2015-12-03 PAO: The Changing Landscape of Diabetes
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The document discusses the rising prevalence of diabetes in the Philippines, highlighting its classification, diagnostic tests, and comprehensive care recommendations. It emphasizes the importance of annual risk evaluations for type 2 diabetes and provides guidelines for screening and management, including a focus on lifestyle modifications and collaboration among healthcare professionals. The key takeaways underline the increasing incidence of diabetes and the need for structured management strategies.
![• Type 1 diabetes mellitus (formerly IDDM or Juvenile
diabetes mellitus): results from auto-immune beta-cell
destruction, leading to absolute insulin deficiency.
Typically but not exclusively in children.
• Type 2 diabetes mellitus (formerly NIDDM or adult-
onset DM): results from a progressive insulin secretory
defect on the background of insulin resistance
• Gestational diabetes mellitus (GDM): diabetes first
diagnosed during pregnancy
• Secondary diabetes e.g., genetic defects in beta cell function or insulin action,
diabetes of the exocrine pancreas (pancreatitis, cystic fibrosis), drug- or chemical-
induced diabetes (such as from the treatment of AIDS, after organ transplantation,
glucocorticoids), other endocrine diseases (Cushing’s syndrome, hyperthyroidism)
Diabetes Mellitus Classification
Jimeno, C. 2014 May 29. A Summary of the Philippines UNITE for Diabetes Clinical Practice Guidelines for the Diagnosis and Management of
Diabetes (Part I: Screening and Diagnosis of DM). Journal of the ASEAN Federation of Endocrine Societies. [Online] 26:1
Diabetes Mellitus Classification](https://image.slidesharecdn.com/2015paoconvention-151216104239/85/2015-12-03-PAO-The-Changing-Landscape-of-Diabetes-16-320.jpg)
![Differentiating Type 1 vs Type 2 Diabetes Mellitus
Jimeno, C. 2014 May 29. A Summary of the Philippines UNITE for Diabetes Clinical Practice Guidelines for the Diagnosis and Management of
Diabetes (Part I: Screening and Diagnosis of DM). Journal of the ASEAN Federation of Endocrine Societies. [Online] 26:1
Characteristics
Type 1
Diabetes Mellitus
Type 2
Diabetes Mellitus
Onset Acute & Asymptomatic Slow & Asymptomatic
Clinical Picture
Weight loss, polyuria,
polydipsia
If symptomatic, similar to T1 DM
- weight loss, polyuria, polydipsia
• Obese •Family history •PCOS
Ketosis Almost always present Usually absent
Therapy Insulin
Lifestyle, oral anti-diabetic
agents, insulin
Adapted from Alberti Diab Care, 2004.8 - ICA – islet cell antibodies; Anti-GAD – glutamic acid decarboxylase antibodies](https://image.slidesharecdn.com/2015paoconvention-151216104239/85/2015-12-03-PAO-The-Changing-Landscape-of-Diabetes-17-320.jpg)
![Jimeno, C. 2014 May 29. A Summary of the Philippines UNITE for Diabetes Clinical Practice Guidelines for the Diagnosis and Management of
Diabetes (Part I: Screening and Diagnosis of DM). Journal of the ASEAN Federation of Endocrine Societies. [Online] 26:1
Summary of Recommendations for Screening &
Diagnosis of Diabetes Mellitus
• All individuals should be evaluated annually for risk
factors for type 2 diabetes & pre-diabetes. (Level 5, Grade D)
• Universal screening using laboratory tests is not
recommended. (Level 5, Grade D)
• Repeat testing annually for Filipinos with Risk
Factors if initial test are negative (Level 5, Grade D)](https://image.slidesharecdn.com/2015paoconvention-151216104239/85/2015-12-03-PAO-The-Changing-Landscape-of-Diabetes-18-320.jpg)
![Diagnostic Examinations
Laboratories Normal Pre-diabetic Diabetic
FBS < 100 mg/dl 100-125 mg/dl >/= 126 mg/dl
75 OGTT < 140 mg/dl 140-199 mg/dl >/= 200 mg/dl
RBS < 140 mg/dl --- >/= 200 mg/dl
At the present time, we cannot recommend the routine use of the following tests for the
diagnosis of diabetes: (Grade C, Level 3)
HBA1c (poor access and lack of standardization), Capillary Blood Glucose, Fructosamine
Jimeno, C. 2014 May 29. A Summary of the Philippines UNITE for Diabetes Clinical Practice Guidelines for the Diagnosis and Management of
Diabetes (Part I: Screening and Diagnosis of DM). Journal of the ASEAN Federation of Endocrine Societies. [Online] 26:1](https://image.slidesharecdn.com/2015paoconvention-151216104239/85/2015-12-03-PAO-The-Changing-Landscape-of-Diabetes-20-320.jpg)
2015-12-03 PAO: The Changing Landscape of Diabetes
