 years 16.5% Prediabetes
Source: 2009–2012 National Health and Nutrition Examination Survey estimates applied to 2012 U.S. Census data Gardete-Correia L et al. First diabetes prevalence study in Portugal: PREVADIAB study. Diabet Med. 2010; 27: 879–81 Soriguer F et al. Prevalence of diabetes mellitus and impaired glucose regulation in Spain: The [email protected] Study. Diabetologia. 2012; 55:88–93. IDF Diabetes Atlas Sixth Edition 2013
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8% 5,7%
18,5% 19,2%
26,1% 29,3%
ROMANIA at a glance - PREDATORR 2013 Prevalence of PREDIABETES by sex and age groups
Mota M. Prevalence of Diabetes Mellitus and Prediabetes in the Adult Romanian Population: PREDATORR Study. Journal of diabetes. 2015 in press (available at http://onlinelibrary.wiley.com/doi/10.1111/1753-0407.12297/abstract)
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Prevalence (%) of IGT (20-79 years) by age and sex, 2013
(Adults 20-79 years) Source: IDF Diabetes Atlas Sixth Edition 2013
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Agenda
• Premises: diabetes as a huge and growing problem • PREDATORR Study • Children with diabetes in Romania • Therapy in type 2 diabetes (CEGEDIM data) • Conclusions • Acknowledgements
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Children with diabetes in Romania
1996: National Diabetes Register of the Child
2014: 401 new cases of type 1 diabetes and 6 new cases of type 2 diabetes in children
2014: type 1 diabetes incidence was 10.7/100000
2014: 2809 Children with diabetes in Romania
There is a public hospital specialized in pediatric diabetes (Medical Center "Cristian Serban" European Centre of Excellence in Pediatric Diabetes in 2011).
Vlad A – ONROCAD Study group, 2015.
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Agenda
• Premises: diabetes as a huge and growing problem • PREDATORR Study • Children with diabetes in Romania • Therapy in type 2 diabetes (CEGEDIM data) • Conclusions • Acknowledgements
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Type of therapy for type 2 diabetes patients
2014 2013
36% 38%
45% 47%
18% 13%
2% 2%
DietPolytherapyBitherapyMonotherapy
TOTAL = 1409 PATIENTS (weighted)
Bitherapy includes fixed combinations
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Type of therapy Classes in monotherapy
BIGUANIDES
SULPHONYLUREAS
INSULINS
AGI
DPP-IV INHIBITORS
GLP-1 AGONISTS
GLINIDES
GLITAZONES
66%
16%
14%
2%
2%
0,40%
0,10%
62%
21%
13%
1%
0,4%
1%
1%
1% 2014 2013
Displaying categories >2%
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Type of therapy, Classes in bitherapy
BIGUANIDES+SULPHONYLUREAS
BIGUANIDES+INSULINS
INSULINS+INSULINS
DPP-IV INHIBITORS+BIGUANIDES
SULPHONYLUREAS+INSULINS
BIGUANIDES+GLP-1 AGONISTS
BIGUANIDES+AGI
35%
24%
12%
9%
5%
4%
2%
39%
24%
9%
6%
5%
1%
1% 2014 2013Displaying categories >2%
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BIGUANIDES+SULPHONYLUREAS+INSULINS
BIGUANIDES+INSULINS+INSULINS
DPP-IV INHIBITORS+BIGUANIDES+SULPHONYLUREAS
AGI+BIGUANIDES+SULPHONYLUREAS
BIGUANIDES+GLP-1 AGONISTS+SULPHONYLUREAS
DPP-IV INHIBITORS+BIGUANIDES
BIGUANIDES+INSULINS
BIGUANIDES+AGI+INSULINS
BIGUANIDES+BIGUANIDES
BIGUANIDES+SULPHONYLUREAS+GLITAZONES
31%
18%
10%
9%
6%
5%
4%
2%
2%
2%
29%
26%
13%
10%
1%
1%
5%
1%
1%
1%
2014 2013
Displaying categories >2%
