1. Osvrt na Prvi dijabetološki kongres FBiH Mostar, 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 % Predvi đ anje 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. 10% zdravstvenog dinara u susjednoj Hrvatskoj otpada na pacijente sa dijabetesom Samo 10% oboljelih od dijabetesa ima dobro kontroliranu bolest Statistika

6. Izabrani slajdovi iz prezentacije prof. Izeta Aganovica

7. 7 | Structured Testing | November, 2012 | Prof. Izet Aganovic Basal glucose level HbA 1c PPG Peak glucose level HbA 1c = glycated hemoglobin FPG = fasting plasma glucose PPG = postprandial plasma glucose FPG Average long-term glucose level ‘ Glucose triad’ of diabetes management

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

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

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

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

12. 12 | Structured Testing | November 2012 | Prof. Izet Aganovic HbA 1C s are not created equal The same values are based on different bG values 12 There is a variable relationship between fasting glucose, postprandial glucose and HbA 1C Source: Diabetes Care, Bonora yr:2001 vol:24 iss:12 pg:2023 -2029 Hb

13. 13 | Structured Testing | November 2012 Prof. Izet Aganovic What the HbA 1c doesn’t tell you … SMBG does 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 There is a variable relationship between fasting glucose, postprandial glucose and HbA1c

14. 14 | Structured Testing | November 2012 | Prof. Izet Aganovic The Lower the HbA 1c …the more it is impacted by postprandial glucose levels Contribution (%) 100 80 60 40 20 0 10.2 Postprandial Fasting HbA1c Ranges 30%40%50%60%55%50%70%30%70%45% Source: Adapted from Monnier et al. Diabetes Care 2003;26:881-885.

15. 15 | Structured Testing | November 2012 Prof. Izet Aganovic Glycemic excursions can be kept under control by bG monitoring Diabetes management remains suboptimal for many Improvements in HbA 1c reduce complications Type 2 diabetes is a progressive disease – so therapy needs to change over time Postprandial hyperglycemia is an important marker for complications Looking at HbA 1c levels is not enough There is a variable relationship between fasting glucose, postprandial glucose and HbA 1c Structured bG monitoring and systematic data analysis can help people with diabetes make lifestyle changes and inform therapeutic decision-making What We Know … What We are Beginning to Understand …

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

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

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