A/Prof Ken Sikaris - Sonic Healthcare - Impact of the diabetes epidemic and changing guidelines on...

A/Prof Ken Sikaris 9th September 2014

Impact of the diabetes epidemic

and changing guidelines

on laboratory workload

A/Prof Ken SikarisDirector of Clinical Support Systems

Sonic Healthcare

BSc(Hons), MBBS, FRCPA, FAACB, FFSc, GAICD

Australia

Diabetes in Australia: 1980 - 2000

’80 ’82 ’84 ’86 ’88 ’90 ’92 ’94 ’96 ’98 ’00

Busselton

b) Nat Heart

Foundation

c) Aust Bureau

Statistics

d) Aust Bureau

Statistics

e) AusDiab

Ausdiab Diabetes Prevalence 1999-2012

Approx 1.5 million today, 3.5 million by 2033.

275 Australians develop type 2 diabetes every day

By 2023 type 2 diabetes is projected to become

the leading specific cause of disease burden for

men and the second leading cause for women.

Diabetes in Australia

ABS Survey 2011-2012

ALL MEN WOMEN

DIABETES Fasting Glucose 5.1% 6.3% 3.9%

HbA1c 5.4% 6.6% 4.2%

PREDIABETES Fasting Glucose 3.1% 4.1% 2.1%

HbA1c 5.4% 5.5% 5.3%

1 in 16 Australians are diabetic

4% reported to have diabetes85% Type 2

12% Type 1

ABS Survey 2011-2012

Diabetes Complications

Cardiovascular Disease

Diabetes or pre-diabetes

In 65% of CVD

Improving CVD: Statins?

CVD mortality trends

Factors

Smoking

Antihypertensives

Statins

Survival after AMI

Angioplasty

Antithrombotics

Leading Causes of Death

CVD Hospitalisations

Improving Diabetes Outcomes

Australian Diabetes Costs

Total Costs

$6.6 billion (2003)

HbA1c $0.01 billion

Cost distribution in Type 2 diabetes

Preventable Health Costs

Diabetic Renal Disease

The Deadly QuartetKaplan Arch Int Med

1989;149:1514-1520

Which one of the

deadly quartet is

missing?

Top tests for diabetes, lipids, HT

BEACH: TYPE 2 DIABETES & GP’s

2000-02 2006-08

GP visits 2.6% 3.3%

Pathology Requests/Visit 63.6% 88.4%

Total Diab Tests 1,700,000 3,100,000

% of all GP pathology 4.9% 6.0%

http://www.medicareaustralia.gov.au/statistics/mbs_item.shtml

MBS Schedule 66608: Vitamin D

MBS Schedule 66551: HbA1c

About $16 million / annum* (50% coned)

MBS Schedule 2517: Diabetes PIP

MBS Schedule 10951: Diabetes Education

MBS Schedule 717: 45y/o Health Check

MBS Schedule 66536: HDLC

MBS Schedule 66560: Microalbumin

MBS Schedule 66542: OGTT

FPG vs 2hPG and diabetes.

6.1 7.0FPG (mmol/L)

7.8 11.1GLU-2h (mmol/L)

Diabetesnormal

(GDM 5.1)

Gestational Diabetes

MBS Schedule 66545: Glucose Challenge Test Pregnancy

MBS Schedule 66545: Oral Glucose Tolerance Test in Pregnancy

MBS Schedule 66554: HbA1c pregnancy

New GDM Criteria

• ADIPS 1999-2014

– Prevalence 8%

• IADPSG (HAPO)

– Projected Prevalence 14%

• Optimal Glucose sample (fluoride-ice/citrate)

–Potential Prevalence 20%

»Same as HAPO

ADA Working Party Report Diabetes Care 2009; 32: 1327-34

ADA recommends: HbA1c 6.5% for diagnosis of diabetes

Stroke

All causes of mortality

ABS Survey 2011-12: Chronic Disease

Cancer Diabetes

Heart Disease

ABS Survey 2011-12: Chronic Disease

Cancer

Diabetes

Heart Disease

Normal Overweight Obese

Females

Incidence of diabetes according to baseline body mass index

Baseline BMI status

Body mass index (BMI: weight/height2) was categorised into three groups: (i) normal: BMI < 25.0 kg/m2; (ii) overweight: 25.0─29.9 kg/m2; and (iii) obese: ≥ 30.0 kg/m2.

Obesity in adults

Overweight children in Australia:

Obesity in Babies ! Lack of Exercise?

sity 2

Changes in Dietary Composition

JAMA Intern Med. 2014;174(4):516-524. Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults Quanhe Yang, Zefeng Zhang, Edward W. Gregg, W. Dana Flanders, Robert Merritt, Frank B. Hu.

Prof Robert Lustig Auckland NZ Feb 2014

Insulin Resistance and Dyslipidemia

TGVLDL

(lipoprotein or hepatic lipase)

(CETP)

(hepaticlipase)

Kidney

Apo A-1(CETP)

FFAFructose

How small is sdLDL?

Modified LDL is atherogenic

LDL gradient gel electrophoresis ‘Lipoprint’

Small Dense LDLAustin MA, King MC, Vranizan KM, Krauss RM, “Atherogenic lipoprotein

phenotype. A proposed genetic marker for coronary heart disease.”

Circulation 1990;82:495-506.

0.5 1.0 1.5 2.0 2.5 3.0

(mmol/L)

Triglycerides

0.5 to <1.0

1.0 to <1.5

1.5 to <2.0

2.0 to <2.5

2.5 to <3.0

Triglycerides (mmol/L)

35% > 1.5 mmol/L

22% > 1.5 mmol/L

Interpretation of blood fats• 30 years ago

– High cholesterol, Triglycerides unimportant

• 20 years ago– Bad cholesterol (LDLC), Good cholesterol (HDLC)

• 10 years ago– Modified LDL atherogenic

• Oxidised, Glycated, Apo(a)/Lp(a), Small Dense LDL)

• Today

– Triglycerides are important!– Move away from LDLC: Non HDLC = LDLC + VLDLC

Perspectives of Ken Sikaris.

TIME® Magazine June 23rd 2014

Professor Richard Johnson

Obesity versus Metabolic Dysfunction

240 million USA Adults

30% Obese

72 million

70% Normal

168 million

40% ‘Sick’

67 million

80% ‘Sick’

57 million

124 million USA Adults

Prof Robert Lustig 2014 Conclusions;

Movies

May 7th 201410th Jan 2014 Jul-Sep 2014

May 7th 2004

‘That Sugar Film’ – Damon Gameau, January 2015

Conclusions

• Pandemic in Obesity & Type 2 diabetes

– Increasing proportion of health costs

– Increasing proportion of Pathology

• Pathology has witnessed pandemic

– Diagnosed

– Monitored

– Prevented?

• Assist in focussing community on prevention

Acknowledgements

• Inspiration

– Ms Louisa Sikaris

A/Prof Ken Sikaris - Sonic Healthcare - Impact of the diabetes epidemic and changing guidelines on...

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