Diabetes management: lessons from around the globe – … · DIABETES MANAGEMENT: LESSONS FROM...

Diabetes management: lessons from around the globe – Romania

S. Popa (Romania)

DIABETES MANAGEMENT: LESSONS FROM AROUND THE GLOBE – ROMANIA

SG Popa, M Mota, E Mota, A Mitrea

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

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.

2014

Diabetes is a huge and growing problem…

2035

… 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

11% of worldwide healthcare expenditure

Agenda


• Protocol number SRDCEB/2012/001; • Eudra CT Number: 2012-004803-12 • Beneficiaries: - Romanian Society of Diabetes, Nutrition and Metabolic

Diseases (RSDNMD) - Romanian Society of Nephrology (RSN) • Investigators: 101 General physician • CRO: CEBIS International (www.cebis-int.com) • Central Laboratory for the analysis of the study: Synevo

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.

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

PREDATORR – Subject inclusion

Inclusion criteria Exclusion criteria

Subjects aged 20-79 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.

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

Subjects were randomly assigned for screening from the list of each GP via a random number generator

ROMANIA at a glance - PREDATORR 2013

NGT 71.9%

Prediabetes 16.5%

Diabetes

11.6%

Known diabetes 9.2%

Unknown diabetes 2.4%

ROMANIA at a glance - PREDATORR 2013 DIABETES

Diabetes in Romania (20-79 years)) Adult Romanian population (20-79 years)

15097473

Number of people with diabetes 1752000

Age- and sex-adjusted prevalence of diabetes

11.6%

Undiagnosed cases (unknown diabetes mellitus – UKDM)

362340

Age- and sex-adjusted prevalence of UKDM 2.4%

Diabetes worldwide …

(Adults 20-79 years); Source: IDF Diabetes Atlas Sixth Edition 2014

Diabetes in Romania - PREDATORR 2013 …

Top 10 countries/territories for prevalence (20-79 years) 2013 and 2035

Source: IDF Diabetes Atlas Sixth Edition 2013

Romania – PREDATORR 2013 11,6%

EUROPE at a glance

Source: IDF Diabetes Atlas Sixth Edition 2014

Romania at glance PREDATORR 2013 …

Diabetes surge in EUROPE

PREDATORR

Romania

1.752 million

11.6% Romania

(Adults 20-79 years) Source: IDF Diabetes Atlas Sixth Edition 2014

Spain 2012 – 13.8% Portugal 2010 – 11.7%

Diagnosed and undiagnosed diabetes among people aged 20 years or older, United States, 2012

Source: 2009–2012 National Health and Nutrition Examination Survey estimates applied to 2012 U.S. Census data

Romania – PREDATORR 2013 1.752 million people have diabetes (11.6% of adult Romanian population)

3.623 million people have undiagnosed diabetes (20.69% of people of diabetes)

11,5% 8,1%

35,5% 29,4%

50,4% 49,3%

ROMANIA at a glance - PREDATORR 2013 Prevalence of impaired glucose regulation by sex and age groups

Mota M. Prevalence of Diabetes Mellitus and Prediabetes in the Adult Romanian Population: PREDATORR Study. Journal of diabetes. 2015 in press (available at http://onlinelibrary.wiley.com/doi/10.1111/1753-0407.12297/abstract)

2,7% 6,9%

10,1%

18,9% 17,7%

27,8%

0,2%

3,2%

4,3%

2.9%

ROMANIA at a glance - PREDATORR 2013 Prevalence of DIABETES and PREDIABETES by age groups

13.3%

22%


10,7%

16,3%

7,9%

16,7%

2,9%

1,9%

ROMANIA at a glance - PREDATORR 2013 Prevalence of DIABETES and PREDIABETES by sex

9.8%

13.6%


3,5% 1,9%

12,1% 8,4%

19,7% 15,9%

0 0,5%

4,9%

1,8%

4,6%

4,1%

ROMANIA at a glance - PREDATORR 2013 Prevalence of DIABETES by sex and age groups

