(Microsoft PowerPoint - Final Deck LA ISPOR Lilly \226.pptx)

(Microsoft PowerPoint - Final Deck LA ISPOR Lilly \226.pptx)

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EPIDEMIOLOGY AND CLINICAL
MANAGEMENT
OF THE DISEASE
Juan José Gagliardino
CENEXA. Centro de Endocrinología Experimental y Aplicada
(UNLP-CCT LA PLATA-CONICET)
Centro Colaborador OPS/OMS para Diabetes
La Plata, ARGENTINA
PREVALENCE AND NUMBER OF ADULT PEOPLE WITH
DIABETES (X 1000)
Mexico
2007: 9.4% – 6.116
2025: 12.2% –
10.811
Colombia
2007: 4.6% – 1.278
2025: 5.9% – 2.251
Peru
2007: 5.4% – 894
2025: 6.6% – 1.544
Chile
2007: 5.9% – 645
2025: 6.9% – 945
Venezuela
2007: 4.9% – 795
2025: 6.0% – 1.388
Brazil
2007: 5.8% – 6.913
2025: 11.4% – 17.627
Argentina
2007: 6% – 1.488
2025: 6.4% – 1.996
IDF. Diabetes Atlas 3rd Edition – 2006
ENFR: PREVALENCES
Variable
2005
2009
Overweight (BMI >25 y <30)
34,4%
35,4%
Obesity (BMI 30)
14,6%
18,0%
Sedentarism
46,2%
54,9%
Hypertension
34,5%
34,8%
High Cholesterol levels
27,9%
29,1%
8,4%
9,6%
Diabetes
National Health Ministry www.minsal.gov.ar
PREVALENCE OF T2DM IN MEXICO
1994-2012
Medical Diagnosis
1994
2000
2006
+ 22 %
4.0 %
+ 25 %
2012
+ 25 %
5.8 %
7.0 %
9.2 %
Medical Diagnosis + Population Survey
+ 37.3 %
6.7 %
J Lipid Res
42; 1299, 2001
+ 56 %
9.2 %
Diabetes Care
2003; 26:2012-26
14.4 %
Salud Pública 2010; 52
Supl1) S54-S63
DIABETES… IS JUST A SIMPLE
PROBLEM OF PREVALENCE?
DIABETIC RETINOPATHY
3
MACROANGIOPATHY
NORMAL CORONARY ARTERY
SEVERE CORONARY
ATHEROSCLEROSIS
Cortessy Dr. N Cédola
WELL BEING (EQ-5D)
Score of Health perception
80
76.3
72.6
75
68.8
70
65
60
55
50
Control
T2DM w/o
Complications
T2DM with
Complications
Group
Elgart J et al. in preparation 2013
4
DIABETES COMPLICATIONS:
WHAT IS GOING ON IN THE
REGION
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Gagliardino et al PAHO J 10: 309, 2001
6
CHRONIC COMPLICATIONS IN NEWLY
DIAGNOSED DIABETIC PATIENTS
Evolutionar
y stages
Early
Intermediat
e
Late
Total
complic.
Retinopathy
2.6%
9.6%
7.0%
19.2%
Neuropathy
24.3%
3.5%
2.6%
30.4%
Nephropath
y
10.4%
7.0%
0.9%
18.3%
CVD
2.6%
7.8%
1.7%
12.1%
PVD
2.6%
2.6%
1.7%
6.9%
Adapted from de Sereday M et al. Endocrinologia y Nutrición 55:64, 2008
T2DM: DEGREE OF METABOLIC
CONTROL
100
% of patients
62.8
HbA1c > 7%
HbA1c < 7%
37.2
0
IDMPS 2d wave (2006-07)
7
% de pacientes
FRCV: Patients at
target
100
90
80
70
60
50
40
30
20
10
0
60.9
45.8
41.8
36
24.9
BP
<130/80 mmHg
LDL-c
<100mg/dL
HDL-c
>40mg/dL
[men]
HDL-c
>50mg/dL
[women]
TG
<150mg/dL
DEGREE OF METABOLIC CONTROL (HbA1c < 7%)
¿IT DEPENDS ON -CELL MASS AND FUNCTION?
T2DM
n 658
D&E
66%
OADs
55%
Only Insulin
29%
OADs +
Insulin
25%
IDMPS Argentina 2d. wave
T2DM
n 646
D&E
64%
OADs
69%
OADs +
Insulin
33%
Only Insulin
33%
IDMPS Argentina 3rd. wave
THIS SITUATION…
¿HAS ANY
SOLUTION?
