Diabetes management: lessons from around the globe Romania. S. Popa (Romania)

Transcription

1 Diabetes management: lessons from around the globe Romania S. Popa (Romania)

2 DIABETES MANAGEMENT: LESSONS FROM AROUND THE GLOBE ROMANIA SG Popa, M Mota, E Mota, A Mitrea

3 Agenda Premises: diabetes as a huge and growing problem PREDATORR Study Children with diabetes in Romania Therapy in type 2 diabetes (CEGEDIM data) Conclusions Acknowledgements

4 Premises Diabetes (DM) and related comorbidities are major public health problems in the new millennium in most countries Recent studies of the prevalence of DM and prediabetes were furnished only for few countries The prevalence of DM, prediabetes and other metabolic diseases has not undergone until present a rigorous scientific evaluation in Romania.

5 Diabetes is a huge and growing problem

6 and the costs to society are high and escalating Diabetes is a human and economic burden 4.9 million deaths per year 50% of deaths under 60 years of age Intersects with all dimensions of development US$612 billion 1 of worldwide healthcare expenditure

7 Agenda Premises: diabetes as a huge and growing problem PREDATORR Study Children with diabetes in Romania Therapy in type 2 diabetes (CEGEDIM data) Conclusions Acknowledgements

8 Protocol number SRDCEB/2012/001; Eudra CT Number: Beneficiaries: - Romanian Society of Diabetes, Nutrition and Metabolic Diseases (RSDNMD) - Romanian Society of Nephrology (RSN) Investigators: 101 General physician CRO: CEBIS International ( Central Laboratory for the analysis of the study: Synevo

9 PREDATORR Primary goals Estimating the prevalence of DM and pre diabetes in the adult population of Romania Estimating the prevalence of overweight and obesity in the adult population of Romania Estimating the prevalence of the chronic kidney disease in the adult population of Romania Note: Prevalence distribution of the pre-specified subgroups (eg age groups etc) is also expected.

10 PREDATORR Secondary goals Estimating the prevalence of DLP in Romania Estimating the prevalence of Hyperuricemia in Romania Estimating the prevalence of Metabolic Syndrome in the population of Romania. Estimating the prevalence of HTN in Romania CVR assessment in the population of Romania: SCORE diagram for the high-risk areas Metabolic risk evaluation through FINDRISC score

11 PREDATORR Subject inclusion Subjects were randomly assigned for screening from the list of each GP via a random number generator Inclusion criteria Subjects aged years Born and with residence in Romania Living for the past 10 years mainly in Romania Included on the list of a GP affiliated with CNAS Signing the I.C. Exclusion criteria Subjects aged <20 and >79 years Born outside Romania Living for the past 10 years mostly outside Romania Refuse or can not sign the informed consent Pregnant or breastfeeding women

12 ROMANIA at a glance - PREDATORR 2013 NGT 71.9% Prediabetes 16.5% Diabetes 11.6% Known diabetes 9. Unknown diabetes 2.4%

13 ROMANIA at a glance - PREDATORR 2013 DIABETES Diabetes in Romania (20-79 years)) Adult Romanian population (20-79 years) Number of people with diabetes Age- and sex-adjusted prevalence of diabetes Undiagnosed cases (unknown diabetes mellitus UKDM) 11.6% Age- and sex-adjusted prevalence of UKDM 2.4%

14 Diabetes worldwide Diabetes in Romania - PREDATORR 2013 (Adults years); Source: IDF Diabetes Atlas Sixth Edition 2014

15 Top 10 countries/territories for prevalence (20-79 years) 2013 and 2035 Romania PREDATORR ,6% Source: IDF Diabetes Atlas Sixth Edition 2013

16 EUROPE at a glance Romania at glance PREDATORR 2013 Source: IDF Diabetes Atlas Sixth Edition 2014

17 Diabetes surge in EUROPE PREDATORR Romania million Romania 11.6% Spain % Portugal % (Adults years) Source: IDF Diabetes Atlas Sixth Edition 2014

18 Diagnosed and undiagnosed diabetes among people aged 20 years or older, United States, 2012 Romania PREDATORR million people have diabetes (11.6% of adult Romanian population) million people have undiagnosed diabetes (20.69% of people of diabetes) Source: National Health and Nutrition Examination Survey estimates applied to 2012 U.S. Census data

19 ROMANIA at a glance - PREDATORR 2013 Prevalence of impaired glucose regulation by sex and age groups 50,4% 49,3% 35,5% 29,4% 11,5% 8, Mota M. Prevalence of Diabetes Mellitus and Prediabetes in the Adult Romanian Population: PREDATORR Study. Journal of diabetes in press (available at

