Osvrt na Prvi dijabetološki kongres FBiH Mostar, Bosna i Hercegovina , Novembar 16 - 18. 2012.

1. Osvrt na Prvi dijabetološki kongres FBiHMostar, Bosna i Hercegovina, Novembar 16 - 18. 2012. Autor: Vildana Bilić

2. Ciljevi prezentacije • Kratki pregled sadržaja Kongresa • Važne poruke

3. Statistika • Učestalost dijabetes melitusa u svijetu u 2011. g.- 8,3 % • Učestalost dijabetes melitusa u Evropi 2011. g.- 8,1 % • Predviđanje za 2030. g. – 51,0 %

4. Statistika • Tri puta veći troškovi za tretman komplikacija u odnosu na bazično liječenje DM-a • Troškovi neupućivanja jednog pacijenta na dijalizu “pokrivaju” troškove prevencije za cijelu populaciju • Dvanaest puta veci troškovi za regulisanje stanja hiper i hipoglikemije u odnosu na troškove za nabavku inzulinskih pumpi

5. Statistika • 10% zdravstvenog dinara u susjednoj Hrvatskoj otpada na pacijente sa dijabetesom • Samo 10% oboljelih od dijabetesa ima dobro kontroliranu bolest

6. Izabrani slajdovi iz prezentacije prof. Izeta Aganovica

7. ‘Glucose triad’ of diabetes management PPG Peak glucose level FPG HbA1c Basal glucose level Average long-term glucose level HbA1c = glycated hemoglobin FPG = fasting plasma glucose PPG = postprandial plasma glucose 7 | Structured Testing | November, 2012 | Prof. Izet Aganovic

8. Poor glycemic control compared with other cardiovascular risk factors Type 2 diabetes Hyperlipidemia Hypertension Controlled Controlled Controlled Uncontrolled Uncontrolled Uncontrolled Source: NHANES IIIhttp://www.cdc.gov/nchs/about/major/nhanes/nh3data.htm. Last accessed 25 January 2007 8 | Structured Testing | November 2012Prof. Izet Aganovic

9. Stepwise Management of Type 2 Diabetes Insulin Oral plus insulin + + Oral combination + Oral monotherapy Diet & exercise 9 | Structured Testing | November 2012 | Prof. Izet Aganovic Adapted from Williams G. Lancet 1994; 343: 95-100.

10. Every 1 point drop in HbA1c reduces the risk of microvascular complications up to 40% Probability Adjusted incidence per 100 person years (%) Updated mean HbA1c concentration (%) Glycosylated hemoglobin (%) DCCT Diabetes 1996: 45: 1289-1298 UKPDS BMJ 2000, 321: 405-412 Source:DCCT, 1993; UKPDS, 1998 10 | Structured Testing | November 2012 | Prof. IzetAganovic 10

11. Diabetes is a progressive disease that requires on-going therapy adjustment Insulin/Hormone Secretion IGT Insulin Sensitivity Postprandial Glucose Fasting Glucose Diabetes Normal Insulin Independent Risk for CVD Normal Blood Glucose AvgDx 9-12yrs* Years Source:Modified from Ramlo-Halsted & Edelman SV. Prim Care. 1999. Harris MI, Klein R et al. Diabetes Care 1992;15:815-819. 11 | Structured Testing | November 2012 | Prof. Izet Aganovic 11 11

12. HbA1Cs are not created equalThe same values are based on different bG values Hb Hb There is a variable relationship between fasting glucose, postprandial glucose and HbA1C Source:Diabetes Care, Bonora yr:2001 vol:24 iss:12 pg:2023 -2029 12 | Structured Testing | November 2012 | Prof. Izet Aganovic 12

13. What the HbA1c doesn’t tell you …SMBG does There is a variable relationship between fasting glucose, postprandial glucose and HbA1c • Identifies hypoglycemic events • Dynamic relationship between insulin, carbohydrates, physical activity and resulting glucose level • Effects of different meals and snacks • Effects of physical activity • Effects of medications 13 | Structured Testing | November 2012Prof. Izet Aganovic

14. The Lower the HbA1c…the more it is impacted by postprandial glucose levels 100 80 60 40 20 0 Postprandial Fasting Contribution (%) 70% 30% 50% 50% 45% 55% 40% 60% 30% 70% <7.3 7.3-8.4 8.5-9.2 9.3-10.2 >10.2 Source:Adapted from Monnier et al. Diabetes Care 2003;26:881-885. HbA1c Ranges 14 | Structured Testing | November 2012 | Prof. Izet Aganovic

15. Glycemic excursions can be kept under control by bG monitoring What We Know … What We are Beginning to Understand … Postprandial hyperglycemia is an important marker for complications Looking at HbA1c levels is not enough There is a variable relationship between fasting glucose, postprandial glucose and HbA1c Structured bG monitoring and systematic data analysis can help people with diabetes make lifestyle changes and inform therapeutic decision-making • Diabetes management remains suboptimal for many • Improvements in HbA1c reduce complications • Type 2 diabetes is a progressive disease – so therapy needs to change over time 15 | Structured Testing | November 2012Prof. Izet Aganovic

16. Prevention = Diagnose + Treat + MonitorThe Diabetes Management Equation • Diabetes is a serious condition for the individual and society. Its rapidly increasing global prevalence is a significant cause for concern. • Any HbA1c reduction below 9% is considered to be cost saving. • Only a systematic diabetes management with guidelines and reimbursement will allow to efficiently manage scarce resources Source:Diabetes Care 20:1847-53; 19978. 16 | Structured Testing | November 2012 | Prof. Izet Aganovic

17. Lessons from UKPDS = Better control means fewer complications EVERY 1% reduction in HbA1c REDUCED RISK* 1% 21% Deaths from diabetes Heart attacks 14% Micro-vascular complications 37% Peripheral vascular disorders 43% *p<0.0001 Source:UKPDS 35. BMJ 2000 17 | Structured Testing | November 2012Prof. Izet Aganovic

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