BackgroundDiabetes is one ofthe major causes ofpremature illnessand deathworldwide.*2010 globalprevalence ofdiabetes 6.4 %...
1998 Thaiprevalence ofdiabetes 4.7% *2009 Thaiprevalence ofdiabetes 6.9% *Reference : Thai national health survey 1998Back...
Complication of DiabetesReference *http://www.medscape.org/viewarticle/449657
Diabetic NephropathyReference *http://www.medscape.org/viewarticle/449657
The goal of treatment for chronickidney disease is to prevent or slowfurther damage
Literature reviewImpact of Glycemic control on survival of diabeticpatients on chronic regular hemodialysisInoueHemodialys...
Literature reviewGlycated protein as indices of glycemic controlin diabetic patient with chronic renal failureHbA1c, fruct...
Literature review• The unrecognized prevalence of chronic kidneydisease in diabetesserum creatinine albuminuria estimatedg...
“*Reference : American Diabetes Association. Standards of Medical Care inDiabetes—2013. Alexandria, VA, American Diabetes ...
Conceptual FrameworkDiabetesDiabetes withnephropathyCKDStage5(ESRD)Stage1Stage4Stage3Stage2Tertiary Prevention-Age-Gender-...
Objectives–––
Study design• Retrospective cohort study– 3-21 2556––DurationStudy areaOutcome measurement
PopulationStudy population )2- 25542555 2556( Target population )( Population )
Study population–22553 2556– Creatinine 2556– Creatinine -2554Inclusion criteriaExclusion criteria
SamplingEstimating population proportion and adjusted framework•40%n = (NZ2α/2 P Q ) / d2(N-1) + Z2α/2 P Q
Methods1.2.3.
Methods4.5.6.1.Gender2. Age3. BMI4.U/D; HT, DLP5.FBS6.HbA1c7.eGFR8.Smorking9.Alcohol drinking10. Medication
Time schedule32556•72556•102556••
14-202556• inclusionexclusion criteria•262556•
ResultDemographic DataGlycemic ControlCorrelations
Demographic DataMean SD (Min-Max) 58 11 (23-82)35 22.7119 77.37 4.5138 89.61 0.68 5.2
72 46.85 3.260 39.01 .62 1.314 9.1Mean SD(Min-Max)63 14 (36-101)Mean SD 155 8
135 87.711 7.18 5.2134 87.0
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/d...
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....
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
Metformin17 11.0137 89.0Glipizide110 71.444 28.6Glibenclamide62 40.392 59.7
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)...
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...
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)
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
Discussion•, ,Glycemic control Is a predictor of survivalfor Diabetic Patients on Hemodialysis• GlipizideUse of insulin an...
Limitation• HbA1cAnemia Hemoglobinopathies• 2• 3. 2553• 4.
Reccomentation• 1.• 2
Acknowledgement•••••••••••
Presentation ท่าหลวง260656
Presentation ท่าหลวง260656
Presentation ท่าหลวง260656
Upcoming SlideShare
Loading in...5
×

Presentation ท่าหลวง260656

272

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
272
On Slideshare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
1
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Presentation ท่าหลวง260656

  1. 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. 2. 1998 Thaiprevalence ofdiabetes 4.7% *2009 Thaiprevalence ofdiabetes 6.9% *Reference : Thai national health survey 1998Background
  3. 3. Complication of DiabetesReference *http://www.medscape.org/viewarticle/449657
  4. 4. Diabetic NephropathyReference *http://www.medscape.org/viewarticle/449657
  5. 5. The goal of treatment for chronickidney disease is to prevent or slowfurther damage
  6. 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. 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. 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. 9. “*Reference : American Diabetes Association. Standards of Medical Care inDiabetes—2013. Alexandria, VA, American Diabetes Association, 2013
  10. 10. Conceptual FrameworkDiabetesDiabetes withnephropathyCKDStage5(ESRD)Stage1Stage4Stage3Stage2Tertiary Prevention-Age-Gender-Race-Behavior-Medication-BMI-Blood pressure-Glycemic control-Lipid profile
  11. 11. Objectives–––
  12. 12. Study design• Retrospective cohort study– 3-21 2556––DurationStudy areaOutcome measurement
  13. 13. PopulationStudy population )2- 25542555 2556( Target population )( Population )
  14. 14. Study population–22553 2556– Creatinine 2556– Creatinine -2554Inclusion criteriaExclusion criteria
  15. 15. SamplingEstimating population proportion and adjusted framework•40%n = (NZ2α/2 P Q ) / d2(N-1) + Z2α/2 P Q
  16. 16. Methods1.2.3.
  17. 17. Methods4.5.6.1.Gender2. Age3. BMI4.U/D; HT, DLP5.FBS6.HbA1c7.eGFR8.Smorking9.Alcohol drinking10. Medication
  18. 18. Time schedule32556•72556•102556••
  19. 19. 14-202556• inclusionexclusion criteria•262556•
  20. 20. ResultDemographic DataGlycemic ControlCorrelations
  21. 21. Demographic DataMean SD (Min-Max) 58 11 (23-82)35 22.7119 77.37 4.5138 89.61 0.68 5.2
  22. 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. 23. 135 87.711 7.18 5.2134 87.0
  24. 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. 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. 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. 27. Metformin17 11.0137 89.0Glipizide110 71.444 28.6Glibenclamide62 40.392 59.7
  28. 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. 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. 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. 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. 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. 33. Limitation• HbA1cAnemia Hemoglobinopathies• 2• 3. 2553• 4.
  34. 34. Reccomentation• 1.• 2
  35. 35. Acknowledgement•••••••••••
  1. A particular slide catching your eye?

    Clipping is a handy way to collect important slides you want to go back to later.

×