Early insulin therapy in people with Type 2 Diabetes, Why, When and How to Start?...
Early insulin therapy in people with Type 2 Diabetes, Why, When and How to Start? Sony W Mudjanarko Department of Internal Medicine dr Soetomo Hospital Surabaya
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Burden of diabetes is expected to increase dramatically within Asia Pacific by 2030 Estimated prevalence of diabetes in adults aged 20–79 years 2010 Country
Prevalence* No. of cases (%) (millions)
Prevalence* (%)
No. of cases (millions)
Estimated increase in
Estimated increase in no. † prevalence (%) of cases (%)
India
7.8
50.77
9.3
87.04
19.2
71.4
China
4.2
43.16
5.0
62.55
19.0
44.9
Thailand
7.1
3.54
8.4
4.96
18.3
40.11
S. Korea
7.9
3.29
9.0
4.32
13.9
31.3
Australia
5.7
1.09
6.8
1.50
19.3
37.6
Taiwan
7.5
0.82
8.5
1.23
13.3
50.0
Hong Kong
8.5
0.59
10.1
0.92
18.8
55.9
Singapore
10.2
0.44
12.4
0.74
21.6
68.2
Malaysia
11.6
1.85
13.8
3.24
19.0
75.1
Vietnam
3.5
1.65
4.4
3.41
25.7
106.7
Philippines
7.7
3.40
8.9
6.16
15.6
81.2
Indonesia
4.8
6.96
5.9
11.98
22.9
72.2
10.3
26.81
12.0
35.96
16.5
34.1
USA §
2030
Sicree R, et al. In: IDF Diabetes Atlas, 4 th edition, 2 009. Available at: http://www.diabetesatlas.org (accessed J an 2010).
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Majority of type 2 DM patients in Asia Pacific fail to reach HbA1c goals
§ DM, diabetes mellitus;; HbA1c, glycated hemoglobin. § 1. Bryant W, et al. MJA 2006;;185:305–9. 2. Kosachunhanun N, et al. J Med Assoc Thai 2006;;89:S66–71. 3. Lee WRW, et al. Singapore Med J 2001;;42:501–7. 4. Nagpal J & Bhartia A. Diabetes Care 2006;;29:2341–8. 5. Soewondo P, et al. Med J Indoes 2010;;19:235–44. 6. Tong PCY, et al. Diab Res Clin Pract 2008;;82:346–52. 7. Pan C, et al. Curr Med Res Opin 2009;;25:39–45. 8. Choi YJ, et al. Diabetes Care 2009;;32:2016–20. 9. Mafauzy M, et al. Med J Malaysia 2011;;66:175–81.
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Type 2 diabetes is NOT a mild disease Stroke
2 to 4 fold increase in cardiovascular mortality and stroke3
Diabetic Retinopathy
Leading cause of blindness in working age adults1
Cardiovascular Disease
8/10 diabetic patients die from CV events4 Diabetic Nephropathy
Diabetic Neuropathy
Leading cause of end-‐stage renal disease2
Leading cause of non-‐traumatic lower extremity amputations5
1 Fong DS, e t al. Diabetes Care 2003; 26 ( Suppl. 1):S99–S102. 2Molitch ME, e t al. Diabetes Care 2003; 26 ( Suppl. 1):S94–S98. 3
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Kannel WB, et al. Am Heart J 1990; 120:672–676. 4Gray R P & Yudkin JS. In Textbook of Diabetes 1997.
[email protected] 5 Mayfield JA, et al. Diabetes Care 2003; 26 ( Suppl. 1):S78–S79.
EPIC-‐Norfolk: CV risk increases with A1C level N = 10,232 40
40
Women
30
30
Events/ 20 100 persons
20
10
10
0
0
