Predator R

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.
Diabetes is a huge and growing problem
2014 2035
and the costs to society are high and escalating
Diabetes is a human and economic burden
4.9 million deaths per year Intersects with all US$612 billion
dimensions of
50% of deaths under 60 development 11% of worldwide healthcare
years of age expenditure
Agenda

PREDATORR Study
Conclusions
Acknowledgements
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
Subjects were randomly assigned for screening from the list of
each GP via a random number generator
Inclusion criteria Exclusion criteria

Subjects aged 20-79 years Subjects aged <20 and >79 years
Born and with residence in Born outside Romania
Romania Living for the past 10 years
Living for the past 10 years mostly outside Romania
mainly in Romania Refuse or can not sign the
Included on the list of a GP informed consent
affiliated with CNAS Pregnant or breastfeeding
Signing the I.C. women
ROMANIA at a glance - PREDATORR 2013
Prediabetes
16.5%
Known diabetes
9.2%
Diabetes
11.6%
NGT
71.9%
Unknown diabetes
2.4%
DIABETES
Diabetes in Romania (20-79 years))
Adult Romanian population 15097473
(20-79 years)
Number of people with diabetes 1752000
Age- and sex-adjusted prevalence of 11.6%
diabetes
Undiagnosed cases 362340
(unknown diabetes mellitus UKDM)
Age- and sex-adjusted prevalence of UKDM 2.4%
Diabetes worldwide
Diabetes in Romania - PREDATORR 2013
(Adults 20-79 years); Source: IDF Diabetes Atlas Sixth Edition 2014
Top 10 countries/territories for prevalence (20-79 years)
2013 and 2035
Romania PREDATORR 2013

11,6%
Source: IDF Diabetes Atlas Sixth Edition 2013
EUROPE at a glance
Romania at glance
PREDATORR 2013

Diabetes surge in EUROPE
PREDATORR
Romania
1.752 million
Romania
11.6%
Spain 2012 13.8%
Portugal 2010 11.7%
(Adults 20-79 years)
Diagnosed and undiagnosed diabetes among
people aged 20 years or older, United States, 2012
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)
Source: 20092012 National Health and Nutrition Examination Survey estimates applied to 2012 U.S. Census data
Prevalence of impaired glucose regulation by sex and age groups
50,4% 49,3%
35,5%
29,4%
11,5% 8,1%
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)
Prevalence of DIABETES and PREDIABETES by age groups
22%
4,3%
13.3%
27,8%
3,2%
18,9% 17,7%
2.9%
10,1%
0,2% 6,9%
2,7%
Prevalence of DIABETES and PREDIABETES by sex
13.6%
2,9%
9.8%
1,9% 16,7%
16,3%
10,7%
7,9%
Prevalence of DIABETES by sex and age groups
24.3%
4,6% 20%
17%
4,1%
4,9%
10.2%
1,8% 19,7%
15,9%
3.5% 12,1%
0 2.4% 8,4%
0,5%
3,5%
1,9%
Prevalence (%) of people with diabetes by age
and sex, 2013
(Adults 20-79 years) Source: IDF Diabetes Atlas Sixth Edition 2013
PREDIABETES
Prediabetes in Romania (20-79 years))

Adult Romanian 15097473
(20-79 years)
Number of people with prediabetes 2491083
Age- and sex-adjusted prevalence of 16.5%
prediabetes
Prediabetes worldwide
Study population Prediabetes Observations

prevalence
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: 20092012 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: 87981
Soriguer F et al. Prevalence of diabetes mellitus and impaired glucose regulation in Spain: The Di@bet.es Study. Diabetologia. 2012; 55:8893.
IDF Diabetes Atlas Sixth Edition 2013
Prevalence of PREDIABETES by sex and age groups
29,3%
26,1%
18,5% 19,2%
8%
5,7%
Prevalence (%) of IGT (20-79 years) by age and sex,
2013
(Adults 20-79 years) Source: IDF Diabetes Atlas Sixth Edition 2013
Agenda

PREDATORR Study
Conclusions
Acknowledgements
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

PREDATORR Study
Conclusions
Acknowledgements
Type of therapy for type 2 diabetes patients
2% 2%
18% 13%
47% Diet
45%
Polytherapy
Bitherapy
Monotherapy
36% 38%
TOTAL = 1409 PATIENTS (weighted)

