中国糖尿病领域新挑战英文.pptx

#,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,1,The Rising Challenge of Diabetes in China,Chang Yu Pan,Department of Endocrinology,Chinese PLA General Hospital,Chinese PLA,Endocrinology and Metabolism,C,entre and Key Laboratory,Apr.11-2008,2,Medical and Health Annual,Encyclopaedia Britannica,1999,3,3,Death from Diabetes 2.9,0,Million,(5.2%of total mortality,),Worldwide,:,1 of,20,death is from diabetes,(,About,8,700,death/day or,6,death/min,),About 1 of,4,death,is DM in Asia-Pacific Region,Death from AIDS:3.0,Million,What AIDS was in the last 20 years of the 20th century,diabetes is going to be in the first 20 years of this century,Roglic et al,2005,The Rising Challenge of Diabetes,4,Lifestyle changes,Urbanization and Longevity in China,National Nutrition and Health Survey,(1982 2002),Carbohydrate+10%,Meat,+57%,eggs,+69%,Total Carloria:2254cal./person/day,5,Prevalence of overweight/obesity in China(20-70 years),Overweight/obesity(BMI,25 kg/m,2,)(WHO criteria),Data from National Nutrition Survey(1992),the Working Group on Obesity in China(2002),Age-standardized Prevalence(%),6,Prevalence of overweight/obesity in Chinese children&adolescents(2002),Data from 2002 National Nutrition and Health Survey,WGOC criteria,%,7,Prevalence of overweight/obesity in Chinese children&adolescents(1985-2000),Ji C et al,Chinese Journal of Epidemiology 2004,Prevalence(%),Boys,Girls,Ages,7-12 years,13-18 years,7-12 years,13-18 years,Year1985 Beijing,5.8,4.8,4.3,5.1,Shanghai,5.4,2.7,2.2,2.8,Coastal cities,1.9,1.5,1.3,0.6,Inland cities,0.6,0.7,2.2,1.8,Year1995 Beijing,17.5,18.1,12.0,11.6,Shanghai,20.5,15.7,11.8,8.0,Coastal cities,7.9,5.2,5.4,6.8,Inland cities,4.0,4.5,2.9,3.9,Year2000 Beijing,29.0,25.0,17.3,14.6,Shanghai,28.9,17.2,15.3,9.6,Coastal cities,20.9,17.2,11.7,9.6,Inland cities,11.8,8.8,6.2,6.5,8,9,Global prevalence of diabetes,*,In 2007,the five countries with the largest numbers of people with diabetes are:,India,China,United States,Russia,Germany,By 2025,the largest increases in diabetes prevalence will occur in low-and middle-income countries,Each year an additional 7 million people worldwide develop diabetes,*Diabetes Atlas,3rd edition,International Diabetes Federation,2006,10,Peoples Republic of China,Prediabetes,2003,33,million(4%),2025,54,million(5%),Diabetes,2003,23,million(3%),2025,46,million(4%),Sicree,Shaw,Zimmet.Diabetes Atlas.IDF.www.idf.org.2006,The prevalence of DM is increasing rapidly,11,Growing prevalence of diabetes and prediabetes in China,National Diabetes Research Group.Chin J Int Med 20:678,1981,Pan XR,et al.Diabetes 20:1664,1997;Gu D,et al.Diabetologia 46:1190,2003,*Screening with FPG only,12,Prevalence of IGT in all age groups was higher than that of Diabetes,Prevalence of IGT and Diabetes in 11 provinces,China,Prevalence,（,%,）,0,2,4,6,8,10,12,20-30,30-40,40-50,50-60,60,Diabetes,IGT,Chin J Epidemiol.1998;19(5):282-285.,13,Shanghai Diabetes Institute,Isolated,fasting DM:0.6%,Isolated post-challenge diabetes:2.4%,Combined DM:1.9%,Total prevalence of newly diagnosed DM:4.9%,Total prevalence of prediabetes:11.7%,Isolated IGT 8.8%,Isolated IFG 1.7%,IFG+IGT 1.2%,75%,15%,10%,Jia WP et al.Dibetologia 2007,Isolated post-challenge DM and IGT Common in China,14,Newly diagnosed diabetes(OGTT),33%,3%,23%,24%,17%,36%,37%,27%,OGTT cohort(n=2,263),Whole population(n=3,513),2/3 of patients have hyperglycaemia,3/4 of patients have hyperglycaemia,Previously known diabetes,Newly diagnosed diabetes(FPG test),NGT,Prediabetes,Hu DY,Pan CY,Yu DM.,Eur Heart J 2006;27:25739.,China Heart Survey dysglycemia is common in patients with CAD,15,WP Jia,et al.Diabetologia,2006(in press),Epidemiological characteristics