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Prevalence*
(%)
No. of cases
(millions)
Estimated
increase in
Estimated
increase in no.
India
7.8
50.77
9.3
87.04
19.2
71.4
China
4.2
43.16
5.0
62.55
19.0
44.9
Thailand
7.1
3.54
8.4
4.96
18.3
40.11
S. Korea
7.9
3.29
9.0
4.32
13.9
31.3
Australia
5.7
1.09
6.8
1.50
19.3
37.6
Taiwan
7.5
0.82
8.5
1.23
13.3
50.0
Hong Kong
8.5
0.59
10.1
0.92
18.8
55.9
Singapore
10.2
0.44
12.4
0.74
21.6
68.2
Malaysia
11.6
1.85
13.8
3.24
19.0
75.1
Vietnam
3.5
1.65
4.4
3.41
25.7
106.7
Philippines
7.7
3.40
8.9
6.16
15.6
81.2
Indonesia
4.8
6.96
5.9
11.98
22.9
72.2
10.3
26.81
12.0
35.96
16.5
34.1
USA
2030
Sicree R, et al. In: IDF Diabetes Atlas, 4 th edition, 2 009. Available at: http://www.diabetesatlas.org (accessed J an 2010).
sonywibisono@yahoo.com
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2
to
4
fold
increase
in
cardiovascular
mortality
and
stroke3
Diabetic
Retinopathy
Leading
cause
of
blindness
in
working
age
adults1
Cardiovascular
Disease
Diabetic
Neuropathy
Leading
cause
of
end-stage
renal
disease2
Leading
cause
of
non-traumatic
lower
extremity
amputations5
1
Fong
DS,
e t
al. Diabetes
Care 2003;
26
( Suppl.
1):S99S102.
2Molitch
ME,
e t
al. Diabetes
Care 2003;
26
( Suppl.
1):S94S98.
3
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Kannel
WB,
et
al.
Am
Heart
J 1990;
120:672676.
4Gray
R P
&
Yudkin
JS.
In
Textbook
of
Diabetes
1997.
sonywibisono@yahoo.com 5
Mayfield
JA,
et
al. Diabetes
Care 2003;
26
( Suppl.
1):S78S79.
40
Women
30
30
Events/
20
100
persons
20
10
10
0
<5
CVD events
All deaths
Men
<5
A1C (%)
A1C,
median
(%)
8
ADA
target
7
6.2%
(upper
limit
of
normal)
6
0
6
9
12
Years
from
randomization
15
3
4
Years
from
randomization
Chlorpropamide
Glipizide
Relative
risk
reduction
(%)
P = 0.029
P = 0.34
P = 0.44
P = 0.052
P
=
0.0099
P
=
0.52
-5
-15
-25
Any
T2DM-related
endpoint
T2DM-
related
death
All
deaths
MI
Stroke
Micro-vascular
endpoints
P*
All-cause mortality
0.02
Metformin
Intensive
MI
0.12
Metformin
Intensive
Stroke
Metformin
Intensive
0.03
0
1
Relative
risk
(95%
CI)
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2
UKPDS
Group.
Lancet.
1 998;352:854-65.
0.12
52
e vents
42%
Risk
(9%63%)
P
=
0.02
0.10
0.10
Any
initial
CV
e vent* 0.06
0.08
CV
death,
nonfatal
MI,
0.06
stroke*
0.04
0.04
0.08
31 e vents
0.02
0.02
0
0
10
57%
Risk
(12%79%)
P
=
0.02
15
20
25 e vents
11 e vents
10
15
20
Time
(years)
DCCT
ends
Conventional
Intensive
DCCT
ends
DCCT/EDIC
Study
Research
Group.
N
Engl
J
Med.
2 005;353:2643-53.
*Cumulative
incidence
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Favors
conventional
glycemic
control
Any
macrovascular*
T2DM
0.81 (0.730.91)
Cardiac
T2DM
0.91 (0.801.03)
Peripheral
vascular
T2DM
0.58 (0.380.89)
Cerebrovascular
T2DM
0.58
(0.460.74)
0
0.5
1
Incidence
rate
ratio
(95%
CI)
UKPDS
9
8.5
ADOPT
Conventional*
Glibenclamide
Metformin
Insulin
Rosiglitazone
Metformin
Glibenclamide
7.5
8
7.5
Recommended
treatment
target <7.0%
6.5
6
6.5
2
4
6
8
Years from randomisation
10
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2
3
Time
(years)
Weight of
study s ize
Participants
Events
UKPDS
3071/1549
426/259
8.6%
PROactive*
2605/2633
164/202
20.2%
ADVANCE
5571/5569
310/337
36.5%
892/899
77/90
9.0%
5128/5123
205/248
25.7%
17267/15773
1182/1136
100%
VADT
ACCORD
Overall
Odds
ratio
(95%
CI)
Odds
ratio
(95%
CI)
0.75 ( 0.541.04)
0.81 ( 0.651.00)
0.92 ( 0.781.07)
0.85 ( 0.621.17)
0.82 ( 0.680.99)
0.85 ( 0.770.93)
0.6
0.8 1.0 1.2 1.4 1.6
Intensive
treatment
Standard
treatment
better
better
* Included non-fatal myocardial infarction and death from all-cardiac mortality
sonywibisono@yahoo.com
Ray
KK
et
a l.
L ancet
2009;373:176572
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Insulin
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ORIGIN
Outcome
Reduction
with
an
Initial
Glargine
Intervention
(ORIGIN)
Trial
Overview
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ORIGIN
Objectives
Assess the relationship between long-term
n-3 fatty acid supplementation and the rate
of CV events
Assess effects of insulin glargine on CV
outcomes
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ORIGIN
Trial
Design
Patients
and
Methods
12,537 patients from 573 sites treated with insulin glargine (open) vs standard
care and n-3 fatty acids (1g per day) versus placebo (double-blind)
Baseline characteristics
- Mean age, 63.5 years
- Females, 35%
- Median FPG, 125 mg/dL
- Median HbA1c, 6.4%
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ORIGIN
Primary outcomes
CV death or MI or stroke
CV death or MI or stroke or revascularization or CHF
hospitalization
Secondary outcomes
Microvascular composite
New T2DM
All cause death
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ORIGIN
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HbA1c 7 .5%
Gejala
(-)
Monoterapi*
dengan
salah
satu
obat
di
bawah
ini
Kombinasi 2 obat
Kombinasi 3 obat
Glukosidase
Alfa
Penghambat
SGLT-2**
Tiazolidindion
Sulfonilurea
Glinid
Agonis
GLP-1
Penghambat
DPP-IV
Tiazolidindion
Penghambat
SGLT-2
Insulin
Basal
SU/Glinid
Kolsevelam**
Bromokriptin-QR
Penghambat
Obat
lini
kedua
+
Penghambat DPP-IV
Metformin
Agonis
GLP-1
Gejala (+)
Agonis
GLP-1
Penghambat
DPP-IV
Kombinasi 3 obat
Tiazolidindion
Penghambat
SGLT-2
Insulin
Basal
Kolsevelam**
Bromokriptin-QR
Penghambat
Glukosidase
Alfa
Keterangan
*Obat
yang
terdaftar,
pemilihan
dan
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tumor hipofisis
Basal
Bolus
Add
prandial
insulin
before
e ach
meal
Glargiine
- Glulisine
Basal Plus
Basal
THANK YOU
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