20 ROMANIA at a glance - PREDATORR 2013 Prevalence of DIABETES and PREDIABETES by age groups 2 4,3% 3, 13.3% 18,9% 17,7% 27,8% 2.9% 0, 2,7% 6,9% 10, Mota M. Prevalence of Diabetes Mellitus and Prediabetes in the Adult Romanian Population: PREDATORR Study. Journal of diabetes in press (available at

21 ROMANIA at a glance - PREDATORR 2013 Prevalence of DIABETES and PREDIABETES by sex 13.6% 2,9% 9.8% 16,3% 1,9% 16,7% 10,7% 7,9% Mota M. Prevalence of Diabetes Mellitus and Prediabetes in the Adult Romanian Population: PREDATORR Study. Journal of diabetes in press (available at

22 ROMANIA at a glance - PREDATORR 2013 Prevalence of DIABETES by sex and age groups 24.3% 4,6% 20% 17% 4, 4,9% % 0 3,5% 2.4% 0,5% 1,9% 12, 1,8% 8,4% 19,7% 15,9% Mota M. Prevalence of Diabetes Mellitus and Prediabetes in the Adult Romanian Population: PREDATORR Study. Journal of diabetes in press (available at

23 Prevalence (%) of people with diabetes by age and sex, 2013 (Adults years) Source: IDF Diabetes Atlas Sixth Edition 2013

24 ROMANIA at a glance - PREDATORR 2013 PREDIABETES Prediabetes in Romania (20-79 years)) Adult Romanian (20-79 years) Number of people with prediabetes Age- and sex-adjusted prevalence of prediabetes 16.5% Mota M. Prevalence of Diabetes Mellitus and Prediabetes in the Adult Romanian Population: PREDATORR Study. Journal of diabetes in press (available at

25 Prediabetes worldwide Study population Prediabetes prevalence Observations US; 20 years 37% Prediabetes Portuguese; years 27% IFG and/or IGT Spanish; 18 years 14.8% IFG and/or IGT European; years 9. IGT Romanian; years 16.5% Prediabetes Source: National Health and Nutrition Examination Survey estimates applied to 2012 U.S. Census data Gardete-Correia L et al. First diabetes prevalence study in Portugal: PREVADIAB study. Diabet Med. 2010; 27: Soriguer F et al. Prevalence of diabetes mellitus and impaired glucose regulation in Spain: The Di@bet.es Study. Diabetologia. 2012; 55: IDF Diabetes Atlas Sixth Edition 2013

26 ROMANIA at a glance - PREDATORR 2013 Prevalence of PREDIABETES by sex and age groups 26, 29,3% 18,5% 19, 8% 5,7% Mota M. Prevalence of Diabetes Mellitus and Prediabetes in the Adult Romanian Population: PREDATORR Study. Journal of diabetes in press (available at

27 Prevalence (%) of IGT (20-79 years) by age and sex, 2013 (Adults years) Source: IDF Diabetes Atlas Sixth Edition 2013

28 Agenda Premises: diabetes as a huge and growing problem PREDATORR Study Children with diabetes in Romania Therapy in type 2 diabetes (CEGEDIM data) Conclusions Acknowledgements

29 Children with diabetes in Romania 1996: National Diabetes Register of the Child 2014: 401 new cases of type 1 diabetes and 6 new cases of type 2 diabetes in children 2014: type 1 diabetes incidence was 10.7/ : 2809 Children with diabetes in Romania There is a public hospital specialized in pediatric diabetes (Medical Center "Cristian Serban" European Centre of Excellence in Pediatric Diabetes in 2011). Vlad A ONROCAD Study group, 2015.

30 Agenda Premises: diabetes as a huge and growing problem PREDATORR Study Children with diabetes in Romania Therapy in type 2 diabetes (CEGEDIM data) Conclusions Acknowledgements

31 Type of therapy for type 2 diabetes patients 18% 13% 45% 47% Diet Polytherapy Bitherapy Monotherapy 36% 38% TOTAL = 1409 PATIENTS (weighted) Bitherapy includes fixed combinations

32 Type of therapy Classes in monotherapy BIGUANIDES 66% 6 SULPHONYLUREAS INSULINS 16% 2 14% 13% AGI DPP-IV INHIBITORS GLP-1 AGONISTS GLINIDES GLITAZONES 0,4% 0,40% 0,10% Displaying categories >

33 Type of therapy, Classes in bitherapy BIGUANIDES+SULPHONYLUREAS 35% 39% BIGUANIDES+INSULINS 24% 24% INSULINS+INSULINS 9% 1 DPP-IV INHIBITORS+BIGUANIDES 6% 9% SULPHONYLUREAS+INSULINS 5% 5% BIGUANIDES+GLP-1 AGONISTS 4% BIGUANIDES+AGI Displaying categories >

