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Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
The Science: Diabetes Control
The National Diabetes Education Program Changing the Way Diabetes is Treated.
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
What is Diabetes?Diabetes is a group of diseases characterized by high levels of blood glucose (blood sugar)
Diabetes can lead to serious health problems and premature death
About 24 million Americans have diabetes
NIDDK, National Diabetes Statistics 2007. www.diabetes.niddk.nih.gov/dm/pubs/statistics/
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
Common Types of Diabetes
Type 1 diabetes• 5% to 10% of diagnosed cases of
diabetes
Type 2 diabetes• 90% to 95% diagnosed cases of
diabetes
NIDDK, National Diabetes Statistics 2007. www.diabetes.niddk.nih.gov/dm/pubs/statistics/
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
Common Types of Diabetes• Gestational Diabetes occurs during
pregnancy• 5 to 10 % of women with gestational diabetes are
found to have type 2 diabetes• Increased lifelong risk for mother and child for
developing type 2 diabetes• 40-60 % women with gestational diabetes will
develop diabetes in the next 5 to 10 years
NIDDK, National Diabetes Statistics 2007. www.diabetes.niddk.nih.gov/dm/pubs/statistics/
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
Risk Factors for Diabetes
• Age 45 and older• Overweight (BMI ≥ 25)• Hypertension• Abnormal lipid levels• Family history of diabetes• Race/ethnicity• History of gestational diabetes
• History of vascular disease• Signs of insulin resistance
(such as PCOS or acanthosis nigricans)
• IGT or IFG on previous test• Inactive lifestyle
American Diabetes Association. Diabetes Care 2008; 31;(Suppl.1):S12-54.
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
Diabetes and Cardiovascular Disease
• Cardiovascular disease is the leading cause of death for people with diabetes
• In adults with diabetes:– 68% die of heart disease or stroke– the risk for stroke is two to four times higher – 75% have high blood pressure– smoking doubles the risk for heart disease
NIDDK, National Diabetes Statistics 2007.
www.diabetes.niddk.nih.gov/dm/pubs/statistics/
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
Diabetes Complications•Diabetes is the leading cause of:
– kidney failure– new cases of adult blindness – nontraumatic lower-limb amputations
•In adults with diabetes:– the risk of periodontal (gum) disease is two to
three times higher– 60 to 70 % have mild to severe nervous
system damageNIDDK, National Diabetes Statistics 2007. www.diabetes.niddk.nih.gov/dm/pubs/statistics/
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
Diabetes Control and Complications Trial (DCCT)
Compared effects of two diabetes treatment regimens – standard therapy and intensive control – on the complications of diabetes in people with type 1 diabetes
DCCT. New England Journal of Medicine, 329(14), September 30, 1993.
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
Glucose control is key to preventing or delaying complications of diabetes
Any sustained lowering of blood glucose helps, even if the person has a history of poor control
DCCT Findings
DCCT. New England Journal of Medicine, 329(14), September 30, 1993.
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
DCCT Findings
Lowering blood glucose reduced risk of:
• Eye disease by 76%
• Kidney disease by 50%
• Nerve disease by 60%
DCCT. New England Journal of Medicine, 329(14), September 30, 1993.
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
United Kingdom Prospective Diabetes Study (UKPDS)
Clinical Trial
Looked at intensive management of blood glucose levels and long term risk-factors for diabetes complications in type 2 diabetes
UKPDS. BMJ. 2000; 321:405-412.
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
Mirrored the findings of DCCT in people with type 2 diabetes—better glucose control reduced development of microvascular complications
Demonstrated the need for management of high blood pressure and cholesterol as well as blood glucose levels (the ABCs of diabetes)
UKPDS Findings
UKPDS. BMJ. 2000; 321:405-412.
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
UKPDS Findings
Stratton IM, et al. BMJ. 2000;321:405-412.
P <.0001 P = .035 P = .021 P = .0001
Risk reduction with 1% decline in annual mean A1C
Micro-vascular Disease
37%
PVD
43%
StrokeMI
14% 12%
Heart Failure
Cataract Extraction
16%19%
0%
15%
30%
45%
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
Epidemiology of Diabetes Interventions and Complications
Study (EDIC)
Observational study
DCCT participants (type 1 diabetes)
Looked at risk factors for long-term complications
DCCT/EDIC N Engl J Med 2005: 353:2643-2653.
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
Participants continue to benefit years later from period of intense glucose control
Years after intensive therapy:• Lasting benefits for eye, nerve, and kidney disease
• Reduces CVD events by more than half
EDIC Findings: Intensive Therapy and Diabetes Complications
DCCT/EDIC N Engl J Med 2005: 353:2643-2653.