DM and IGT in a Chinese adult population:the Shanghai Diabetes Studies(SHDS),Prevalence(%),Incidence(%),three-year cumulative incidence rates,incidence rates per year,1999-2001,n=5628,2002-2004,n=2709,16,Chinese individuals with IGT progress to type 2 diabetes faster than American individuals with IGT,2hPG levels of IGT controls in Da-Qing Study and DPP were similar(mean value 160mg/dL),17.2,11.1,13.3,0,2,4,6,8,10,12,14,16,18,20,Chinese BMI 22.4kg/m,2,ChineseBMI 27.5kg/m,2,AmericanBMI 34.2kg/m,2,Incidence/100pys,Chinese IGT population is at high risk of DM,Pan XR,et al.Diabetes Care 1997;20:53744.,Knowler WC,et al.NEJM 2002;346:393,403.,17,Da Qing IGT intervention Study,577 IGT,519 Control,4%IGT,0.4%NGT,The appearance of ECG consistent with CHD,IGT and the risk of CVD,Diabetes Care 1993:16.150-156,18,IGT and Atherosclerosis,-Study from PLA General Hospital in China,*,*,*,IGT,NGT,DM,IGT,IGT,NGT,NGT,DM,DM,N:97(NGT),51(IGT),73(DM),Adjusted by age and sex,*P0.05,P0.005,v.s.,NGT,Jing WS,Pan CY,Lu JM,et al.Chin J Endocrinol 20(2):136-139,19,The cumulative rate of CVD,Coxs Proportional Harzard Model,Xu Xj,Pan CY Tian H.et al,Chin J Gerontol.2001,.,0.97,0.98,0.99,1.00,1,2,3,4,Year,NGT,IGT,DM,The CVD Risk of IGT and Diabetes-,Study from PLA General Hospital in China,Cumulative rate,0,20,CODIC2Control of Type 2 Diabetes in China,Biao X,Pan CY,Ji LN,et al.CODIC2,2007,in press,N=1530,N=2054,N=524,21,Surveillance of Type 2 Diabetes in China,Grade of Hospitals,No.of,Hospitals,Patient,Numbers,1998,3,27,2430,2001,2&3,49,2248,2003,3,30,2729,2006,1,2&3,60,2779,2001 hospitals distribution:Grade 3:32(65%),Grade 2:17(35%),2006 hospitals distribution:Grade 3:43(72%),Grade 2:16(27%),Grade 1:1(2%),Patient Population,22,BMI,Anti-obesity Treatment:,2001,2003,2006,1.5%,1.0%,1.0%,BMI was analysed for patients 18 years only,24.6,24.3,24.0,23.7,10,15,20,25,30,1998,2001,2003,2006,BMI(kg/m,2,),Pan CY.Intern Journ Endocr.&Mtab.,2005,25(3):174-178.,23,WAIST,90.8,87.2,80,85,90,95,100,105,Male,Female,Waist(cm),Mean Waist in 2006,%Waist 90cm(Male),80cm(Female),2003,2006,Waist was analysed for patients 18 years only,51.1,75.9,54.9,78.3,40,45,50,55,60,65,70,75,80,85,Male,Female,Proportion of Patients(%),Pan CY.Intern Journ Endocr.&Mtab.,2005,25(3):174-178,24,MEAN HbA,1c,LEVELS,%HbA1c 6.5%,8%,26%,11%,23%,%HbA1c 7%,18%,41%,26%,41%,Local HbA,1c,(past 12 month):57%(1998),31%(2001),55%(2003),54%(2006),8.8,7.7,7.5,7.6,0,1,2,3,4,5,6,7,8,9,10,11,12,Mean HbA,1c,(%),6.5%,Nine years change in diabetes management,DIABCARE Study Result(1998-2006),2003,2001,1998,2006,Pan CY.Intern Journ Endocr.&Mtab.,2005,25(3):174-178,25,LIPID PROFILES,Target TC:1.1 mmol/L TG:1.5 mmol/L,43%,41%,41%,41%,32%,31%,28%,34%,52%,60%,60%,61%,5.0,5.1,5.1,4.9,3.5,4.5,5.5,1998,2001,2003,2006,mmol/L,1.3,1.4,1.3,1.4,1.0,1.1,1.2,1.3,1.4,1.5,1998,2001,2003,2006,1.9,2.0,1.9,2.1,1.0,1.2,1.4,1.6,1.8,2.0,2.2,2.4,2.6,1998,2001,2003,2006,TC,HDL-c,TG,Pan CY.Intern Journ Endocr.&Mtab.,2005,25(3):174-178,26,Type of Treatment for Dyslipidaemia,Treated for Dyslipidaemia%,Statin,%,2001,25,12,2003,25,13,2006,27,17,Pan CY.Intern Journ Endocr.&Mtab.,2005,25(3):174-178,27,HYPERTENSION,+,+sbp/dbp,130/80(recommendation on optimal control of,ADA 2004&AP guidelines 2002),Treatment for Hypertension,2001:44%,2003:48%,2006:53%,1998 2001 2003 2006,Smoking:,14%,18%,17%,21%,Drinking:,14%,11%,11%,16%,Patient is,currently,a smoker or,consumes alcohol(Regular consumption is defined as,more than 3 times per week),76.1,77.2,0,10,20,30,40,50,60,70,80,2003,2006,Proportion of Patients(%),response rate 98%99%,Pan CY.Intern Journ Endocr.