Post on 08-Jul-2015
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