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The Science:  Diabetes Control The National Diabetes Education Program   Changing the Way Diabetes is Treated.
What is Diabetes? ,[object Object],[object Object],[object Object],NIDDK, National Diabetes Statistics 2007.  www.diabetes.niddk.nih.gov/dm/pubs/statistics/
Common Types of Diabetes ,[object Object],[object Object],[object Object],[object Object],NIDDK, National Diabetes Statistics 2007.  www.diabetes.niddk.nih.gov/dm/pubs/statistics/
Common Types of Diabetes ,[object Object],[object Object],[object Object],[object Object],NIDDK, National Diabetes Statistics 2007.  www.diabetes.niddk.nih.gov/dm/pubs/statistics/
Risk Factors for Diabetes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],American Diabetes Association. Diabetes Care 2008; 31;(Suppl.1):S12-54.
Diabetes and Cardiovascular Disease ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NIDDK, National Diabetes Statistics 2007.  www.diabetes.niddk.nih.gov/dm/pubs/statistics/
Diabetes Complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],NIDDK, National Diabetes Statistics 2007.  www.diabetes.niddk.nih.gov/dm/pubs/statistics/
Diabetes Control and Complications Trial (DCCT)   ,[object Object],DCCT. New England Journal of Medicine, 329(14), September 30, 1993.
Glucose control  is key to preventing or delaying complications of diabetes Any sustained lowering of blood glucose helps , even if the person has a history of poor control DCCT Findings   DCCT. New England Journal of Medicine, 329(14), September 30, 1993.
DCCT Findings ,[object Object],[object Object],[object Object],[object Object],DCCT. New England Journal of Medicine, 329(14), September 30, 1993.
United Kingdom Prospective Diabetes Study (UKPDS)  ,[object Object],[object Object],UKPDS. BMJ. 2000; 321:405-412.
Mirrored the findings of DCCT in people with type 2 diabetes—better glucose control reduced development of microvascular complications Demonstrated the need for management of high blood pressure and cholesterol as well as blood glucose levels (the ABCs of diabetes) UKPDS Findings  UKPDS. BMJ. 2000; 321:405-412.
UKPDS Findings Stratton IM, et al.  BMJ . 2000;321:405-412. P  <.0001 P  = .035 P  = .021 P  = .0001 Risk reduction with 1% decline in annual mean A1C 0% 15% 30% 45% Micro-vascular Disease 37% PVD 43% Stroke MI 14% 12% Heart Failure Cataract Extraction 16% 19%
Epidemiology of Diabetes Interventions and Complications Study (EDIC)   ,[object Object],[object Object],[object Object],DCCT/EDIC N Engl J Med 2005: 353:2643-2653.
[object Object],[object Object],[object Object],[object Object],EDIC Findings: Intensive Therapy and Diabetes Complications DCCT/EDIC N Engl J Med 2005: 353:2643-2653.
Cumulative Incidence  Years from Study Entry EDIC Findings: Cardiovascular Events Cumulative Incidence of First of Any Event 0  1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21 Risk reduction 42%  95% CI: 9% to 63% P = 0.02 0.12 0.10 0.08 0.06 0.04 0.02 0.00 Conventional Intensive DCCT/EDIC N Engl J Med 2005: 353:2643-2653.
Conventional Intensive Non-Fatal MI, Stroke, or CVD Death EDIC Findings: Cardiovascular Events 0  1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19  20  21 Years from Study Entry 0.00 0.02 0.04 0.06 0.08 0.10 0.12 Cumulative Incidence  Risk reduction 57%  95% CI: 12% to 79% P = 0.02 DCCT/EDIC N Engl J Med 2005: 353:2643-2653.
UKPDS 10 yr Follow-Up Study-  insulin/sulfonylurea group ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],N Engl J Med 2008; 359
UKPDS 10 yr Follow-Up Study-  metformin group ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],N Engl J Med 2008; 359
UKPDS 10 yr Follow-Up Study- Blood Pressure findings ,[object Object],[object Object],[object Object],N Engl J Med 2008; 359
Recent Clinical Trial Findings: ,[object Object],[object Object],[object Object],[object Object],ACCORD:  N Engl J Med 2008; 358(24):2545-59 ADVANCE:  N Engl J Med 2008; 358 (24): 2560-72 VADT:  J Diabetes Complications 2003; 17 (6): 314-22
Key points of recent findings:  ,[object Object],[object Object],[object Object],N Engl J Med 2008; 359
SEARCH  For Diabetes in Youth Study ,[object Object],[object Object],[object Object],(SEARCH) . Diabetes Care 2006 29(8): 1891-6.
SEARCH Findings ,[object Object],[object Object],[object Object],(SEARCH) . Diabetes Care 2006 29(8): 1891-6.
SEARCH Findings ,[object Object],[object Object],[object Object],[object Object],(SEARCH) . Diabetes Care 2006 29(8): 1891-6.
National Diabetes Education Program   Materials
Diabetes Control: Patient Materials
Diabetes Control:  Health Care Professionals
NDEP Websites
Other NDEP Campaign Tools  at  www.YourDiabetesInfo.org ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],The U.S. Department of Health and Human Services’ National Diabetes Education Program is jointly sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention with the support of more than 200 partner organizations.

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The Science Diabetes Control

  • 1. The Science: Diabetes Control The National Diabetes Education Program Changing the Way Diabetes is Treated.
  • 2.
  • 3.
  • 4.
  • 5.
  • 6.
  • 7.
  • 8.
  • 9. Glucose control is key to preventing or delaying complications of diabetes Any sustained lowering of blood glucose helps , even if the person has a history of poor control DCCT Findings DCCT. New England Journal of Medicine, 329(14), September 30, 1993.
  • 10.
  • 11.
  • 12. Mirrored the findings of DCCT in people with type 2 diabetes—better glucose control reduced development of microvascular complications Demonstrated the need for management of high blood pressure and cholesterol as well as blood glucose levels (the ABCs of diabetes) UKPDS Findings UKPDS. BMJ. 2000; 321:405-412.
  • 13. UKPDS Findings Stratton IM, et al. BMJ . 2000;321:405-412. P <.0001 P = .035 P = .021 P = .0001 Risk reduction with 1% decline in annual mean A1C 0% 15% 30% 45% Micro-vascular Disease 37% PVD 43% Stroke MI 14% 12% Heart Failure Cataract Extraction 16% 19%
  • 14.
  • 15.
  • 16. Cumulative Incidence Years from Study Entry EDIC Findings: Cardiovascular Events Cumulative Incidence of First of Any Event 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Risk reduction 42% 95% CI: 9% to 63% P = 0.02 0.12 0.10 0.08 0.06 0.04 0.02 0.00 Conventional Intensive DCCT/EDIC N Engl J Med 2005: 353:2643-2653.
  • 17. Conventional Intensive Non-Fatal MI, Stroke, or CVD Death EDIC Findings: Cardiovascular Events 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 Years from Study Entry 0.00 0.02 0.04 0.06 0.08 0.10 0.12 Cumulative Incidence Risk reduction 57% 95% CI: 12% to 79% P = 0.02 DCCT/EDIC N Engl J Med 2005: 353:2643-2653.
  • 18.
  • 19.
  • 20.
  • 21.
  • 22.
  • 23.
  • 24.
  • 25.
  • 26. National Diabetes Education Program Materials
  • 28. Diabetes Control: Health Care Professionals
  • 30.
  • 31.