&Mtab.,2005,25(3):174-178,28,METABOLIC SYNDROME,Criteria,MS%,CDS,61.4,IDF,59.9,CDS-Chinese Diabetes Society IDF-International Diabetes Federation,29,About 55%DM outpatients have complications,Biao X,Pan CY,Ji LN,et al.CODIC2,2007,in press,Top three complications,Complication of,Type 2 Diabetes in China,30,Global cost of diabetes*,Economic and societal costs mainly arise from complications of diabetes,Economic consequences result largely from:,Cost of care,Loss of productivity due to disability and premature death,In 2007,global health expenditures to treat and prevent diabetes total at least,US$232 billion,*Diabetes Atlas,3rd edition,International Diabetes Federation,2006,31,Total Direct Medical Cost of treating Type 2 DM in urban China,Billion RMB,4.38%,Chen Xingbao.Chinese health economics,2003*,Tang Ling.China Diabetic Journal.2003*,32,Direct Medical Cost for patients with Diabetes in China,Billion RMB,18,.9%,81.1%,0.00%,50.00%,100.00%,Direct Medical Cost,Direct Medical Cost for patients,with complication),(,Direct Medical Cost for patients,without complications),Chen Xingbao.Chinese health economics,2003*,Tang Ling.China Diabetic Journal.2003*,33,Effect of complications on costs,Increase in costs vs.no complications,218%,313%,935%,Chen Xingbao.Chinese health economics,2003*Tang Ling.China Diabetic Journal.2003*,Total Direct Medical Cost of treating Type 2 DM in urban China,RMB,34,CHD deaths than expected from,baseline,mortality rates,Data from England and Wales between 1981 and 2000 in men and women aged 3584 years,There were 68,230 fewer CHD deaths than expected from baseline mortality rates in 1981,-100,000,-80,000,-60,000,-40,000,-20,000,0,20,000,Deaths prevented or postponed,in 2000,Factors,CHD deaths,include,smoking,cholesterol,and BP and,changes in treatments,Factors,CHD deaths,include,diabetes,and,obesity,Unal B,et al.Circulation,2004;109:11011107.,延迟或预防死亡,68,230,(,2,0003,000,),35,D,iabetes mortality continues,its steady escalation,Freid VM,et al.,National Center for Health Statistics,2003,.,Year,Age,adjusted death raterelative to 1980,cerebrovascular disease,40,60,80,100,120,140,1980,1990,2000,H,eart disease,Cancer,Diabetes,36,Cause of death in China,Data from National Disease Surveillance System of China(1991-2000),Top 3 fatal diseases in 2000,1,412,999,2,488,266,1,530,423,Cause of death in China,37,Motality of Diabetes in Urban Chinese,Sources:Ministry of Health of China:Annual Statistical Reports of Death,injuries and Cause of Death 2001,38,WPDD 2002.www.wpdd.org/downloads/Diabetes_Book.pdf.,Early,D,iagnosis of,P,rediabetes is essential,Western Pacific Diabetes Declaration(WPDD),G,uidelines:,“,The risk of,C,omplications is,R,elated to the,D,uration of,D,iabetes,as well as the,D,egree of,H,yperglycaemia.However,due to,D,elayed,D,iagnosis,t,hese,C,omplications may,A,lready be,P,resent at,D,iagnosis.”,Early diagnosis and management of prediabetescan reduce the risk of both type 2 diabetes and cardiovascular disease,39,Summary,The prevalence of DM and IGT is increasing rapidly as a result of lifestyle changes,urbanization and longevity.,China is currently the second on the list of the top ten countries with the highest DM burden,Estimated that as the population of China reaches 1.3 billion in the early 21st century,700,000 new cases of type 2 diabetes occur every year among 24-74 year-old HbA1c and CVD risk factors control with current treatment is poor;,In China,81%Of total direct medical cost for patients with complications,Even,IGT,are associated with increased cardiovascular risk and mortality driven largely by postprandial hyperglycaemia,40,Conclusion,Prediabetes(IGT),might,be,Optimal Time for Intervention of,Diabetes and CVD Prevention,Early,D,iagnosis of,P,rediabetes,and DM,is essential,41,Thank you!,