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Sony Wibisono M
Diabetes and Nutrition Centre Surabaya – Division of
Endocrinology and Metabolism - Department of Internal
medicine – Faculty of Medicine Airlangga University Surabaya
Banjarmasin, 10 May 2014
Overview of presentation
Conclusion
2013 IDF Diabetes Atlas - Sixth edition
A huge and growing problem
Guidelines UKPDS
ACCORD1 VADT2
Primary CVD
10% (p=0.16) 13% (p=0.12)
endpoint
Mortality
22% (p=0.04) 6.5% (p=NS)
(overall)
SAVOR EXAMINE
Median age (yr) 65 61
Duration of diabetes (yr) 10.3 7.3
HbA1c 8.0% 8.0%
Established CVD
Hypertension 81% 83%
Prior MI 38% 88%
Prior HF 13% 28%
eGFR (ml/min) 72 71
Individual Endpoints
Scirica et al. NEJM 369(2013)1317-26
Hospitalization for Heart Failure
* *
* * * *
*p<0.001
Scirica et al. NEJM 369(2013)1317-26
Glycemic Indices Over Time
Worldwide
White Orientation
et al. NEJM Plan 2013-2014
369(2013)1327-35
Hypoglycemia
Significantly more patients in saxagliptin group than placebo
reported at least one Hypoglycemia
p<0.001
p=0.002
15
10
(%)
p=0.047
5 p=0.33
No cardiovascular protection
hospitalization for heart failure
Differently…
11 140 patients
CONTROL Group; Turnbull FM, Abraira C, Anderson RJ, et al. Diabetologia. 2009;52:2288-2298.
Renal Protection
ESRD
65%
Intensive glucose control based on
gliclazide MR improves kidney outcomes
ADVANCE results for different stages of renal disease in the intensive arm based on gliclazide MR.
VADT
SAVOR ADVANCE
Antidiabetic agents:
Metformin 69% 74%
Sulfonylureas 40% 93%
DPP-4 inh. 99% 0%
TZDs 5% 17%
Insulin 44% 40%
Cardiovascular agents:
Statin 81% 46%
RAS blocking 82% 89%
-blockers 63% any BP lowering drug
Aspirin 78%
Worldwide
Scirica Orientation
et al. NEJM Plan 2013-2014
369(2013)1317-26
Hypoglycemia
SAVOR ADVANCE
SAVOR1 ADVANCE2
Hospitalization for
27% (p=0.007) 5% (p=0.45)
heart failure
Evidence of CV
protection
Thank You