diabetes update(bode - atlanta)

8/6/2019 Diabetes Update(Bode - Atlanta)

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Diabetes UpdateFacts, Trends and Observations

Bruce Bode, MD, FACE

Atlanta Diabetes Associates


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Ultimate Goals Of DiabetesTreatment

Sustained Normal Blood

Glucose Control

Lowest Incidence ofHypoglycemia

No Long Term Diabetes

Complications

No Acute DiabetesComplications

=

=

Best Quality of Life with aChronic Disease


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Relative Risk of Progression ofRelative Risk of Progression of

Diabetic ComplicationsDiabetic Complications

DCCT Research Group, N Engl J Med1993,329:977-986.

1

3

5

7

9

11

13

15

6 7 8 9 10 11 12

Retinop

Neph

Neurop

RE

LATIVE

RISK

Mean A1C


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Gain of15.3 yearsof complication freeliving compared to conventionaltherapy

Gain of5.1 years of life compared toconventional therapy

Lifetime Benefits ofLifetime Benefits ofIntensive Therapy (DCCT)Intensive Therapy (DCCT)

DCCT Study Group,JAMA 1996,276:1409-1415.


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DCCTDCCT

10% reduction in HbA1c

43% reduced risk of retinopathy

progression

18% increased risk of severe

hypoglycemia with coma and/or

seizure

DCCT Research Group, N Engl J Med1993,329:977-986.


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*Percent risk reduction per 0.9% decrease in HbA1C ;UKPDS. Lancet. 1998;352:837-853.

Lowering A1C Reduces RiskLowering A1C Reduces Risk

of Complicationsof Complications

Reduc

tionin

risk(%)*

p=0.029

p=0.0099

p=0.052

p=0.015

p=0.000054

0

-10

-20

-30

-40

-50

-12

-25

-16

-34

-21

Any diabetes-relatedendpoint

Microvascularendpoint

MI

Retinopathy

Albuminuria at 12years

United Kingdom Prospective Diabetes StudyUnited Kingdom Prospective Diabetes Study(UKPDS)(UKPDS)


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New Targets of

Intensive Diabetes Management

Near-normal glycemia

A1C less than 6.5%

Post-prandial:


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How Are We Doing?


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U.S. Diabetes PrevalenceU.S. Diabetes Prevalence

Diabetes kills 1 Americanevery 3 minutes

New case diagnosed every

40 seconds

More deaths than AIDSand breast cancer

combined

Average life expectancy:

15 years less than non-

diabetes population

Afflicts over 177 million

people worldwide

300 million afflicted by

2025

18 Million


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World View

177 million worldwide

4th leading cause of death by disease

India 33 million people with diabetes

China 23 million people with diabetes Population of diabetes will double to triple by

2025

One out of every three Americans born today

will develop diabetes

Time magazine December2003; CDC


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$92

$109

$138

$40$47

$54

$132

$156

$192

$0

$40

$80

$120

$160

$200

$240

Direct Indirect Total

2002

2010

2020

Diabetes Care 26:917-932, 2003

Costs Continue to Increase (U.S.)


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Percentage of Patients With Diabetes

Having A1C


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Lessons from the DCCT and UKPDS:Lessons from the DCCT and UKPDS:

Sustained Intensification of Therapy is DifficultSustained Intensification of Therapy is Difficult

DCCT EDIC

(Type 1)UKPDS (Type 2),

Insulin Group

DCCT/EDIC Research Group. New Engl J Med2000; 342:381-389

Steffes M et al. Diabetes 2001; 50 (suppl 2):A63UK Prospective Diabetes Study Group (UKPDS) 33

Lancet1998; 352:837-853

4

6

8

10

9.0

8.1

7.3

7.9

0 6.5 + 4 + 6 yrs

DCCT EDIC

0

6

7

8

0 2 4 6 8 10 yrs

A1C (%)

Normal

Baseline

A1C (%)


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Relationship between % BG inTarget and A1C Level

Brewer K, Chase P, Owen S, Garg S, Diabetes Care 1998, 21:2.

Within Target

Above Target

Below Target

33%

18%49%

A1C = 7%

A1C = 8.5%

46%

12%

42%

A1C = 8%

41%

14%

45%


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Primary Objectives of EffectivePrimary Objectives of Effective

ManagementManagement

A1C%

SBPmm Hg

LDLmg/dL

45 50 55 60 65 70 75 80 85 90

9

Diagnosis

8

7

130

100

145

140

Patient Age

Reduction

of both

micro- and

macro-

vascular

eventrates

by 75%!

lGde 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.


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How is diabetes currently

being treated?


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Roper Starch Worldwide

Gold Standard market research study of

diabetes patients 18 years and older

Self reported information

Conducted annually in the U.S.

N= 6,000

Roper Starch Worldwide, 2002


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PROGRESSION TO INSULIN USE (US)Among Type 2 diabetic patients sampled

Prior Therapy Prior Therapy Prior Therapy43% no prior therapy 51% exclusive pills 66% no prior therapy

41% exclusive pills 14% insulin 18% diet/no med

5% diet to pills 13% pills to insulin 8% insulin

Average time on pillsbefore moving to

insulin

= 4.9 years

Average time on dietbefore moving to

pills

= 3.2years

Average time on pillsbefore moving to

insulin

=5.6years

E x c l u s i v

1 5 %

D u a l I n s

1 3 %

E x c l u s i v

6 3 %

T o t a l T y p e



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Trends Among Insulin Injectors

IntensiveTherapy

46%

PumpTherapy

Multiple DailyInjections2001

Conventional

54%

Intensive

Therapy

57%

PumpTherapy

Multiple DailyInjections2002

Conventional

%


20%

37%

43%

31%

15%


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ADA Physician Reported Treatment Choices

Based on aggregate responses (N=213)

23% Conventional (1-2shots/day)

57% Intensive(3 or more

shots/day)20% Insulin Pump Therapy

Insulin TreatedPatients

ADA 2003, Physician Survey, MedtronicMiniMed


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26,500

43,000

81,000

162,000

200,000

0

50,000

100,000

150,000

200,000

'95 '97 '99 2001 2003

Total Patients Using Insulin Pumps

Estimated figures for 2003


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Other Possible Contributions to

Intensive Management

PATIENT ATTITUDES AND

BEHAVIORS

DEMOGRAPHICS (US)


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DEMOGRAPHICS (US)

By education and income

%

EDUCATION

High School orless

College


%

INCOME LEVEL

$100K


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HCPs Frequently Visited By Patients

TYPE 1

%

TYPE 2

%


What type of healthcare professional do you normally

visit for your diabetes care?


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Most Feel That They Are In Good Control

Needsimprovement

Good control


Are you satisfied with your diabetes control?

8119

US

% incidencewithin total

sample


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Most Patients Are Satisfied With Their Health

86

7172

0

20

40

60

80

100

US

Satisfied with overall health T1 T2



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Self-Reported A1C Results

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

4.1-5.0 5.1-6.0 6.1-7.0 7.1-8.0 8.1-9.0 9.1-10.0 10.1-

11.0

Over

11.0

Don't

Know

T1

T2



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Summary

Diabetes prevalence and costs continue togrow

Lower treatment targets will likely drive the

adoption of more intensive management

The use of intensive insulin managementcontinues to grow with a notable increase in

insulin pump useA potential barrier to intensivemanagement is patients lack of awareness

and perception of good control

diabetes update(bode - atlanta)

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