Upload
nguyenthuy
View
216
Download
3
Embed Size (px)
Citation preview
3/6/17
1
PreventingaChronicDiseasebyManagementofPrediabetes
EdenM.MillerD.O.&KevinT.MillerD.O.
Disclosures
EdenM.Miller,D.O.• EliLilly• NovoNordisk• AstraZeneca• Jenssen• AbboA• Omnipod• BehringerIngelheim
KevinT.Miller,D.O.• Ihavenothingtodisclose
3/6/17
2
WhatisPrediabetes?• A1c>5.7%butlessthan6.5%
• AnA1cbetween6.0%-6.5%hasa5yearriskofbetween25%-50%ofdevelopingdiabetes
• ThosewithA1c>6.0%shouldhaveaggressiveintervenSon.
• FPGfrom100mg/dlto125mg/dl
• 2hPPG75-gOGTT140mg/dlto199mg/dl
Whoshouldbescreened?
• AdultswithBMI>25orAsianAmericans>23• HighriskEthnicGroups(AfricanAmerican,LaSno,NaSveAmerican,AsianAmericanorPacificIslanders)• Allpeopleaged45orolder• FamilyhistoryofType2DM(FirstDegreeRelaSve)• WomenwithdxofPCOSorGestaSonalDiabetes• PaSentswithdxofCVD,orHTN• PhysicalInacSvity,otherdysmetaboliccondiSons(HDL<35orTG>250)oracanthosisnigricans• Score5orhigheronDiabetesRiskTest
3/6/17
3
EpidemiologyofPrediabetesinUS• In2012,86millionpeopleintheU.S.hadPrediabetes• 29millionhavediagnosisofT2DM• 1.4millionnewpaSentsdiagnosedeveryyear• OrderofprevalencebasedonethnicityNaSveAmerican15.9%AfricanAmerican13.2%Hispanic12.8%Asians9.0%Caucasian7.6%
CostofDiabetesManagement• $322Billioncostdiagnoseddiabetes$244Billionindirectcare:43%InpaSenthospitalcare18%PrescripSonmedicaSonforcomplicaSons12%AnSdiabeScagentsandsupplies9%Officevisits1in5HealthCaredollarsspentofDM40%increasefrom2007-2012
• Expenditureforpeoplewithdiabetesis2.3SmeshigherthanpaSentswithout.
3/6/17
4
TheEconomicBurdenofElevatedBloodGlucoseLevelsin2012:DiagnosedandUndiagnosedDiabetes,GestationalDiabetes
Mellitus,andPrediabetesTimothyM.Dall1⇑,WenyaYang2,PragnaHalder2,BoPang2,Marjan
Massoudi3,NeilWintfeld3,AprilP.Semilla1,JerryFranz3&PaulF.Hogan2
• 2007,researchersfoundthatoverfiveyears,thecostofprediabetesincreased74percent(to$44billion)whilethecostofundiagnoseddiabetesroseastaggering82percent(to$33billion).• $244billionfordiagnoseddiabetes,$33billionforundiagnoseddiabetes,$44billionforprediabetes,and$1.3billionforGDM• Prediabetescosts$510annuallyperperson(medicalcostsonly);undiagnoseddiabetes,$4,030;anddiagnoseddiabetes,$10,970.ThecostofGDMpercaseaveraged$5,800inhigherdeliverycostsandothercostsduringthenewborn’sfirstyearoflife.ThiscostincreasedasthepaSentagedatSmeofdiagnosis.
Conclusion
ThesestaSsScsunderscoretheimportanceoffindingwaystoreducetheburdenof
prediabetesanddiabetesthroughprevenSonandtreatment.
3/6/17
5
ImprovedIdentiRicationofatRiskPopulation• AmpleEvidencethatDM2geneScbasis• 70%riskMonoZygoScTwinsvs.20-30%DizygoScTwins• 40%riskifoneparentand70%if2parentshaveDM
• Over65GeneScmarkersidenSfiedthatincreasetheriskof
developingT2DM
• Theyanoncodingvariantgenesandonlyincreaseriskby10-30%• NotEnoughconclusiveevidenceexistsyettobeabletopredictT2DM
usinggeneSctesSng.• BestPredic+onmodelsinclude:age,obesity,sedentary,lowfiber/
highfatdiet,family/culturalhistory,gestaSonalDM,elevatedfasSngglucose.HTN,dyslipidemia,andcertainmedicaSons(HCTZ,BetaBlockers,andStaSns)
• FINRISKStudyhasshowthegreatestpredictordevelopingT2DM
LimitationsofPrediabetesDiagnosis
• NoGuaranteeindividualwilldevelopdisease
• DiagnosScCriteriaarenot100%sensiSveorspecific
• AsaresultliAleresearchonpharmacologicevidenceforprimaryprevenSonsince
“atriskpopulaSonisdifficulttobecertain”
3/6/17
6
ICD-10codesfor“Prediabetes”
• R73.0AbnormalGlucose• R73.01ImpairedFasSngGlucose• R73.02ImpairedGlucoseTolerance• R73.03Prediabetes• R73.09OtherAbn.GlucoseincludingA1c• R73.9HyperglycemiaUnspecified• E88.81MetabolicSyndrome/InsulinResistant• E66.Obesity
EvidenceBasedRisk-Reduction• 7%-10%weightloss
• 150minutesmoderateexerciseperweek
• IncreasedFiber,lowerSaturatedFat,IncreasedFruitandVegetablediet(MediterraneanDiet)
• Results40-70%relaSveriskreducSon
3/6/17
7
PharmacologicalIntervention
• Menormin(strongestevidencebasedbutlesscosteffecSvethanlifestyle,31-70%relaSveriskreducSon)
• AlphaGlucosidaseinhibitors
• PiogliSzone(72%riskreducSon-DeFranzo)
• Orlistat
Whatcanwedoinourcommunities?
3/6/17
11
CommunityResourceBooklet
AllMaterialsCanBeFoundForFreeAt:
www.cohealthcouncil/diabetes-clinical