Recommended
More Related Content
What's hot
What's hot (20)
Similar to Diabetes risks and complications 2010
Similar to Diabetes risks and complications 2010 (20)
Recently uploaded
Recently uploaded (20)
Diabetes risks and complications 2010
- 2. Famous Diabetic people- Mae West, Jonny cash, Tommy Lee
- 18. Diabetes Risk factors and complications Tracy Ross What do people die from? What do diabetic people die from?
- 19. Deaths by cause in the general population, men aged 40-59 www.heartstats.org
- 20. Deaths by cause in people with diabetes, men aged 40-59, 1972/99, UK www.heartstats.org
- 21. Causes of Death in People with Diabetes Geiss et al., 200 5
- 26. Family history Relationship Type 2 Type 1 Mother 19% 2 Father 14% 9 Both 25% nil Sister &brother 75% 10% Twin 99% 50%
- 28. HbA 1c – relationship with CV risk 1% increase in HbA 1c 21% increase in diabetes-related deaths p<0.0001 14% increase in myocardial infarction p<0.0001 43% increase in peripheral vascular disease p<0.0001 Glycaemia increase Associated risk increase Stratton IM et al . BMJ 2000; 321: 405–12.
- 31. Risk of developing Type 2 diabetes with weight change Colditz GA, et al. Ann Intern Med 1995; 122: 481-486 (from Medicine 2003;31)
- 32. Type 2 diabetes – impact on CV risk Non-smoker, age 60 years 1. British Cardiac Society, British Hyperlipidaemia Society, British Hypertension Society, British Diabetic Association. Heart 1998; 80 (suppl 2): S1 – S29. CHD risk 15 – 30% over next 10 years CHD risk <15% over next 10 years CHD risk >30% over next 10 years No diabetes Diabetes SBP SBP TC: HDL TC: HDL 3 4 5 6 7 8 9 10 11 110 120 130 140 160 170 180 190 150 3 4 5 6 7 8 9 10 11 110 120 130 140 160 170 180 190 150
- 42. Treating Type 2 diabetes Treat Reduce: Cardiovascular risk Microvascular complications Hyperglycaemia to achieve tight glycaemic control Insulin resistance – a root cause of Type 2 diabetes
- 45. Chronic Complications of Diabetes Nephropathy 16% of all new patients needing renal replacement therapy have diabetes Erectile Dysfunction May affect up to 50% of men with long-standing diabetes Retinopathy Most common cause of blindness in people of working age Macrovascular and Cerebrovascular Disease 2–3 fold increased risk of coronary heart disease and stroke Foot Problems 15% of people with diabetes develop foot ulcers; 5–15% of people with diabetic foot ulcers need amputations The Audit Commission. Testing Times. A Review of Diabetes Services in England and Wales, 2000.
- 46. Findings in the UKPDS 50% of newly presenting patients with type 2 diabetes already have one or more complications at diagnosis Retinopathy : 21% Hypertension : 35% Stroke or TIA: 7% Absent f oot pulses: 13% Intermittent claudication: 3% Ischaemic skin changes to feet: 6% Erectile dysfunction: 20% Plasma creatinine >120 mol/l: 3% Myocardial Infarction: 1% Abnormal ECG: 18% UKPDS Group. Diabetes Research 1990;13:1–11.
- 48. Eye Retina
- 56. UKPDS – benefits of tight blood pressure control – risk of complications reduced? UKPDS 36. BMJ 2000; 321: 412 – 19. 10 mmHg lower systolic blood pressure 12% lower risk of myocardial infarction 19% lower risk of stroke 15% lower risk of heart failure 17% lower risk of diabetes-related deaths
- 59. Why do Patients With Type 2 Diabetes Develop Cardiovascular Disease? Hypertension Obesity Raised LDL cholesterol Low HDL cholesterol Hypertriglyceridaemia Type 2 Diabetes Cardiovascular Disease Risk
- 72. Inpatients with Diabetes Figs from menu audit of one week 2003. C&D Trust pop. 240,000
Editor's Notes
- 60-70% deaths in diabetes due to heart disease
- 89% of people with diabetes have modifible isk factos compared to 78% general population Smoking Cessation reduces cardiovascular risk by half after 1 year and after ten years the risk is the same as an individual who has never smoked
- Several studies have shown that the risk of cardiovascular disease rises with increasing blood glucose levels. 1,2 Evidence from the UKPDS (see slides 33–38) has shown that glycaemia is continuously related to the risk of cardiovascular disease and other complications associated with Type 2 diabetes, 1 in particular, increases in HbA 1c have been associated with increases in diabetes-related death, fatal and non-fatal myocardial infarction, stroke and peripheral vascular disease, and microvascular complications such as retinopathy. 2 Epidemiological extrapolations from this study study show that a 1% higher HbA 1c is associated with a highly significant (p<0.0001): 2 21% increase in risk of diabetes-related deaths 14% increase in myocardial infarction 43% increase in peripheral vascular disease. Therefore, cardiovascular disease and microvascular complications of Type 2 diabetes may be reduced by stricter control of blood glucose levels and blood pressure. The benefit of tight glycaemic control is also seen in respect of microvascular complications, with a 37% increase in risk for every 1% increase in HbA 1c . 2 1. Coutinho M, Gerstein HC, Wang Y, Yusuf S. Diabetes Care 1999; 22: 233–40. 2. Stratton IM, Adler AI, Andrew H et al . BMJ 2000; 321: 405 – 12.