- 1. The Changing Landscape of Diabetes Jeremy F. Robles, MD, FPCP, FPSEDM Director, Philippine Society of Endocrinology, Diabetes & Metabolism (PSEDM) Section of Endocrinology, Diabetes & Metabolism - Chong Hua Hospital (Cebu) Department of Medicine, Cebu Institute of Medicine (CIM) - Cebu Velez General Hospital (CVGH)
- 2. Philippine Diabetes • Prevalence: Global and National Statistics • Diabetes Classification • Diagnostic tests and Evaluations • Treatment options and Comprehensive care
- 5. Global Prevalence of Diabetes IDF Diabetes Atlas I Seventh edition 2015
- 8. IDF Diabetes Atlas I Seventh edition 2015 Western Pacific Region
- 10. Diabetes is among the leading causes of Mortality in the Philippines WHO Western Pacific Country Health information Profiles 2011
- 12. 8th National Nutrition Survey 2013 Diabetes Prevalence in the Philippines (2013) Prevalence of diabetes significantly increased between 2008 & 2013. Urban poor have a higher prevalence Diabetes with increasing trend with increasing age and wealth. 4 3 5 5 0 1.5 3 4.5 6 1998 2003 2008 2013 Prevalence(%)
- 13. 8th National Nutrition Survey (FNRI)
- 14. 8th National Nutrition Survey (FNRI)
- 15. 8th National Nutrition Survey (FNRI)
- 16. • Type 1 diabetes mellitus (formerly IDDM or Juvenile diabetes mellitus): results from auto-immune beta-cell destruction, leading to absolute insulin deficiency. Typically but not exclusively in children. • Type 2 diabetes mellitus (formerly NIDDM or adult- onset DM): results from a progressive insulin secretory defect on the background of insulin resistance • Gestational diabetes mellitus (GDM): diabetes first diagnosed during pregnancy • Secondary diabetes e.g., genetic defects in beta cell function or insulin action, diabetes of the exocrine pancreas (pancreatitis, cystic fibrosis), drug- or chemical- induced diabetes (such as from the treatment of AIDS, after organ transplantation, glucocorticoids), other endocrine diseases (Cushing’s syndrome, hyperthyroidism) Diabetes Mellitus Classification Jimeno, C. 2014 May 29. A Summary of the Philippines UNITE for Diabetes Clinical Practice Guidelines for the Diagnosis and Management of Diabetes (Part I: Screening and Diagnosis of DM). Journal of the ASEAN Federation of Endocrine Societies. [Online] 26:1 Diabetes Mellitus Classification
- 17. Differentiating Type 1 vs Type 2 Diabetes Mellitus Jimeno, C. 2014 May 29. A Summary of the Philippines UNITE for Diabetes Clinical Practice Guidelines for the Diagnosis and Management of Diabetes (Part I: Screening and Diagnosis of DM). Journal of the ASEAN Federation of Endocrine Societies. [Online] 26:1 Characteristics Type 1 Diabetes Mellitus Type 2 Diabetes Mellitus Onset Acute & Asymptomatic Slow & Asymptomatic Clinical Picture Weight loss, polyuria, polydipsia If symptomatic, similar to T1 DM - weight loss, polyuria, polydipsia • Obese •Family history •PCOS Ketosis Almost always present Usually absent Therapy Insulin Lifestyle, oral anti-diabetic agents, insulin Adapted from Alberti Diab Care, 2004.8 - ICA – islet cell antibodies; Anti-GAD – glutamic acid decarboxylase antibodies
- 18. Jimeno, C. 2014 May 29. A Summary of the Philippines UNITE for Diabetes Clinical Practice Guidelines for the Diagnosis and Management of Diabetes (Part I: Screening and Diagnosis of DM). Journal of the ASEAN Federation of Endocrine Societies. [Online] 26:1 Summary of Recommendations for Screening & Diagnosis of Diabetes Mellitus • All individuals should be evaluated annually for risk factors for type 2 diabetes & pre-diabetes. (Level 5, Grade D) • Universal screening using laboratory tests is not recommended. (Level 5, Grade D) • Repeat testing annually for Filipinos with Risk Factors if initial test are negative (Level 5, Grade D)
- 20. Diagnostic Examinations Laboratories Normal Pre-diabetic Diabetic FBS < 100 mg/dl 100-125 mg/dl >/= 126 mg/dl 75 OGTT < 140 mg/dl 140-199 mg/dl >/= 200 mg/dl RBS < 140 mg/dl --- >/= 200 mg/dl At the present time, we cannot recommend the routine use of the following tests for the diagnosis of diabetes: (Grade C, Level 3) HBA1c (poor access and lack of standardization), Capillary Blood Glucose, Fructosamine Jimeno, C. 2014 May 29. A Summary of the Philippines UNITE for Diabetes Clinical Practice Guidelines for the Diagnosis and Management of Diabetes (Part I: Screening and Diagnosis of DM). Journal of the ASEAN Federation of Endocrine Societies. [Online] 26:1
- 23. Diabetes Care June 2012 vol. 35 no. 6 1364-1379 Antihyperglycemic therapy in type 2 diabetes: General Recommendations.
