Presentation ท่าหลวง260656
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Presentation ท่าหลวง260656 Presentation Transcript

  • 1. BackgroundDiabetes is one ofthe major causes ofpremature illnessand deathworldwide.*2010 globalprevalence ofdiabetes 6.4 %2030 globalprevalence ofdiabetes 7.8 %**Reference : World Health Organization
  • 2. 1998 Thaiprevalence ofdiabetes 4.7% *2009 Thaiprevalence ofdiabetes 6.9% *Reference : Thai national health survey 1998Background
  • 3. Complication of DiabetesReference *http://www.medscape.org/viewarticle/449657
  • 4. Diabetic NephropathyReference *http://www.medscape.org/viewarticle/449657
  • 5. The goal of treatment for chronickidney disease is to prevent or slowfurther damage
  • 6. Literature reviewImpact of Glycemic control on survival of diabeticpatients on chronic regular hemodialysisInoueHemodialysisHbA1C* Reference:Oomichi T, Emoto M, Tabata T, Morioka T, Tsujimoto Y, Tahara H, Shoji T, Nishizawa Y. :Impact of glycemic controlon survival of diabetic patients on chronic regular hemodialysis:7 year observational study. Division of Metabolism,Endocrinology, and Molecular medicine, Department of Internal Medicine, Osaka city university Graduate medical school,1-4-3, Asahi-machi Osaka, Japan 545-8585
  • 7. Literature reviewGlycated protein as indices of glycemic controlin diabetic patient with chronic renal failureHbA1c, fructosamine albumin adjusted fructosaminemean capillary blood glucose concentration HbA1Cmean capillary blood glucose concentration*Reference: Morgan. L, Marenah, C.B., Jeffcoate, W.J. and Morgan, A.G.,Glycated proteins as indices of Glyceamiccontrol in Diabetic patients with Chronic renal failure.Diabet.Med,13:514-519
  • 8. Literature review• The unrecognized prevalence of chronic kidneydisease in diabetesserum creatinine albuminuria estimatedglomerular eGFR• *Reference: [5] Wild S, Roglic G, Green A,Sicree R,King H:Global prevalence of diabetes:estimates for the year 2000• and projections for 2030.Diabetes Care27:1047-1053,2004
  • 9. “*Reference : American Diabetes Association. Standards of Medical Care inDiabetes—2013. Alexandria, VA, American Diabetes Association, 2013
  • 10. Conceptual FrameworkDiabetesDiabetes withnephropathyCKDStage5(ESRD)Stage1Stage4Stage3Stage2Tertiary Prevention-Age-Gender-Race-Behavior-Medication-BMI-Blood pressure-Glycemic control-Lipid profile
  • 11. Objectives–––
  • 12. Study design• Retrospective cohort study– 3-21 2556––DurationStudy areaOutcome measurement
  • 13. PopulationStudy population )2- 25542555 2556( Target population )( Population )
  • 14. Study population–22553 2556– Creatinine 2556– Creatinine -2554Inclusion criteriaExclusion criteria
  • 15. SamplingEstimating population proportion and adjusted framework•40%n = (NZ2α/2 P Q ) / d2(N-1) + Z2α/2 P Q
  • 16. Methods1.2.3.
  • 17. Methods4.5.6.1.Gender2. Age3. BMI4.U/D; HT, DLP5.FBS6.HbA1c7.eGFR8.Smorking9.Alcohol drinking10. Medication
  • 18. Time schedule32556•72556•102556••
  • 19. 14-202556• inclusionexclusion criteria•262556•
  • 20. ResultDemographic DataGlycemic ControlCorrelations
  • 21. Demographic DataMean SD (Min-Max) 58 11 (23-82)35 22.7119 77.37 4.5138 89.61 0.68 5.2
  • 22. 72 46.85 3.260 39.01 .62 1.314 9.1Mean SD(Min-Max)63 14 (36-101)Mean SD 155 8
  • 23. 135 87.711 7.18 5.2134 87.0
  • 24. 42 27.3112 72.7Cholesterol≤200 mg/dl 114 74>200 mg/dl 40 26LDL≤100mg/dl 79 51.3>100mg/dl 75 48.7HDL≤40mg/dl 32 20.8>40mg/dl 122 79.2Triglyceride
  • 25. Glycemic controlFBS):Mean SD (Min-Max)137 25.5(88-216)FBS)≤130mg/dl 74 48.1>130mg/dl 80 51.9HbA1C):Mean SD (Min-Max)7.9 1.3(4.9-11.2)HbA1C)≤6.5% 24 15.6
  • 26. GFR):Mean SD (Min-Max)6.4 3.6(0.31-24.82)GFR)≤6.5ml/min/m2/year 74 48.1>6.5ml/min/m2/year 80 51.9231 20.13121 78.6
  • 27. Metformin17 11.0137 89.0Glipizide110 71.444 28.6Glibenclamide62 40.392 59.7
  • 28. CorrelationGFR)≤6.5 >6.5 OR95%ConfidenceIntervalP-VALUEFBS) 1.1620.617-2.189 0.642≤130 37(50)37(50)>130 37(46.25)43(53.75)HbA1C) 2.480.993-6.208 0.047
  • 29. GFR)≤6.5 >6.5 OR95%ConfidenceIntervalP-VALUEMetformin 0.9560.348-2.624 0.9318(47.06) 9(52.94)66(48.18) 71(51.82)Glipizide0.4110.200-0.845 0.01446(41.82)64(58.18)16(36.
  • 30. GFR)≤6.5 >6.5 OR95%ConfidenceIntervalP-VALUEGlipizide 2.430.200-0.845 0.01428(63.64)16(36.36)46(41.82)64(58.18)
  • 31. Discussion• (SD)6.4(3.6)ml/min/m2/year(SD) 3.8 ( 4.2) 4.0( 3.1)ml/min/year•6.5%6.5 ml/min/m2/year 2.48
  • 32. Discussion•, ,Glycemic control Is a predictor of survivalfor Diabetic Patients on Hemodialysis• GlipizideUse of insulin and oral hypoglycemicmedications in patients with diabetes mellitus and advancedkidney disease
  • 33. Limitation• HbA1cAnemia Hemoglobinopathies• 2• 3. 2553• 4.
  • 34. Reccomentation• 1.• 2
  • 35. Acknowledgement•••••••••••