The concept of Diabetes & CV risk:A lifetime risk challenge

Priorities in the management

of type 2 diabetes:

Past, present and future

Sir George Alberti, MDDiabetes UK ChairmanNewcastle, United Kingdom

Cardio Diabetes Master ClassEuropean chapterMunich, GermanyMay 6-8, 2011

Slide lecture prepared and held by:

Presentation topic

TYPES OF DIABETES

“Diabetes mellitus … manifests itself in two principle clinical forms (a) acute and (b) chronic. Acute diabetes usually occurs in persons under 40 years of age … in children and young adults. Chronic diabetes … occurs as a rule in elderly people … and often in those who are … decidedly obese.

Saundby, 1907

GROWING RATES OF DIABETES WORLDWIDE

• 30 million people in 1985

• 100 million in 1994

• 200 million in 2003

• 380 million by 2025

• 3.8 million deaths per year

• 30 million people in 1985

• 100 million in 1994

• 200 million in 2003

• 380 million by 2025

• 3.8 million deaths per year

Global projections for the diabetes epidemic: 2007-2025 (millions)

IDF Atlas 2006

46.5 80.373%

67.0

99.448%

10.4 18.780%

24.5 44.581%

53.2

64.121%

28.3

40.543%

16.2 32.7102%

World 2007 = 246

million 2025 = 380

millionIncrease 55%

Diabetes Atlas, 3rd edition, IDF 2006

The relationship between BMI and the risk of developing type 2 diabetes

Type 2 diabetes, the metabolic syndrome and cardiovascular disease in Europe

5

1.0 1.0 1.0 1.5

4.4

6.7

11.621.3

42.1

2.22.9

4.3 5.0

15.827.6

40.3

54.0

93.2

8.110

Women

Men

40

70

100

0<22 <23 23-

23.9

Body mass index (kg/m2)

24.9 26.9 28.9 30.9 32.9 34.924- 25- 27- 29- 31- 33- 35+

Ris

k o

f ty

pe

2 d

iab

etes

Android (Apple) vs Gynoid (Pear) Obesity

Jean Vague 1947

PRIORITIES FOR THE MANAGEMENT OF TYPE 2 DM

• Early aggressive management of glucose• ?start at “prediabetic” levels?• Early aggressive management of CVD risk factors

PRIORITIES FOR THE MANAGEMENT OF TYPE 2 DM

Key Challenges• Prevention • Behavioural change• Cellular and molecular mechanisms• Genetic basis??• Stem cell therapy• B-cell replacement/regeneration• Safe, effective insulin sensitisers• Anti-obesity agents• CVD prevention

THE UNMET NEEDS: TREATMENT

• Better education

• Effective behavioural therapy

• Preservation of B-cell function

• Specific prevention of complications

• Better monitoring of control

• Prevention of cardiovascular disease

• Societal interventions• INDIVIDUALISED THERAPY