K. David McCowen, MD, FACPMedical Director, DiabetesEndocrine Consultants NorthwestFranciscan Medical Group

Prevention of T2DMStemming the Tide

• T2DM: 93% of all DM

• Rapid expansion of disease incidence

• Always preceded by Impaired Glucose

Tolerance (IGT) 790.21

• FBS = 100 – 125 mg/dl

• HgbA1c – 5.7 or 6.0 to 6.5 %

2 | Creating Healthier Communities | Best practices for managing high-risk clinical populations

Diabetes Prevention Program (DPP)

• Treated IGT patients: Life Style Changes vs Metformin (Met)

vs no intervention. Now we have 10 year data.

• Delay development of DM: LSC = 11%; Met = 3%.

• Reduction of DM incidence: LSC = 20%; Met = 8%.

• Above compared to the no intervention arm.

• Reduced microvascular, neuropathic, and CV complications.

• Quality Adjusted Life Years (QALY): cost $8800 LSC;

$29,900 Met.

• Survival up 0.5 years LSC; 0.2 years Met.

3 | Creating Healthier Communities | Best practices for managing high-risk clinical populations

DPP continued

• THE COST EFECTIVNESS IMPROVED WHEN THE

INTERVENTIONS WERE IMPLEMENTED IN

ROUTINE CLINICAL PRACTICE

• Last month FMG implemented a robust DM treatment

pathway.

• We included the therapy of IGT as equally (and

probably more) important than the DM1 and DM2

pathways.

4 | Creating Healthier Communities | Best practices for managing high-risk clinical populations

5 | Creating Healthier Communities | Best practices for managing high-risk clinical populations

6 | Creating Healthier Communities | Best practices for managing high-risk clinical populations

Identify

Assessment & Diagnosis

Treatment

THANK YOU