2014 ROTARY INTERNATIONAL CONVENTION

Rotarian Action Group on

Diabetes

2014 ROTARY INTERNATIONAL CONVENTION

Diabetes Overview

Prof Martin Silink

Rotary Club of Lane Cove

University of Sydney

Diabetes Atlas 2013

Type 1 children 500,000

Type 2 adults 382,000,000

>7 million more each year

4,000,000 Deaths per year

1,000,000 Amputations per year

Leading cause of adult blindness

Leading cause of adult kidney failure

80% in developing world

Prevalence estimates for 2013

The Size of the Problem

Diabetes in Australia – the epidemic grows

A touch of sugar can’t be too serious ?

???????

Does Mild Diabetes exist?

Burden of disease in Australia

DALY’s

(Disability

Adjusted

Life Years)

Number of

years lost

due to

ill-health,

or early

death

Not all cells are equally damaged by high glucose levels

Most cells are able to maintain a relatively normal

internal glucose level despite elevated blood

glucose

Four organs are not effective in doing this:

Retina Nerves Kidney Large arteries

Retinopathy Neuropathy Nephropathy

Key Concepts in Chronic Complications

Atherosclerosis

FinnDiane Study of Mortality and Nephropathy

Groop PH et al Diabetes 2009;58:1651-1658

4201 people with T1D

Finland major clinics

Mean Ages 36-42

Diabetes 20-32 years

SMR 2.8

SMR 0.8

SMR 9.2

GLUCOSE + SUPEROXIDE

Reactive oxygen species

Damage is caused by:

Prevention of Chronic Complications

Major Trials proving Glucose control matters

Type 1 diabetes

• DCCT 1983-1993

• Post DCCT/EDIC 1993+

Type 2 diabetes

• UKPDS 1978-1998

• Kumamoto 1992-2000

Key Concepts in Chronic Complications

Key Results of DCCT:

1441 patients with T1D, aged 13-39 years

Half treated intensively to maintain HbA1c 7.2%

Half treated conventionally maintained HbA1c 9.2%

Intensive treatment reduced:

• eye disease by 76%

• kidney disease by 50%

• nerve disease by 60%

Diabetes Control and Complications Trial Results

Trials proved

Glucose Control Matters

Key Concepts in Chronic Complications

Modern-Day Clinical Course of Type 1 Diabetes Mellitus After 30 Years’

Duration

The Diabetes Control and Complications Trial/Epidemiology of Diabetes

Interventions and Complications and Pittsburgh Epidemiology of Diabetes

Complications Experience (1983-2005) D Nathan et al, and Diabetes Control and

Complications Trial/Epidemiology of Diabetes Interventions and Complications

(DCCT/EDIC) Research Group* Arch Intern Med. 2009 July 27; 169(14): 1307–

1316. doi: 10.1001/archinternmed .2009.193

Retinopathy

Nephropathy

Cardiovascular

Disease

Cumulative incidences after 30 years

of diabetes:

CT IT

Retinopathy 50% 21%

Nephropathy 25% 9%

Cardiovascular disease 14% 9%

<1% became blind, required kidney

replacement, or had an amputation

DCCT/EDIC Study after 30 Years

Trials proved

Metabolic Memory

Period of good control has long

term benefits

Key Concepts in Chronic Complications

Preventing the Diabetes Burden

Primary

Prevention

Secondary

Prevention

Tertiary

Prevention

Life

Expectancy

in T1D and T2D

Glucose monitoring

Lifestyle

No smoking

Physical activity

BP control

Lipid Control

Improving

social determinants

of health

Access to care

Self empowerment

Intensive therapy

Diabetes education

Strategies to Improve Life Expectancy in Diabetes

Complications screening

Aspirin

Early

diagnosis

What can Rotary do?

SUPPORT:

Insulin

Glucose monitoring

Diabetes education

Training of health professionals

Complication screening

Foot care

Eye care

BP control

ADVOCATE:

Healthy cities

Healthy schools

Healthy work

Healthy foods

PROMOTE:

Healthy weight

Healthy eating

Healthy activity

What can Rotary do?

LFAC

Be the voice of the community for healthy living

Please join the Rotarian Action Group on Diabetes

RAGD

Thank you

RAGD