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T1D incidence is rising 3-5% per year Incidence /100,000/ yr in children aged 0-14.

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Presentation on theme: "T1D incidence is rising 3-5% per year Incidence /100,000/ yr in children aged 0-14."— Presentation transcript:

1 T1D incidence is rising 3-5% per year Incidence /100,000/ yr in children aged 0-14

2 Ongoing Prevention Trials TRIGR - cows milk elimination NIP - omega-3 nutritional supplementation PrePoint Study – oral insulin in high risk subjects TrialNet – oral insulin TrialNet – oral GAD – in development TrialNet – anti-CD3, anti CD20, anti CTLA-4 Late stage Early stage

3 Mean HbA1c in BDC patients by age diabetes duration > 1 year n = 150->171n = 611->850n = 806 -> 1205

4 Improvement of glycemic control in Hannover children Proportion of patients (%) Individual yearly median HbA1c T Danne 2008

5 Glycemic Control Is Improving in US Adults with T2D & T1D NHANES Diabetes Care 2008; 31:81-86

6 HbA1c has improved post-DCCT, but the incidence of severe hypoglycemia has doubled Bulsara et al. Diabetes Care 2004

7 Risk of Hypoglycemia vs. Complications Skyler JF. DCCT Endocrinol Metab Clin North Am. 1996;25: RR HbA 1c % Diabetic retinopathy Nephropathy Neuropathy Microalbuminuria Severe hypoglycemi a /100 p-yrs ISPAD 07 adults ADA kids

8 <7.5% <7% <8% Our goal is somewhere there, but it depends on the patient and on a lot of other things

9 A1c as close to normal as possible without severe hypoglycemia

10 ,2 0,4 0,6 0, HbA1c (3-12mo) < 7.5% (n=112) 12.4 HbA1c (3-12mo) > 7.5% (n=109) p<0.03 diabetes duration (years) probability for remaining free of retinopathy Metabolic memory from the first year of DM predicts later development of background retinopathy Berlin Retinopathy Study

11 Copyright restrictions may apply. Prevalence of Hypertension at Each Year of the EDIC Study JAMA 2003;290:

12 Cumulative Incidence of the First Occurrence of Nonfatal MI, Stroke, or CVD Death Years since entry Cumulative incidence of nonfatal MI, stroke, or death from cardio. disease Conventional treatment Intensive treatment DCCT/EDIC Study Research Group, N Engl J Med 2005; 353: Intensive Conventional No. at Risk N Engl J Med 2005; 353;

13 T1D cohorts dx: CVD incidence in T1D is increasing, despite declining CVD mortality in the general population Mortality per 100,000 U.S. standard population Cumulative incidence of CAD by 30 yr T1D duration (%) CDC/NCHS, National Vital Statistics System, Mortality Pabianco G et al. EDC Study, Diabetes :1463-9


15 Think Activity Encourage daily activity, year-round G Scheiner 2008

16 Patient characteristicsRecommended cutoff points No other risk factors for cardiovascular disease LDL-C levels persistently >190 mg/dL despite diet Rx Other risk factors present, (obesity, hypertension, smoking family history of premature CVD) LDL-C levels persistently >160 mg/dL despite diet Rx Children with diabetes mellitus LDL-C levels 130 mg/dL LDL-C levels 100 mg/dL Daniels SR et al. Pediatrics 2008; 122: Recommended LDL-Cholesterol Concentrations for Pharmacologic Treatment of Children and Adolescents 10 Years and Older

17 Changes in Insulin Therapy T Danne, Hannover, 2008 n= Proportion of patients (%) Two injections MDI CSII

18 Insulin Therapy MDI vs. CSII HbA1c distribution T Danne, Hannover 2006 MDI CSII

19 Improved Nightime Glucose Excursions with STS Glucose Sensor Garg S et al: Diabetes Care: 2006, 29; Blinded period Unblinded period < Glucose Range (mg/dl) Time Spent (hours) 38% Reduction* 14% Increase* 9% Reduction* 33% Reduction* 8% Increase* *p <

20 CGM/CSII help those who use it, not those who just wear it! STAR 1: 138 CSII patients on CGM for 6 months Hirsh I. et al, STAR 1, ADA 2007, abstract 90 HbA1c (%)

21 Glucose Levels in CL vs. Hybrid Control Weinzimer et al. DC 2008;31:934

22 Nasal Exenatide Serum Glucose and Insulin Blase et al. Diabetes : Suupl 1: Abstract 195-OR.

23 Patients Using Insulin Pumps & CG sensors Patients Using Insulin Pumps & CG sensors HSBC Global Research

24 Dow Jones

25 Cost Estimates of Intensive Treatment Annual Cost Estimates* DCCT 1995BDC Pumps$5,800$9,400 $11,000 MDI$4,000$4,900 $ 7,000 * cost of DKA, hypoglycemia not included

26 Between 2000 and 2006, Colorado had a 73 percent increase in the number Of children living in poverty


28 Two tracks of diabetes care: For Haves and Have Nots? Health care reform, perhaps?

29 Patient web portal - replace log-book - empower patient - interface with provider - 3 rd party reimbursement Electronic Medical Record

30 30 Therapy Accessibility & Consumer Electronics Integration Confidential. Not to be circulated outside of Medtronic

31 Thank you for coming and for active participation! Safe travels! Final versions of slides next week on www. Many thanks to the Speakers, Sponsors and Staff! See you back in July 2010!

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