- 24. Initiation of Drug Therapy among Newly Diagnosed Type 2 Diabetes Patients Newly Diagnosed T2DM HbA1C < 9 FBS < 250 mg/dl Combination Therapy HbA1C >/= 9 FBS >/= 250 mg/dl Insulin Therapy Monotherapy Consider Combination Tx UNITE for Diabetes Philippine Clinical Practice Guidelines for the Diagnosis and Management of Diabetes 2015
- 25. Sequential Insulin Strategies in Type 2 Diabetes Mellitus UNITE for Diabetes Philippine Clinical Practice Guidelines for the Diagnosis and Management of Diabetes 2015 Non-Insulin Regimens Basal Insulin + 1 Rapid acting Insulin Premix Insulin Basal Insulin (Usually with oral meds) Basal Insulin + >2 Rapid acting Insulin
- 26. OPD Management of Diabetes UNITE for Diabetes Philippine Clinical Practice Guidelines for the Diagnosis and Management of Diabetes 2015 • Medical History & Physical Examination • Cardiovascular Risk Assessment • Foot Evaluation • Dental History and Oral Health • Thyroid Gland Evaluation • Eye Evaluation • Comprehensive evaluation for retinopathy for T2DM by an ophthalmologist upon diagnosing diabetes. (Grade A, Level 1)
- 27. COMPLICATIONS AND CARDIOVASCULAR RISK FACTORS AMONG NEWLY-DIAGNOSED TYPE 2 DIABETICS IN MANILA Phil. J. Internal Medicine, 47: 99-105, May-June, 2009 • N = 172 patients • Findings: • 20% (n=34) with peripheral neuropathy • 42% (n=72) with proteinuria • 12% (n=20) with diabetic retinopathy Mia C. Fojas, M.D., Frances Lina Lantion-Ang, M.D.,Cecilia A. Jimeno, M.D., Darby Santiago, M.D., Milagros Arroyo, M.D., Aurora Laurel, Heustein Sy, M.D. and Jason See, M.D.
- 29. Diabetes Eye Health: Integrating Eye Health Care in Diabetes Management 2015
- 30. Diabetes Eye Health: Integrating Eye Health Care in Diabetes Management 2015
- 31. OPD Management of Diabetes UNITE for Diabetes Philippine Clinical Practice Guidelines for the Diagnosis and Management of Diabetes 2015 • Achieve glycemic targets within 6 months • Treat and control Hypertension and Dyslipidemia • Integrate therapeutic Lifestyle Change: • Medical Nutrition Therapy: Diet • Physical Activity • Long term Diabetes Care Plan • Regular follow-up & monitoring • Vaccinations (Influenza & Pneumonia)
- 32. Key points • Increasing Prevalence of Diabetes (Globally & Nationally) • Lifestyle: Rapid urbanization a significant contributing factor but poor lifestyle habits are a main concern • Local Guidelines: Streamlined approach for Diagnosis, Management & Follow-up for Diabetic Patients • Comprehensive evaluation for Diabetes Complications • Need for collaborative approach to management with various subspecialties of interest.
Editor's Notes
- #39: UKPDS, microvascular endpoints (including retinopathy and nephropathy) decreased by 37% with each 1% absolute reduction in HbA1c, with no threshold observed
- #45: UKPDS, microvascular endpoints (including retinopathy and nephropathy) decreased by 37% with each 1% absolute reduction in HbA1c, with no threshold observed