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
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Years from Study EntryYears from Study Entry
EDIC Findings: Cardiovascular EventsCumulative Incidence of First of Any EventCumulative Incidence of First of Any Event
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
Risk reduction 42% Risk reduction 42% 95% CI: 9% to 63%95% CI: 9% to 63%P = 0.02P = 0.02
0.120.12
0.100.10
0.080.08
0.060.06
0.040.04
0.020.02
0.000.00
ConventionalConventional
IntensiveIntensive
DCCT/EDIC N Engl J Med 2005: 353:2643-2653.
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
ConventionalConventional
IntensiveIntensive
Non-Fatal MI, Stroke, or CVD DeathNon-Fatal MI, Stroke, or CVD Death
EDIC Findings: Cardiovascular Events
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 210 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21
Years from Study EntryYears from Study Entry
0.000.00
0.020.02
0.040.04
0.060.06
0.080.08
0.100.10
0.120.12
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Risk reduction 57% Risk reduction 57% 95% CI: 12% to 79%95% CI: 12% to 79%P = 0.02P = 0.02
DCCT/EDIC N Engl J Med 2005: 353:2643-2653.
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
UKPDS 10 yr Follow-Up Study- insulin/sulfonylurea group
Differences in A1C between intensive & standard glycemic control treatment groups were lost after one year
Relative risk reductions at 10 yr in intensive insulin/sulfonylurea group: 9% for any diabetes end point (P=0.04) 24% microvascular disease (P=0.001) 15% myocardial infarction (P=0.01) 13% death from any cause (P=0.007)
N Engl J Med 2008; 359
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
UKPDS 10 yr Follow-Up Study- metformin group
Differences in A1C between intensive & standard glycemic control treatment groups were lost after one year
Relative risk reductions at 10 yr in intensive
metformin group: 21% for any diabetes end point (P=0.01) 33% myocardial infarction (P=0.005) 21% death from any cause (P=0.002)
N Engl J Med 2008; 359
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
UKPDS 10 yr Follow-Up Study- Blood Pressure findings
Between group differences lost within 2 yrs
Significant relative risk reductions in tight control group were not maintained
Benefits of BP control do not extend beyond intensive therapy period & ongoing treatment is essential
N Engl J Med 2008; 359
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
Recent Clinical Trial Findings:Intensive glucose control in type 2 diabetes:• lowers risk of new or worsening
microvascular complications (ADVANCE)• was associated with increased mortality in
patients with longstanding DM and known CVD (ACCORD)
• increases risk of severe hypoglycemia (ADVANCE, ACCORD and VADT)
ACCORD: N Engl J Med 2008; 358(24):2545-59ADVANCE: N Engl J Med 2008; 358 (24): 2560-72VADT: J Diabetes Complications 2003; 17 (6): 314-22
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
Key points of recent findings: • Intensive glucose control in newly diagnosed
type 1 or type 2 diabetes has benefits during intensive therapy AND a legacy effect for later micro- and macrovascular benefits
• Optimal glucose management should start as early as possible & continue as long as possible
• While the A1C goal for the general population is <7%, treatment must be individualized.
N Engl J Med 2008; 359
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
SEARCH For Diabetes in Youth Study
Observational study
Physician-diagnosed diabetes in youth ages 0-19
Data will help researchers better understand and treat diabetes in young people
(SEARCH). Diabetes Care 2006 29(8): 1891-6.
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
SEARCH FindingsDetermine prevalence and correlates of selected CVD risk factors among youth with diabetes
21% of young people with diabetes had at least two CVD risk factors
Prevalence of CVD risk factors was higher among youth aged 10-19 years and among girls
(SEARCH). Diabetes Care 2006 29(8): 1891-6.
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
SEARCH Findings
In young people with type 2 diabetes:
• 92% had at least two CVD risk factors
In young people with type 1 diabetes:
• 14% had at least two CVD risk factors
(SEARCH). Diabetes Care 2006 29(8): 1891-6.
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
National Diabetes Education Program Materials
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
Diabetes Control: Patient Materials
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
Diabetes Control: Health Care Professionals
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
NDEP Websites
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
Other NDEP Campaign Tools at www.YourDiabetesInfo.org• TV, radio, and print PSAs
• Sample feature articles
• Sample press releases and media advisories
• Fact sheets
• Web buttons/blurbs
• NDEP logos and banners
Diabetes: Control
Revised November 2008
The National Diabetes Education Program
wwwYourDiabetesInfo.org ∙ 1-888-693-NDEP
A joint program of NIH and CDC
For more information about NDEP and to order or download free
materials:
Call 1-888-693-NDEPor
Visit www.YourDiabetesInfo.orgThe U.S. Department of Health and Human Services’ National
Diabetes Education Program is jointly sponsored by the National Institutes of Health and the Centers for Disease Control and
Prevention with the support of more than 200 partner organizations.