- 12x RR increase if >20kg weight change in 14 years!!! 7x increase if 11-19.9kg This was in women but still probably translates to the weaker sex too
- In a study by Haffner et al., d iabetic patients without previous myocardial infarction had as high a risk of myocardial infarction as non-diabetic patients with previous myocardial infarction. 1 The increased risk in diabetes is not simply due to the presence of hypertension or high cholesterol levels, which is common in these patients. 1 People with hypertension concomitant to diabetes have an almost 3-fold greater risk of cardiovascular mortality than non-diabetic patients across all blood pressure levels according to the Multiple Risk Factor Intervention Trial (MRFIT). 2 Similarly, MRFIT demonstrated that at each cholesterol level, coronary heart disease mortality rates were 3–4 times higher in people with diabetes. 2 Therefore, specific risk tables/charts for diabetic patients, such as those issued by the joint British societies, should be used to assess cardiovascular risk in these patients, rather than standard ones. 3 1. Haffner SM, Lehto S, Ronnemaa T et al . N Engl J Med 1998; 339: 229–34. 2. Stamler J, Vacaro O, Neaton O et al . Diabetes Care 1993; 16: 434–44. 3. British Cardiac Society, British Hyperlipidaemia Society, British Hypertension Society, British Diabetic Association. Heart 1998; 80 (suppl 2): S1 – S29.
- Our current understanding of the pathophysiology of Type 2 diabetes plus evidence from the UKPDS has shown that the aim of treatment should be not only to provide tight and sustained control of blood glucose, but also to reduce the long-term morbidity and mortality associated with cardiovascular disease and microvascular complications. The UKPDS has demonstrated that for many patients this has not been achieved. Earlier intervention with combination therapy may be necessary to provide lasting glycaemic control for the majority of patients. 1 However, treatment aimed at reducing other cardiovascular risk factors, such as insulin resistance, may be required. 2 There is therefore a role for agents that target insulin resistance – such as the thiazolidinediones. 1. Turner RC, Cull CA, Frighi V et al . JAMA 1999; 281: 2005 – 12 . 2. Haffner SM, Miettinen H. Am J Med 1997; 103: 152–62.
- The majority of patients first seek medical attention when they experience symptoms including extreme thirst, excessive urination, weight loss and fatigue. However, as many as 60% of patients ignore their symptoms and do not present to the doctor until their condition has progressed and complications have developed. These complications may include hypertension, coronary heart disease, circulatory disorders, nerve damage and kidney disorders. If left untreated, these complications can lead to heart attacks, blindness, lower-limb amputation and kidney transplantation. The effect of these complications are costly not only to the individual, but to society, as they not only result in severe disability but also restrict a patient’s mobility and ability to work. UKPDS Group. UK Prospective Diabetes Study 6. Complications in newly diagnosed type 2 diabetic patients and their association with different clinical and biochemical risk factors. Diabetes Research 1990;13:1–11.
- The benefits of tight glycaemic control have already been discussed, but the UKPDS also investigated the effects of tight blood pressure control. Patients with diabetes randomised to tight blood pressure control (mean achieved blood pressure 144/82 mmHg) had a lower risk of a range of endpoints. 1 Epidemiological extrapolation showed that overall, a 10 mmHg lower systolic blood pressure was associated with a reduction in the risk of myocardial infarction by 12%, stroke by 19%, heart failure by 15% and diabetes-related deaths by 17% and microvascular endpoints by 13%. 1,2 Diabetes UK treatment targets for the control of cardiovascular risk factors in people with diabetes now suggest that 140/80 mmHg represents good control of blood pressure, 3 another example of the UKPDS results directly influencing treatment guidelines. 1. UKPDS Group. BMJ 1998; 317: 703-13. 2. Adler IA, Stratton IM, Andrew H et al . BMJ 2000; 321: 412–19. 3. Diabetes UK. Recommendations for the management of diabetes in primary care . 2nd ed. London, October 2000.
- These are some key points from NICE. This is the algorithm provided by NICE, there are a number of provisos identified (see previous slide or guidelines) a In young patients (under 55) whose BP may be managed on monotherapy, consider starting with a beta-blocker. b Patients at high risk have a strong family history of type 2 diabetes, have impaired glucose tolerance (FPG >– 6.5 mmol/l), are clinically obese (body mass index >– 30) or are of South-Asian or African-Caribbean ethnic origin. c Beta-blocker contraindications include asthma, coronary obstructive pulmonary disease and heart block. d Offer an angiotensin receptor blocker (ARB) if an angiotensin-converting enzyme inhibitor (ACEi) is not tolerated because of cough. Contraindications include known or suspected renovascular disease and pregnancy. e Only dihydropyridine calcium-channel blockers should be prescribed with a beta-blocker. Contraindications include heart failure. f Consider offering a beta-blocker or angiotensin-converting enzyme inhibitor (ACEi if not yet used), another drug or specialist referral. A beta-blocker and thiazide-type diuretic combination may become necessary in patients at high risk of developing diabetes if hypertension or CVD progresses.
- Coster et al - HTA report 2000 HTA report concluded that self-monitoring is well established as a practice but that the evidence-base is weak Optimal use of the technique has not been established