3.5% 2.4%

17%

10.2%

24.3%

20%


Prevalence (%) of people with diabetes by age and sex, 2013


ROMANIA at a glance - PREDATORR 2013 PREDIABETES

Prediabetes in Romania (20-79 years)) Adult Romanian (20-79 years)

15097473

Number of people with prediabetes 2491083

Age- and sex-adjusted prevalence of prediabetes

16.5%


Prediabetes worldwide …

Study population Prediabetes prevalence

Observations

US; ≥20 years 37% Prediabetes Portuguese; 20-79 years 27% IFG and/or IGT Spanish; ≥18 years 14.8% IFG and/or IGT European; 20-79 years 9.2% IGT Romanian; 20-79 years 16.5% Prediabetes

Source: 2009–2012 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: 879–81 Soriguer F et al. Prevalence of diabetes mellitus and impaired glucose regulation in Spain: The [email protected] Study. Diabetologia. 2012; 55:88–93. IDF Diabetes Atlas Sixth Edition 2013

8% 5,7%

18,5% 19,2%

26,1% 29,3%

ROMANIA at a glance - PREDATORR 2013 Prevalence of PREDIABETES by sex and age groups


Prevalence (%) of IGT (20-79 years) by age and sex, 2013


Agenda


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 10.7/100000

2014: 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.

Agenda


Type of therapy for type 2 diabetes patients

2014 2013

36% 38%

45% 47%

18% 13%

2% 2%

DietPolytherapyBitherapyMonotherapy

TOTAL = 1409 PATIENTS (weighted)

Bitherapy includes fixed combinations

Type of therapy Classes in monotherapy

BIGUANIDES

SULPHONYLUREAS

INSULINS

AGI

DPP-IV INHIBITORS

GLP-1 AGONISTS

GLINIDES

GLITAZONES

66%

16%

14%

2%

2%

0,40%

0,10%

62%

21%

13%

1%

0,4%

1%

1%

1% 2014 2013

Displaying categories >2%

Type of therapy, Classes in bitherapy

BIGUANIDES+SULPHONYLUREAS

BIGUANIDES+INSULINS

INSULINS+INSULINS

DPP-IV INHIBITORS+BIGUANIDES

SULPHONYLUREAS+INSULINS

BIGUANIDES+GLP-1 AGONISTS

BIGUANIDES+AGI

35%

24%

12%

9%

5%

4%

2%

39%

24%

9%

6%

5%

1%

1% 2014 2013Displaying categories >2%

BIGUANIDES+SULPHONYLUREAS+INSULINS

BIGUANIDES+INSULINS+INSULINS

DPP-IV INHIBITORS+BIGUANIDES+SULPHONYLUREAS

AGI+BIGUANIDES+SULPHONYLUREAS

BIGUANIDES+GLP-1 AGONISTS+SULPHONYLUREAS

DPP-IV INHIBITORS+BIGUANIDES

BIGUANIDES+INSULINS

BIGUANIDES+AGI+INSULINS

BIGUANIDES+BIGUANIDES

BIGUANIDES+SULPHONYLUREAS+GLITAZONES

31%

18%

10%

9%

6%

5%

4%

2%

2%

2%

29%

26%

13%

10%

1%

1%

5%

1%

1%

1%

2014 2013


Type of therapy, Classes in polyherapy

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%

2%

2%

2%

2%

2%

2%

2%

42%

13%

11%

4%

4%

3%

3%

3%

3%

2%

1%

1%

1%

0,4%

2014 2013

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%

2%

2%

2%

2%

2%

2%

2%

18%

7%

4%

11%

4%

4%

4%

8%

2%

1%

1%

1%

1%

1%

2014 2013

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%

2%

2%

2%

2%

2%

2%

6%

1%

12%

4%

7%

5%

3%

1%

3%

1%

4%

3%

2%

1%

1%

2014 2013

Brands in bitherapy Brands in polytherapy


Agenda


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.

Agenda


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’’ (www.cebis-int.com), 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

Diabetes management: lessons from around the globe – … · DIABETES MANAGEMENT: LESSONS FROM...

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