EPIDEMIOLOGY OF DIABETES AND ITS COMPLICATIONS IN TRANSCARPATHIAN REGION
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1 EPIDEMIOLOGY OF DIABETES AND ITS COMPLICATIONS IN TRANSCARPATHIAN REGION Reporter: Yuriy Korsak Co-authors: Mykola Kishko, Yosyp Pichkar, Olga Krafchyk, Olga Oleksyk Užhorod National University Transcarpathian Regional Clinical Hospital n.a. A. Novak Užhorod, Ukraine
2 Epidemiology of DM 31,904 people 2.56 % More than 285 million people 4.1 % 1,221,300 people 2.67 %
3 The purpose of the study to study the prevalence of diabetes mellitus and its complications in Transcarpathian region
4 Dynamics of diabetes prevalence in Transcarpathia Type 1 Diabetes Type 2 Diabetes
5 Proportion of different types of diabetes in Transcarpathia 100% 14.5% 13.2% 6.24% 80% 60% 40% 20% 0% Type 1 Diabetes Type 2 Diabetes
6 Proportion of insulin therapy of diabetes in Transcarpathia 100% 16.3% 14.6% 15.5% 80% 60% 40% 20% 0% Treatment with insulin Non-insulin treatment
7 Proportion of insulin therapy of type 2 diabetes in Transcarpathia 100% 2.1% 1.7% 9.2% 80% 60% 40% 20% 0% Treatment with insulin Non-insulin treatment
8 Diabetes complications in Transcarpathia % % 46.4% 7.79% 9.94% 46.0% 7.53% 2.49% 13.2% 1.78% 28.12% 59.1% 26.04% 3.44% 9.8% 3.01% 21.41% 47.3% 19.68% Nephropathy Retinopathy Cataract Neuropathy 0.65% 2.7% 0.51% Diabetic foot Limb angiopathy Gangrene Total DM Type 1 DM Type 2 DM
9 Endocrinological care in Transcarpathian region Outpatient visits per 1 endocrinologist per year (*1 000) Endocrinologists (per diabetic population) Inpatient beds (per diabetic population)
10 Diabetes education and podiatric 8,00% care in Transcarpathia 4,00% 0,00% Diabetic education service, % of diabetes cases Diabetic foot service, % of diabetes cases Diabetic amputations, of diabetes cases
11 Compensation levels of diabetes in 30 Transcarpathia (4459 cases) % 18.3% 20.1% 20.6% % % 11.2% 0 <7% 7-8% 8-9% 9-10% 10-11% >11% HbA1c
12 Summary 1. There is 1.8-fold increase in DM prevalence over last decade 2. The portion of T2DM grew from 85.5% up to 93.8% over last decade 3. Insulin treatment of T2DM increased 4.4-fold but still remained under recommended value (9.2% against 20-30%) 4. T1DM complications are 3-6 times more often than T2DM ones 5. Diabetic care is slowly shifting accents to outpatient help though therapeutic load per endocrinologist is excessive 6. Diabetic education and diabetic foot care showed certain improvement in recent years though it remains definitely insufficient (only 11.4% of controlled DM)
13 Thank you for attention!
14 DIRECT AND INDIRECT REVASCULARIZATION OF LOWER EXTREMITIES IN Reporter: Yuriy Korsak DIABETIC PATIENTS Co-authors: Vyacheslav Korsak, Vasyl Rusyn, Oleksiy Nosenko Užhorod National University Transcarpathian Regional Clinical Hospital n.a. A. Novak Užhorod, Ukraine
15 The purpose of the study to evaluate the effectiveness of different methods of surgical treatment of peripheral atherosclerosis in diabetic patients
16 Surgical treatment of diabetic patients I group 140 patients (femoral-popliteal-tibial reconstruction); ІІ group 32 patients (indirect revascularization).
17 Methods of direct revascularization Thrombendarterectomy of femoral or popliteal artery 53 (37.9%) Femoral-popliteal grafting 56 (40%) Femoral-popliteal prosthetics 9 (6.4%) Popliteal-tibial grafting 22 (15.7%)
18 Thrombendarterectomy of femoral artery and autovenous plastics 12 cases
19 Thrombendarterectomy of Hunter channel and autovenous plastics - 27 cases
20 Thrombendarterectomy of tibial arteries and autovenous plastics 14 cases
21 Autovenous femoral-popliteal grafting 56 cases
22 Femoral-popliteal GORE-TEX prosthetics 9 cases
23 Below-knee grafting 22 cases Popliteal-fibularis autovenous grafting 4 cases
24 Popliteal-tibioanterior autovenous grafting 3 cases
25 The results of direct revascularizations in diabetic patients % % Thrombosis Graft infection / erosion Amputation % Mortality 5 2.1% 0
26 Long-term results of direct revascularizations % 56.4% Graft patency Limb salvage
27 Methods of indirect revascularizations Rotor osteotrepanation of tibia (ROT) ROT combined with profundoplastics
28 Diagnostic approach to indirect revascularizations Ultrasound Dopplerography Rö-contrast Angiography Radionuclide angiography
29 Intra-arterial radionuclide angiography
30 Intra-arterial radionuclide angiography (hyper- and hypoperfusion of foot)
31 ROT of tibia
32 ROT of tibia (5 incisions)
33 ROT and fasciotomy
34 Rö-graphy of shins after ROT in 3 years in 9 years
35 In 2 weeks In 4 weeks In 3 months In 1.5 year In 2 years
36 Limb salvage after indirect revascularizations (Kaplan-Meier analysis) 100% 90% 80% 70% F, % 60% 50% 40% 30% 42,4% 33,3% Контроль РОТ 20% 100% 10% 90% 0% час спостереження, місяці F, % 80% 70% 60% 50% 40% 30% 47,7% 42,4% Контроль РОТ+Проф 20% 10% 0% час спостереження, місяці
37 Indirect revascularizations in diabetic patients ROT Profund. + ROT
38 The results of indirect revascularizations in diabetic patients % 56.3% 43.8% Early 1 year 2 years Limb salvage
39 Summary 1. Surgical treatment of chronic limb ischemia must include direct and indirect revascularizations 2. The results of direct revascularizations showed 61.4% graft patency and 75% limb salvage during the 2 nd year and 56.4% graft patency and 71% limb salvage up to the 3 rd year of follow-up in diabetic patients 3. The results of indirect revascularizations (mainly ROT) showed 43.8% limb salvage till the end of 2 nd year of follow-up in diabetic patients
40 Thank you for attention!
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