34 Type of therapy, Classes in polyherapy BIGUANIDES+SULPHONYLUREAS+INSULINS BIGUANIDES+INSULINS+INSULINS DPP-IV INHIBITORS+BIGUANIDES+SULPHONYLUREAS AGI+BIGUANIDES+SULPHONYLUREAS 18% 10% 13% 9% 10% 26% 3 29% BIGUANIDES+GLP-1 AGONISTS+SULPHONYLUREAS 6% DPP-IV INHIBITORS+BIGUANIDES BIGUANIDES+INSULINS BIGUANIDES+AGI+INSULINS BIGUANIDES+BIGUANIDES BIGUANIDES+SULPHONYLUREAS+GLITAZONES 5% 4% 5% Displaying categories >

35 Type of therapy Brands Brands in monotherapy SIOFOR DIAPREL METFOGAMMA LANTUS GLUCOPHAGE GLURENORM metforminum NOVOMIX AMARYL HUMALOG LEVEMIR GLUCOBAY HUMULIN JANUVIA 48% 9% 9% 6% 4% 4% 3% 4 13% 1 4% 4% 3% 3% 3% 3% 0,4% DIAPREL+SIOFOR LANTUS+SIOFOR JANUVIA+SIOFOR AMARYL+SIOFOR SIOFOR+LEVEMIR DIAPREL+METFOGAMMA NOVOMIX 30+SIOFOR GLIBOMET LEVEMIR+NOVORAPID SIOFOR+GLUCOBAY LANTUS+APIDRA METFOGAMMA+LANTUS NOVORAPID+LANTUS HUMALOG+LANTUS BYDUREON+SIOFOR 20% 8% 7% 6% 4% 4% 4% 3% 18% 7% 4% 1 4% 4% 4% 8% LANTUS+DIAPREL+SIOFOR DIAPREL+SIOFOR+LEVEMIR SIOFOR+AMARYL+LANTUS JANUVIA+SIOFOR+AMARYL SIOFOR+DIAPREL+JANUVIA SIOFOR+AMARYL+GLUCOBAY GLUCOBAY+SIOFOR+DIAPREL JANUVIA+GLIBOMET LEVEMIR+NOVORAPID+SIOFOR LEVEMIR+AMARYL+SIOFOR BYDUREON+DIAPREL+SIOFOR BYETTA+DIAPREL+SIOFOR SIOFOR+NOVORAPID+LANTUS LANTUS+GLIBOMET SIOFOR+LANTUS+APIDRA AMARYL+METFOGAMMA+LANTUS SIOFOR+APIDRA+LANTUS 9% 6% 5% 5% 4% 4% 4% 4% 3% 3% 3% 6% 1 4% 7% 5% 3% 3% 4% 3% Brands in bitherapy Brands in polytherapy Displaying categories >

36 Agenda Premises: diabetes as a huge and growing problem PREDATORR Study Children with diabetes in Romania Therapy in type 2 diabetes (CEGEDIM data) Conclusions Acknowledgements

37 Conclusions The PREDATORR study, for the first time, provides data for Romania on the prevalence of DM and prediabetes and their relationship with important risk factors in a representative sample of the Romanian adult population. The final data of the PREDATORR study indicate an increased prevalence of diabetes and prediabetes, which has doubled compared to previous estimations These results are of high value for the health authorities and can be used to help inform decision making in order to initiate the implementation of prevention programs that may reduce the economic burden of DM in Romania.

38 Agenda Premises: diabetes as a huge and growing problem PREDATORR Study Children with diabetes in Romania Therapy in type 2 diabetes (CEGEDIM data) Conclusions Acknowledgements

39 Acknowledgements Sponsors: Romanian Society of Diabetes Nutrition and Metabolic Diseases (RSDNMD), IHS Sofmedica, Abbott, Astra Zeneca, Novo Nordisk, MSD, Servier, Novartis, Worvag Pharma The Company CEBIS International ( for: Study Documentation Development, Feasibility, Project Management, Monitoring, Data Management, Statistical Analysis and Final Report Profesor Cristian Baicus - Head of the Clinical Epidemiology Unit of Bucharest, in the RECIF (Reseau d Epidemiologie Clinique International Francophone) and INCLEN (International Clinical Epidemiology Network) for review / validation of the statistical analysis Synevo Central Laboratory, for performing the analysis of the study Those 101 general physicians who who enrolled the participants, filled in the study questionnaires, and collected blood and urine samples from the participants