Presenter Disclosure

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1 Presenter Disclosure Linong Ji.M.D Consulting and lecture fee Eli Lilly, Bristol-Myers Squibb, Novartis, Novo Nordisk, Merck, Bayer, Takeda, Sanofi-Aventis, GlaxoSmithKline, Roche, Johnson & Johnson, boehinger ingelheim, Guangzhou Zhongyi Pharmaceutical, Roche Diagnostics Employee: Peking University People s Hospital Research Support: Roche Diagnostics

2 SMBG Frequency and Experience in China Linong Ji, MD Peking University People s Hospital

3 Rapid Growth of Diabetes Prevalence in China 9.7% Diabetes Prevalence urban: 4.5% rural: 1.8% % 0.67% <China Guideline for Type 2 Diabetes>(Discussion Edition). 2 Yang WY, et al. NEJM 2010; 362:

4 China HbA1c monitor net work Time and sample size Time: 2009/7-2009/11 Number: (90474 on oral agent ) 4

5 Glycemic control----65% not on HbA1c target 6.5 HbA1c<7 7 HbA1c<8 HbA1c>7% 8 HbA1c<9 HbA1c 9 5

6 Hb A 1c(%) Glycemic control level of insulin treated type 2 patients in China HbA1c monitoring network (2010) mean 餐时胰岛素 Prandial 基础胰岛素 Basal 预混胰岛素 Pre-mix N=52649

7 IDMPS The International Diabetes Management Practices Survey The IDMPS is a 5-year observational survey documenting the management of people with diabetes in the developing world; including countries in Asia, Eastern Europe, Latin America and the Middle East and Africa There is 5 waves, one per year, each examining a different aspect of diabetes management Chan JCN, et al. Diabetes Care 2009;32:

8 IDMPS Wave 1 was conducted in 17 countries around the globe 11,799 patients with T1D and T2D recruited by 937 physicians Asia (n=5,888) Eastern Europe (n=3,519) Latin America (n=2,116) Africa (n=276) Korea Romania Argentina Tunisia China Bulgaria Ecuador Indonesia Turkey Venezuela India Bosnia Colombia Hong Kong Taiwan Malaysia Thailand Chan JCN, et al. Diabetes Care 2009;32:

9 IDMPS : Only 36% of T2D patients were at glycemic target (HbA1c <7%) across regions HbA1c <7% 36.4% Blood Pressure <130/80 mmhg 19.2% All regions (n=9,901) LDL cholesterol <100 mg/dl 33.2% HDL cholesterol >40 mg/dl 64.4% Triglycerides <150 mg/dl Reached HbA1c, blood pressure, and LDL cholesterol recommended targets 49.0% 3.6% 0% 20% 40% 60% % Patients (with available data) Chan JCN, et al. Diabetes Care 2009;32:

10 IDMPS-T1D patient profiles were similar in all regions T1D study population (mean±sd) Asia (n=510) Eastern Europe (n=914) Latin America (n=404) All T1D (n=1,898) Mean age (years) 35.0± ± ± ±14.0 Mean diabetes duration (years) 9.7± ± ± ±9.2 BMI (kg/m 2 ) Men 22.0± ± ± ±3.7 Women 22.1± ± ± ±3.8 HbA1c (%) 8.6± ± ± ±2.0 Chan JCN, et al. Diabetes Care 2009;32:

11 IDMPS: key results in T2DM patients Very few T2D patients reached glycemic, blood pressure and lipid targets across regions HbA1c <7% Blood Pressure <130/80 mmhg LDL cholesterol <100 mg/dl 12.0% 36.0% 36.0% 37.3% 36.4% 22.1% 21.8% 19.2% 31.6% 25.5% 37.0% 33.2% Latin America (n=1,712) Eastern Europe (n=2,605) Asia (n=5,376) All regions (n=9,901) HDL cholesterol >40 mg/dl 63.4% 64.5% 64.4% 64.4% Triglycerides <150 mg/dl 48.2% 44.6% 51.4% 49.0% Reached HbA1c, blood pressure, and LDL cholesterol recommended targets 3.8% 1.3% 4.7% 3.6% 0% 20% 40% 60% % Patients (with available data) 11 Chan JCN, et al. Diabetes Care 2009;32:

12 IDMPS: 36% of T2D patients had never had their HbA1c measured across regions All regions T2D patients (n=9,901) Never had HbA1c measured 36% Not screened for complications in last 2 years 11-36% No health coverage 33% Reported diabetes-associated hospitalization or work absenteeism in last 6 months 10% Chan JCN, et al. Diabetes Care 2009;32:

13 IDMPS China: Self Monitoring Blood Glucose (2006) Number (%) of patients T1 DM T2 DM N=63 Diet and exercise N=7 OHA alone N=300 Insulin + OHA N=241 SMBG total 63.5 % 14.3 % 23.3 % 50.2 % FBG 97.6 % 100 % 94.6 % 97.6 % PPG 95.0 % 100 % 86.5 % 89.5 % Frequency/week Mean ± SD 1.92 ± ± ±1.71