Type of therapy, Classes in polyherapy
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Type of therapy Brands
Brands in monotherapy
SIOFOR
DIAPREL
METFOGAMMA
LANTUS
GLUCOPHAGE
GLURENORM
metforminum…
NOVOMIX
AMARYL
HUMALOG
LEVEMIR
GLUCOBAY
HUMULIN
JANUVIA
48%
9%
9%
6%
4%
4%
3%
2%
2%
2%
2%
2%
2%
2%
42%
13%
11%
4%
4%
3%
3%
3%
3%
2%
1%
1%
1%
0,4%
2014 2013
DIAPREL+SIOFOR
LANTUS+SIOFOR
JANUVIA+SIOFOR
AMARYL+SIOFOR
SIOFOR+LEVEMIR
DIAPREL+METFOGAMMA
NOVOMIX 30+SIOFOR
GLIBOMET
LEVEMIR+NOVORAPID
SIOFOR+GLUCOBAY
LANTUS+APIDRA
METFOGAMMA+LANTUS
NOVORAPID+LANTUS
HUMALOG+LANTUS
BYDUREON+SIOFOR
20%
8%
7%
6%
4%
4%
4%
3%
2%
2%
2%
2%
2%
2%
2%
18%
7%
4%
11%
4%
4%
4%
8%
2%
1%
1%
1%
1%
1%
2014 2013
LANTUS+DIAPREL+SIOFOR
DIAPREL+SIOFOR+LEVEMIR
SIOFOR+AMARYL+LANTUS
JANUVIA+SIOFOR+AMARYL
SIOFOR+DIAPREL+JANUVIA
SIOFOR+AMARYL+GLUCOBAY
GLUCOBAY+SIOFOR+DIAPREL
JANUVIA+GLIBOMET
LEVEMIR+NOVORAPID+SIOFOR
LEVEMIR+AMARYL+SIOFOR
BYDUREON+DIAPREL+SIOFOR
BYETTA+DIAPREL+SIOFOR
SIOFOR+NOVORAPID+LANTUS
LANTUS+GLIBOMET
SIOFOR+LANTUS+APIDRA
AMARYL+METFOGAMMA+LANTUS
SIOFOR+APIDRA+LANTUS
9%
6%
5%
5%
4%
4%
4%
4%
3%
3%
3%
2%
2%
2%
2%
2%
2%
6%
1%
12%
4%
7%
5%
3%
1%
3%
1%
4%
3%
2%
1%
1%
2014 2013
Brands in bitherapy Brands in polytherapy
Displaying categories >2%
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Agenda
• Premises: diabetes as a huge and growing problem • PREDATORR Study • Children with diabetes in Romania • Therapy in type 2 diabetes (CEGEDIM data) • Conclusions • Acknowledgements
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Conclusions
The PREDATORR study, for the first time, provides data for Romania on the prevalence of DM and prediabetes and their relationship with important risk factors in a representative sample of the Romanian adult population.
The final data of the PREDATORR study indicate an increased prevalence of diabetes and prediabetes, which has doubled compared to previous estimations
These results are of high value for the health authorities and can be used to help inform decision making in order to initiate the implementation of prevention programs that may reduce the economic burden of DM in Romania.
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Agenda
• Premises: diabetes as a huge and growing problem • PREDATORR Study • Children with diabetes in Romania • Therapy in type 2 diabetes (CEGEDIM data) • Conclusions • Acknowledgements
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Acknowledgements • Sponsors: Romanian Society of Diabetes Nutrition and Metabolic Diseases (RSDNMD), IHS Sofmedica, Abbott, Astra Zeneca, Novo Nordisk, MSD, Servier, Novartis, Worvag Pharma
• The Company “CEBIS International’’ (www.cebis-int.com), for: Study Documentation Development, Feasibility, Project Management, Monitoring, Data Management, Statistical Analysis and Final Report
• Profesor Cristian Baicus - Head of the Clinical Epidemiology Unit of Bucharest, in the RECIF (Reseau d’Epidemiologie Clinique International Francophone) and INCLEN (International Clinical Epidemiology Network) for review / validation of the statistical analysis
• Synevo Central Laboratory, for performing the analysis of the study
• Those 101 general physicians who who enrolled the participants, filled in the study questionnaires, and collected blood and urine samples from the participants