ctg fact sheets

7/30/2019 CTG Fact Sheets

1/10

Good glycemic control significantly reduces the riskof serious, long-term complications of type 2diabetes.

A 1% reduction in HbA1c reduces diabetes-relateddeaths by 21%, risk of microvascular complicationsby 37% and myocardial infarction by 14%.1

Over 60% of people with type 2 diabetes are still notachieving recommended glycemic goals despite

stringent guidelines for diabetes management.2-6

Urgent action is needed to increase the proportion ofindividuals achieving recommended glycemic goals.

Management strategies that aim to get patients to goalfor glycemic control should reduce the risk of serious,long-term complications of diabetes and improvequality of life.

Global Partnership for Effective DiabetesManagement

Recommendation:

Aim for good glycemic control, defined asHbA1c < 6.5%*

7

*Or fasting/preprandial plasma glucose < 110 mg/dL (6.0 mmol/L) where

assessment of HbA1c is not possible.

1 Stratton IM, et al. Br Med J 2000; 321:405412.

2 Liebl A, et al. Diabetologia 2002; 45:S23S28.

3 Saydah SH, et al. JAMA 2004; 291:335342.

4 American Diabetes Association. Diabetes Care 2004; 27 (Suppl. 1):S15S34.

5 European Diabetes Policy Group. Diabet Med1999; 16:716730.

6 Canadian Diabetes Association. Can J Diabetes 2003; 27 (Suppl. 2):S1S152.

7 Del Prato S, et al. Int J Clin Pract2005; 59:13451355.

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FACTsheet 1 Good glycemic control

Did you know? A call to action

HbA1c

1%37%

21%

14%


2/10

Frequent self-monitoring of blood glucose levels hasbeen associated with better glycemic control.1

70% of patients who regularly self-monitor bloodglucose achieve HbA1c 8% compared with only 18%of patients who irregularly self-monitor and 22% ofpatients who do not self-monitor.2

Proactive management of diabetes will ensure thatglycemic goals are being met and maintained.

Regular monitoring by both patients and healthcareprofessionals allows treatment to be frequentlyreviewed and, where appropriate, necessary modificationand self-modifications in treatment regimens to beimplemented.

Global Partnership for Effective Diabetes

Management

Recommendation:

Monitor HbA1c every 3 months in addition toregular glucose self-monitoring3

1 Karter AJ, et al. Am J Med2001; 111:19.

2 Blonde L, et al. Diabetes Care 2002; 25:245246.


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FACTsheet 2 Regular monitoring of glycemia


Diabetes care teamCombined synergistic efforts of

team are crucial to ensure effective

monitoring of glycemic control

Healthcare professionalsRegular monitoring of HbA1c

PatientSelf-monitoring

of blood glucose

+


3/10

Type 2 diabetes is a complex disorder characterizedby hyperglycemia, dyslipidemia and hypertension recommended treatment targets exist for all three.1-3

Hyperglycemia, dyslipidemia and hypertension areall significant risk factors for vascular complicationsand mortality in people with diabetes.4-6

Only 15% of patients in a recent study achievedHbA1c goals, while a significantly higher proportion

reached lipid and blood pressure goals.7

The need for a holistic approach to treating type 2diabetes is reflected in current treatment guidelines,which include targets for glycemic control, lipids andblood pressure.1-3

In order to reduce the risk of diabetes-relatedcomplications, individuals should receive intensive andeffective treatment for all metabolic disturbances,including hyperglycemia.


Recommendation:

Aggressively manage hyperglycemia,dyslipidemia and hypertension with the sameintensity to obtain the best patient outcome8

1 American Diabetes Association. Diabetes Care 2004; 27 (Suppl. 1):S15S34.

2 European Diabetes Policy Group. Diabet Med1999; 16:716730.

3 Canadian Diabetes Association. Can J Diabetes 2003; 27 (Suppl. 2):S1S152.

4 Stamler J, et al. Diabetes Care 1993; 16:434444.

5 UK Prospective Diabetes Study (UKPDS) Group. BMJ 1998; 317:703713.

6 Stratton IM, et al. Br Med J 2000; 321:405412.

7 Gaede P, et al. N Eng J Med2003; 348:383393.


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FACTsheet 3 Holistic approach to type 2 diabetesmanagement


20

30

10

40

50

60

70

80

46%

Systolic

BP

< 130 mmHg

72%

Diastolic

BP

< 80 mmHg

58%

Triglycerides

< 150 mg/dL

72%

Total

cholesterol

< 175 mg/dL

Individu

alsachieving

treatmentgoals(%)

0

15%

HbA1c< 6.5%


4/10

Given the complex nature of type 2 diabetes,involvement of professionals with relevant expertiseis essential to identify the needs of the individual.

The application of extensive knowledge of type 2diabetes, medications available now and inthe future and patient education are likely toimprove outcomes.

Patients who visit specialist diabetes care units as

well as their family physician have significantly lowerrisk of mortality and increased survival comparedwith patients who only visit their physician.1

Involvement of healthcare professionals with particularexpertise in the management of diabetes will help moreindividuals reach glycemic goal and thus reduce therisk of complications.

Careful review of treatment, including vigilant monitoringand motivation, and robust support for the individualseducational requirements, should improve glycemiccontrol.