14 Compass study glucose control in insulin treated type 2 patients HbA1c n min Max mean (SD) HbA1c N (%) HbA1c 6.5% HbA1c % HbA1c % HbA1c>

15 COMPASS Study Daily SMBG in insulin treated type 2 diabetes patients Daily SMBG ( times/day) >4 random Basal Prandial Basal -bolus Pre-mix % 8.0%.8% 1.6% 0% 55.2% % 20.5% 0% 4.5%.0% 45.5% % 16.9% 11.9% 5.1% 3.4% 47.5% % 12.7% 3.5% 2.4% 1.6% 62.9%

16 Major barriers in SMBG SMBG concept Patients education, self management Commitments from care providers Financial : reimbursement issue Action diet exercise SMBG Interpretation durg1 drug2 drug3 Glucose control drug4

17 A Nationwide Survey of Diabetes Education, Self-Management and Glycaemic Control in Patients with Type 2 Diabetes in China A multi-central, cross-sectional, questionnaire-based survey From April, 2010 to July, 2010 Face to face interviews Type 2 diabetes patients with duration 1 year 50 sites across 29 provinces and municipal cities in China involved in 6061patients with type 2 diabetes were surveyed Variables (%) Age, mean (SD) Sex Male (%) % Female (%) % BMI, mean (SD) (4.10) Duration of Diabetes, mean (SD) 8.79 (6.85) Chinese Diabetes Education Status Survey study group. A Nationwide Survey of Diabetes education, Self-management and Glycaemic Control in Patients with Type 2 Diabetes in China. 17

18 80% Patients Considered They Received Education on Diabetes No 20.2% Whether or Not Patients Received Diabetes Education after Diagnosis Yes 79.8% 100% Proportion of Patients Received Different Aspects of Education on Diabetes 80% 60% 65.8% 72.3% 67.3% 59.4% 57.8% 47.0% 40% 20% (N=5961) 0% Common knowledge Diet Exercise Drugs (Insulin) Self-monitor of BG Diabetic Complications Chinese Diabetes Education Status Survey study group. A Nationwide Survey of Diabetes education, Self-management and Glycaemic Control in Patients with Type 2 Diabetes in China. 18

19 Resource for Diabetes Relevant Knowledge Patients Proportion 100% 80% 83.3% 60% 52.8% 40% 35.8% 20% 14.6% 10.6% 5.7% 0% Health professionals Community TV/radio Journals/books Internet No idea of Diabetes Chinese Diabetes Education Status Survey study group. A Nationwide Survey of Diabetes education, Self-management and Glycaemic Control in Patients with Type 2 Diabetes in China. 19

20 Over 56% of the Patients did not know the HbA 1c Target Value 56.65% No! Knowing of HbA 1c Target Value 43.35% Yes! Chinese Diabetes Education Status Survey study group. A Nationwide Survey of Diabetes education, Self-management and Glycaemic Control in Patients with Type 2 Diabetes in China. 20

21 Diabetes Self-Care Activities Assessment The mean scores for subscales of SDSCA (N=5958): Medications 5.95 Foot care 4.16 Blood glucose testing 2.96 Exercise Specific diet General diet Score Chinese Diabetes Education Status Survey study group. A Nationwide Survey of Diabetes education, Self-management and Glycaemic Control in Patients with Type 2 Diabetes in China. 21

22 The scores of Diabetes Self-Care Activities was higher in patients received diabetes education Score * General diet Specific diet Exercise Blood glucose testing * P<.0001 between the two groups * * Patients with Diabetes education (N=4753) Patients without Diabetes education (N=1025) * 4.27 * 3.77 Foot care * Medications Diabetes self-care assessed by the Summary of Diabetes Self-Care Activities (SDSCA) scale on a scale of 1 to 7 Chinese Diabetes Education Status Survey study group. A Nationwide Survey of Diabetes education, Self-management and Glycaemic Control in Patients with Type 2 Diabetes in China. 22

23 The Average Value of Glycosylated Hemoglobin (HbA 1c ) Lower in Patients with and without Diabetes Education (N=2868) (N=612) HbA 1c (%) Patients with Diabetes education 8.83 Patients without Diabetes education Chinese Diabetes Education Status Survey study group. A Nationwide Survey of Diabetes education, Self-management and Glycaemic Control in Patients with Type 2 Diabetes in China. 23

24 Chinese Diabetes Society Diabetes Care & Education Study Group of Chinese Diabetes Society founded, 2007 Chinese Guideline on Glucose Monitoring, 2010 China Guideline For Diabetes Care & Education, 2010 A Nationwide Survey of Diabetes education, Self-management and Glycaemic Control in Patients with Type 2 Diabetes in China, 2010 Practical Guideline on Insulin Treatment Diabetes Educators Training Program SMBG is not reimbursed The educator as profession is not recognized by government and payer 24

25 Thank You! 25