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  1. COS The Philippine Cardiovascular Outcome Study Diabetes Mellitus (PhilCOS-DM):An 8-year Follow-up of the 1998 Food and Nutrition Research Institute 5th National Nutrition Survey (FNRI-NNS) in the National Capital Region, Region 3 and Region 4.Rody G. Sy, MDMaria Luz Joanna B. Soria, MD Bernard S. Vega. MDJennifer S. Flores, MDFelicidad Velandria, RNDFelix Eduardo Punzalan, MDTommy Ty-Willing, MDCardiovascular Institute CARDINAL SANTOS MEDICAL CENTERCardiovascular Section University of the Philippines-Philippines General Hospital

  2. Introduction

  3. Introduction • Diabetes Mellitus is a risk factor for: • Atherosclerosis • Coronary heart disease • Heart Failure

  4. Incidence of Fatal or Nonfatal MI During a 7-Year Follow-up in Relation to History of MI in Nondiabetic vs Diabetic Subjects: East-West Study 45.0 Nondiabetics with prior MI Nondiabetics with no prior MI Diabetics with prior MI Diabetics with no prior MI p<0.001 Incidence During Follow-up (%) 20.2 18.8 P<0.001 3.5 (n=69) (n=1304) (n=169) (n=890) Events per100 person-yr: 3.0 0.5 7.8 3.2 Haffner SM et al. N Engl J Med 1998;339:229-234.

  5. Global Projections for the Diabetes Epidemic: 2000–2025 20.9. 25.8 23% 21.935.8 64% ASIA 102.2 189.4 85% 5.5 11.6 111% 6.9 15.5 120% 1.3 2.2 69% World 2000 = 159 million 2025 = 280 million Increase of 76% Numbers are in Millions Zimmet P et al..

  6. Diabetes in Asia is a Growing Epidemic 20% Prevalence growth Number of People with Diabetes (000) Source: http://www.eatlas.idf.org/prevalence/index (accessed 10/7/2005)

  7. Introduction • 1983 & 1998 prevalence of DM 4% • 2003 NNHeS prevalence of DM 4.6%

  8. PhilCOS-DM In 2006, we attempted the first longitudinal study in the Philippines on some cardiovascular and diabetic outcomes.

  9. COS Objectives A descriptive cohort study to determine: • 8-year incidence rate of diabetes mellitus and impaired fasting glucose (IFG) based on fasting blood glucose (FBG) • prevalence rate of diabetes mellitus, IFG and impaired glucose tolerance (IGT) based on interview, FBG and 2-hours post glucose (2H PG) load, of the NCR, Region 3, and Region 4.

  10. COS Methodology Selection of FNRI-NNS subjects: two-staged stratified sampling design (1998) 8-years follow-up 2006 PhilCOS NCR, n= 345 (73%) Reg3, n= 309 (88%) Reg4, n= 431 (87%) TOTAL = 1085 (82%) 1998 FNRI-NNS NCR, n= 470 Reg3, n= 351 Reg4, n= 495 TOTAL = 1316

  11. COS Methodology 1998 FNRI (N=1316) Unretrieved =18% 2006 revisited (N= 1085) Alive = 913 FBG (N=864) Barangay Health Workers Questionnaire One Touch Ultratm 75 gram glucose load 2h post-glucose load (N=800)

  12. COS Validation of the “One touch glucometer CBG vs FBS-CSMC

  13. COS Criteria for DM, IFG, IGT

  14. COS Data Processing & Analysis • Encoding – Microsoft Access • Analysis – SPSS V12 • Data storage – MS Excel & SPSS V12

  15. COS RESULTS

  16. COS Demographics of the 1998 FNRI-NNS

  17. COS Demographics of the 2006 PhilCOS

  18. COS Prevalence of Diabetes Mellitus based on FBG, 2H PGL, Diabetic Questionnaire, and Combination PhilCOS-DM accepted that the most accurate prevalence rate of Diabetes was the combination of the 3 measures: 18%.

  19. COS - Prevalence of IFG and IGT based on FBG and 2H-PG load

  20. COS The 8-years Incidence of DM using FBG

  21. COS Spectrum of Glucose Homeostasis: From 1998 IFG to DM, IFG and normal in 2006 PhilCOS-DM Among IFGs 48% became diabetics in 8 years.

  22. COS Spectrum of Glucose Homeostasis: From 1998 Normoglucose to DM, IFG and Normal in 2006 PhilCOS-DM The 8-years incidence rate of IFG is 10%.

  23. COS Prevalence of DM using FBG, 2 hour PG, or Combination (n=800) FBG>126 = 9% 2H-PGL>200 = 10% 5% 6% FBG & 2HPG 2HPG alone FBG alone 4% • 2HPG provides better information regarding future risk for CVD… • Elevated 2HPG also predicts the CVD risk in subjects with NORMAL FBG. • Class 1, Level of Evidence A. • ESC and EASD guidelines, 2007

  24. COS Prevalence of IFG, IGT or Combination (n=800) IFG (100-125 mg/dL) = 31% IGT (140-199 mg/dL) = 26% 20% 15% IFG alone IFG & IGT IGT alone 11%

  25. COS Prevalence of IFG, IGT or Combination IGT = 208 IFG = 248 46% 38% IFG alone IFG & IGT IGT alone 16% FBG predicted more pre-diabetics, but a further 38% can be predicted by 2H PG.

  26. COS Limitations of the Study • Use of capillary blood sample • Respondent migration and relocation • Sampling limited to previously generated by the 1998 FNRI-NNS • ? “more urban” cohort • ? “healthier” non-respondents • ? Overestimate of morbidities comparing 2-points in time

  27. COS Conclusions • Incidence rate of DM = 12% • Incidence rate of IFG = 10% • Prevalence rate of DM = 18% • Prevalence rate of IFG = 31% • Prevalence rate of IGT = 26%

  28. COS Awaiting… The PhilCOS Extension Study

  29. COS PhilCOS Extension of the study: • Region 6 - Cebu • Region 10 – Mindanao • Region 5 - Bicol

  30. COS Acknowledgement Sponsors : Philippine Diabetes Association Philippine Lipid and Atherosclerosis Society Philippine Society of Hypertension Therapharma, Inc. Pfizer Phils., Inc. Johnson & Johnson Research Assistants : Maryjun Rangel and Armand Soriano Collaborators : Philippines Diabetes Association key opinion leaders’ forum Special Mention : Municipal Health Officers and Barangay Health workers

  31. PhilCOS DM

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