Recommendation:

Refer all newly diagnosed patients to a unitspecializing in diabetes care where possible2

1 Verlato G, et al. Diabetes Care 1996; 19:211213.


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FACTsheet 4 The role of specialist care units


17%

In the Verona Diabetes Study,

individuals attending a specialist

diabetes center had a substantially

improved chance of survival

compared with those seen only

by family physicians


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Approximately 8085% of people with type 2diabetes have insulin resistance the inability of thebody to use its own insulin.1,2

-cell dysfunction the reduced ability ofpancreatic -cells to secrete insulin in response tohyperglycemia is a major defect in patients withtype 2 diabetes.3,4

Insulin resistance, implicated in almost 50% of

cardiovascular events in type 2 diabetes, is asstrong a risk factor for cardiovascular diseaseas smoking.57

When selecting a therapeutic regimen, it is important toconsider whether agents can address the underlyingpathophysiology of type 2 diabetes.

Insulin resistance and -cell dysfunction are bothimportant targets for therapeutic intervention toimprove outcomes in type 2 diabetes.


Recommendation:

Address the underlying pathophysiology,including treatment of insulin resistance8

1 Bonora E, et al. Diabetes 1998; 47:16431649.

2 Haffner SM, et al. Circulation 2000; 101:975980.

3 UK Prospective Diabetes Study (UKPDS) Group. Diabetes 1995; 44:12491258.

4 UK Prospective Diabetes Study (UKPDS) Group. Lancet1998; 352:837853.

5 Hanley AJ, et al. Diabetes Care 2002; 25:11771184.

6 Bonora E, et al. Diabetes Care 2002; 25:11351141.

7 Strutton D, et al. Am J Man Care 2001; 7:765773.


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FACTsheet 5 Address the underlying pathophysiologyof type 2 diabetes


Present in > 80% ofpeople with type 2 diabetes

Approximately doublesthe risk of a cardiac event

Implicated in almost halfof CHD events in individuals

with type 2 diabetes

Insulinresistance IR


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Traditional stepwise management of type 2 diabetesinvolves diet and exercise oral monotherapy up-titration of oral monotherapy combinationtherapy and finally addition of insulin.

It is a reactive strategy that can involve significantdelays between steps and, therefore, prolong theloss of glycemic control. Even short periods ofhyperglycemia significantly increase the risk ofcomplications.1-3

There is a need to move away from a reactive, stepwisemanagement approach towards a new treatmentparadigm, including the use of early combinationtherapy.

A proactive approach is more likely to ensureindividuals achieve goals more quickly and maintainthem, while minimizing exposure to potentiallydamaging periods of hyperglycemia.


Recommendation:

Treat patients intensively so as to achievetarget HbA1c < 6.5%* within 6 monthsof diagnosis4

*Or fasting/preprandial plasma glucose < 110 mg/dL (6.0 mmol/L) where

assessment of HbA1c is not possible.

Combination therapy should include agents with complementary

mechanisms of action.

1 EDIC Group.JAMA 2003; 290:21592167.

2 EDIC Group.JAMA 2002; 287:25632569.3 Nathan DM, et al. N Engl J Med2003; 348:22942303.


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FACTsheet 6 The need for an early and intensive approach


0 1 2 3 4 5 6

Months from diagnosis

Treat to goal

of HbA1c < 6.5%*

by 6 months

Paradigm for early combination treatment

If HbA1c < 9%

at diagnosis

Initiate monotherapy

in parallel with

diet/exercise

If HbA1c > 6.5%*

at 3 months

Initiate combination

therapy in parallel

with diet/exercise

If HbA1c 9%

at diagnosis

Initiate combination

therapy or insulin

in parallel with

diet/exercise


7/10

Approximately 75% of type 2 diabetes patients donot achieve their glycemic goals with monotherapy.1

Combination therapy offers several potentialadvantages, including better glycemic control andimproved tolerability, compared with high-dosemonotherapy.

In one study, 55% of patients achieved HbA1c < 7%with combination therapy compared with 45% of

patients receiving up-titrated monotherapy.Combination therapy was also better tolerated.2

Earlier initiation of combination therapy has thepotential to increase the proportion of individualsreaching glycemic goals, reduce exposure to periods ofhyperglycemia and reduce risk of complications.

The stepwise treatment approach of diet and exercisefollowed by the addition of increasing doses of oralmonotherapy can cause unacceptable delays inassisting individuals to achieve their glycemic goals.


Recommendation:

After 3 months, if patients are not at targetHbA1c < 6.5%*, consider combination therapy

3

*Or fasting/preprandial plasma glucose < 110 mg/dL (6.0 mmol/L) where assessment

of HbA1c is not possible.

1 Turner RC, et al. JAMA 1999; 281:20052012.

2 Rosenstock J, et al. Diabetes 2004; 53 (Suppl 2):A144.


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FACTsheet 7 Benefits of earlier initiation ofcombination therapy


0

2

4

6

8

10

12

7%

3%

45%

55%

GI side effects

0

10

20

30

40

50

60

HbA1c

MET 1 g/day

+ MET 1 g/day

MET 1 g/day

+ RSG 8 mg/day

MET = metformin

RSG = rosiglitazone

MET 1 g/day

+ RSG 8 mg/day

MET 1 g/day

+ MET 1 g/day

Patientsdisco

ntinuingdue

toGIdisturbances(%)

PatientsachievingHbA1c

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