EXPERIMENTAL DESIGN
All three Argentinean health subsectors (public health, social security and the private,
prepaid system) participated in the study.
GPs Selection
Randomized group allocation
18 GPs
Not receiving education
13 Patients
Not receiving
education
(Total 117)
GROUP 1
13 Patients
Receiving
education
(Total 117)
GROUP 3
18 GPs
Receiving education
13 Patients
Not receiving
education
(Total 117)
GROUP 2
13 Patients
Receiving
education
(Total 117)
GROUP 4
Gagliardino JJ et al. Diabet Med. 2013 May 13. doi: 10.1111/dme.12230. [Epub ahead
of print]
CHANGES IN HbA1c LEVELS
Delta
0
0.
1
Basal
9
-
NE
DE
Both
$479
$547
0.
$171
3
Final
ME
$161
0.
HbA1c (%)
5
-
8
0.
7
-
7
6
0.
9
NE
ME
Bot
h
Gagliardino JJ et al. Diabet Med. 2013 May 13. doi: 10.1111/dme.12230. [Epub ahead
Group
DE
of print]
CHANGES IN SYSTOLIC BLOOD PRESSURE
0
NE
Delta
-3
Basal
Both
-9
$56
-
$77
-
15
0
SBP (mmHg)
DE
$145
-6
12
Final
ME
$16
15
18
14
0
13
0
NE
ME
Group
DE
Bot
h
Gagliardino JJ et al. Diabet Med. 2013 May 13. doi: 10.1111/dme.12230. [Epub ahead
of print]
CHANGES IN SERUM TRIGLYCERIDE
20
$5
4
Delta
10
0
$63
$15
7
$4
3
10
Basal
Final
20
TG (mg/dL)
200
150
50
NE
ME
Group
DE
Bot
h
Gagliardino JJ et al. Diabet Med. 2013 May 13. doi: 10.1111/dme.12230. [Epub ahead
of print]
People with
DM
Health Care Team
Members
Comunity
Industry
Health and Education
Authorities
Health Insurance
Organizations
Even worse, we
Olaf, the same
have just
happened on our crashed against
last trip!
the same rock!
*+,“ECONOMICS OF TREATMENT/MANAGEMENT OF
DIABETES”
EVIDENCE FROM LA AND THE MEXICAN CASE
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AGENDA
- DIABETES
ECONOMIC TRENDS: EVIDENCE
-ECONOMIC IMPACT OF TREATMENT STRATEGIES
WORLDWIDE
LAN COUNTRIES
- COSTS OF MAIN CHRONIC COMPLICATIONS OF
DIABETES
- ISSUES AND CHALLENGES FOR LATIN AMERICAN
COUNTRIES.
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*200 THOUSAND NEW CASES ARE REGISTERED ANNUALLY BY SOME COUNTRIES.
* 30-55% OF THE DIABETIC POPULATION DOES NOT KNOW THEY HAVE THE DISEASE
* 93.7% OF THE DIABETIC ADULTS IN
TREATMENT NOT SOLVE THEIR GLYCEMIC TARGETS
* MORE PROBABILITY OF SUFFERING
CARDIOVASCULAR COMPLICATIONS, KIDNEY,
VISUAL AND NEUROLOGICAL (3 TIMES MORE IN DIABETIC)
HIGH EPIDEMIOLOGIC & ECONOMIC BURDEN TO THE SOCIETY
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ANNUAL CASE MANAGEMENT AND AVERAGE COST OF DIABETES
LA AND DEVELOPED COUNTRIES (2010).
92% DNC
8% DC
800
708
700
671
571
600
563
500
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399
400
376
326
300
200
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$52
ARE SPENT BY PATIENTS AND THEIR FAMILIES.
$37 IS SPENT BY INSURED INSTITUTIONS
$11 FOR UNINSURED INSTITUTIONS
COMPARING INPATIENT VS. OUTPATIENT,
• FOR EVERY US$100 SPENT:
$60 GOES FOR HOSPITAL CARE (UNCONTROLLED / COMPLICATED CASES)
$40 OUTPATIENT CARE GOES TO MEET THE DEMAND OF CONTROLLED CASES)
ON THE RELATIVE WEIGHT OF GOODS,
• FOR EVERY US$100 SPENT:
$17 GOES FOR CONSULTATION / DIAGNOSIS
$33 GOES FOR DRUG ACQUISITION
$12 GOES FOR COVERING HOSPITALIZATION COSTS
$38 GOES TO COVER COMPLICATION RELATED COSTS
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