2014 2013
Bitherapy includes fixed combinations
Type of therapy
Classes in monotherapy
66%
BIGUANIDES 62%
16%
SULPHONYLUREAS 21%
14%
INSULINS 13%
2%
AGI 1%
2%
DPP-IV INHIBITORS 0,4%
0,40%
GLP-1 AGONISTS 1%
0,10%
GLINIDES 1%
2014 2013
GLITAZONES 1%
Displaying categories >2%
Type of therapy,
Classes in bitherapy
35%
BIGUANIDES+SULPHONYLUREAS 39%
24%
BIGUANIDES+INSULINS 24%
12%
INSULINS+INSULINS 9%
9%
DPP-IV INHIBITORS+BIGUANIDES 6%
5%
SULPHONYLUREAS+INSULINS 5%
4%
BIGUANIDES+GLP-1 AGONISTS 1%
2%
BIGUANIDES+AGI 1%
2014 2013
Type of therapy,
Classes in polyherapy
31%
BIGUANIDES+SULPHONYLUREAS+INSULINS 29%
18%
BIGUANIDES+INSULINS+INSULINS 26%
10%
DPP-IV INHIBITORS+BIGUANIDES+SULPHONYLUREAS 13%
9%
AGI+BIGUANIDES+SULPHONYLUREAS 10%
6%
BIGUANIDES+GLP-1 AGONISTS+SULPHONYLUREAS 1%
5%
DPP-IV INHIBITORS+BIGUANIDES 1%
4%
BIGUANIDES+INSULINS 5%
2%
BIGUANIDES+AGI+INSULINS 1%
2%
BIGUANIDES+BIGUANIDES 1%
2%
BIGUANIDES+SULPHONYLUREAS+GLITAZONES 1%
2014 2013
Type of therapy
Brands
Brands in monotherapy Brands in bitherapy Brands in polytherapy
9%
20% LANTUS+DIAPREL+SIOFOR 6%
48% DIAPREL+SIOFOR 18%
SIOFOR 42% 6%
8% DIAPREL+SIOFOR+LEVEMIR 1%
9% LANTUS+SIOFOR 7%
DIAPREL 13% SIOFOR+AMARYL+LANTUS
5%
7% 12%
9% JANUVIA+SIOFOR 4%
METFOGAMMA 5%
11%
6%
JANUVIA+SIOFOR+AMARYL 4%
6% AMARYL+SIOFOR 11% 4%
LANTUS 4% SIOFOR+DIAPREL+JANUVIA 7%
4%
SIOFOR+LEVEMIR 4% 4%
4% SIOFOR+AMARYL+GLUCOBAY 5%
GLUCOPHAGE 4% 4%
DIAPREL+METFOGAMMA 4% 4%
4% GLUCOBAY+SIOFOR+DIAPREL 3%
GLURENORM 3% 4%
NOVOMIX 30+SIOFOR 4% 4%
3% JANUVIA+GLIBOMET 1%
metforminum 3% 3%
GLIBOMET 8% LEVEMIR+NOVORAPID+SIOFOR
3%
3%
2%
NOVOMIX 3% 2% 3%
LEVEMIR+NOVORAPID 2% LEVEMIR+AMARYL+SIOFOR 1%
2% 2%
AMARYL 3% SIOFOR+GLUCOBAY 1% BYDUREON+DIAPREL+SIOFOR
3%
2% 2% 2%
HUMALOG 2% LANTUS+APIDRA 1% BYETTA+DIAPREL+SIOFOR
2% 2% 2%
LEVEMIR 1% METFOGAMMA+LANTUS 1% SIOFOR+NOVORAPID+LANTUS 4%
2% 2% 2%
GLUCOBAY NOVORAPID+LANTUS 1% LANTUS+GLIBOMET 3%
1%
2% 2%
2% HUMALOG+LANTUS 1%
SIOFOR+LANTUS+APIDRA 2%
HUMULIN 1%
2% 2%
2% BYDUREON+SIOFOR AMARYL+METFOGAMMA+LANTUS 1%
JANUVIA 0,4% 2%
SIOFOR+APIDRA+LANTUS 1%
2014 2013
2014 2013 2014 2013

Agenda

PREDATORR Study
Conclusions
Acknowledgements
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

PREDATORR Study
Conclusions
Acknowledgements
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 dEpidemiologie 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

Predator R

Enviado por

Dados do documento

Título original

Direitos autorais

Formatos disponíveis

Compartilhar este documento

Compartilhar ou incorporar documento

Opções de compartilhamento

Você considera este documento útil?

Este conteúdo é inapropriado?

Direitos autorais:

Formatos disponíveis

Predator R

Enviado por

Direitos autorais:

Formatos disponíveis

Diabetes management:

lessons from around

SG Popa, M Mota, E Mota, A Mitrea

Premises: diabetes as a huge and growing problem

Diabetes (DM) and related comorbidities are major

Premises: diabetes as a huge and growing problem

Estimating the prevalence of DM and pre diabetes in

Estimating the prevalence of DLP in Romania

Inclusion criteria Exclusion criteria

Diabetes in Romania - PREDATORR 2013

Romania PREDATORR 2013

Source: IDF Diabetes Atlas Sixth Edition 2014

Romania PREDATORR 2013

Prediabetes in Romania (20-79 years))

Study population Prediabetes Observations

Premises: diabetes as a huge and growing problem

1996: National Diabetes Register of the Child

Vlad A ONROCAD Study group, 2015.

Premises: diabetes as a huge and growing problem

TOTAL = 1409 PATIENTS (weighted)

Displaying categories >2%

Premises: diabetes as a huge and growing problem

Premises: diabetes as a huge and growing problem

The Company CEBIS International (www.cebis-int.com), for: Study

Profesor Cristian Baicus - Head of the Clinical Epidemiology Unit of Bucharest, in

Synevo Central Laboratory, for performing the analysis of the study

Você também pode gostar