Diabetic Microvascular Disease:The Role of Glycemic Control and
the Impact on Public Health
Robert E. Ratner, MD
MedStar Research Institute
Georgetown University Medical School
Washington, DC
Diabetes: The Numbers
The National Diabetes Education Program
www.ndep.nih.gov
A joint program of NIH and CDC
December 2006
EVERY 24 HOURS• New Cases – 4,100• Amputations – 230 (60% of non-traumatic
amputations annually)• Blindness – 55 (#1 cause)• Kidney Failure – 120 (#1 cause)
Derived from NIDDK, National Diabetes Statistics fact sheet. HHS, NIH, 2005.
Adjusted ESRD incident rates of ESRD due to diabetes
Incident ESRD patients; adjusted for age, gender, & race.
USRDS, accessed July 13, 2007
Prevalence of Visual Impairment per 100 Adults with Diabetes, by Age, United States, 1997–2003
Source: National Diabetes Surveillance System – CDC website (http://www.cdc.gov/diabetes/statistics/index.htm)
Cumulative Incidence of Hard End-Points: The Pittsburgh EDC Study
Renal Failure Total CAD
Pambianco G. Diabetes 55:1463, 2006
%%%
DCCT: Relationship between Glycemic Control and Retinopathy Progression
Lachin J. Diabetes 57:995, 2008
ukpds
Microvascular Endpoints (cumulative)Microvascular Endpoints (cumulative)
p=0.0099
0%
10%
20%
30%
0 3 6 9 12 15
% o
f pat
ient
s w
ith a
n ev
ent
Years from randomisation
Intensive
Conventional
Risk reduction 25%(95% CI: 7% to 40%)
renal failure or death, vitreous haemorrhage or photocoagulation346 of 3867 patients (9%)
ukpds
Glucose Control Study SummaryGlucose Control Study Summary
The intensive glucose control policy maintained a lower HbA1c by mean 0.9 % over a median follow up of 10 years from diagnosis of type 2 diabetes with reduction in risk of:
12% for any diabetes related endpointp=0.029
25% for microvascular endpointsp=0.0099
21% for retinopathy at twelve yearsp=0.015
33% for albuminuria at twelve yearsp=0.000054
ukpds
Microvascular EndpointsMicrovascular Endpoints
0.5
1
10
15
0 5 6 7 8 9 10 11
37% decrease per 1% decrement in HbA1c
p<0.0001
Updated mean HbA1c
Haz
ard
ratio
UKPDS 35. BMJ 2000; 321: 405-12
UKPDS: A1c as Predictor of Micro- and Macrovascular Disease
Microvascular
Myocardialinfarction
-123456789
10
5 6 7 8 9 10 11
Updated Mean A1c
Est
. H
azar
d R
atio
Stratton IM et al. BMJ. 2000; 321:405-412.
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