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Dysglycaemia and cardiovascular risk

Asian experience

Chang-Yu Pan, China

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Western-Pacific region

Diabetes

2003 43 million (3%)

2025 76 million (4%)

Prediabetes2003 79 million (6%)

2025 120 million (7%)

IDF Diabetes Atlas. www.eatlas.idf.org.

Growing prevalences of diabetes and

prediabetes in Asia

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Peoples Republic of China

Diabetes

2003 23 million (3%)

2025 46 million (4%)

Prediabetes2003 33 million (4%)

2025 54 million (5%)

IDF Diabetes Atlas. www.eatlas.idf.org.

Growing prevalences of diabetes and

prediabetes in China

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Prediabetes is common in China

particularly IGT

75%

10%

15%

Isolated IFG1.7%

Isolated IGT

8.8%

IFG + IGT 1.2%

Total prevalence of prediabetes: 11.7%

Shanghai Diabetes InstituteShanghai community cross-sectional epidemiological survey

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Chinese IGT population is

at high risk of type 2 diabetesChinese individuals with IGT progress to type 2 diabetes

faster than American individuals with IGT

2hPG levels of IGT controls in Da-Qing Study and DPP were similar (mean value 160mg/dL)

17.2

11.1

13.3

0

24

6

8

10

12

14

16

18

20

Chinese

BMI 22.4kg/m2Chinese

BMI 27.5kg/m2American

BMI 34.2kg/m2

Incidence/100pys

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DECODA (n=6,817)

Nakagami T, et al. Diabetologia 2004;47:38594.

0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

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Postprandial hyperglycaemia is associated

with an increased risk of mortality

FPG (mmol/L)

adjusted for 2hPG criteria2hPG (mmol/L)

adjusted for FPG criteria

0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

Multivariatehazardratio

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Tai ES, et al. Diabetes Care 2004;27:172834.

Singapore National Health Survey 1992 (n=3,568)

Individuals with IGT

had a higher risk of

ischaemic heart

disease than those

with NGT

in each FPG category

0

0.5

1.0

1.5

2.0

2.53.0

3.5

6.0

NGT IGT

FPG level (mmol/L)

Hazardratio

Postprandial hyperglycaemia is

associated with an increased risk of CVD

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China Heart Survey study design

52 hospitals in 7 citiesin China

Enrolled patients admitted

with CAD (n=3,513)

Data collected by case recordform

Patients without known

diabetes received OGTTs

Hu DY, et al. Eur Heart J 2006;27:25739.

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Newly diagnosed

diabetes (OGTT)33%

3%

23%

24%

17%

36%

37%

27%

OGTT cohort(n=2,263)

Whole population(n=3,513)

~2/3 ofpatients have

hyperglycaemia

~3/4 ofpatients have

hyperglycaemia

Previously

known diabetes

Newly diagnosed

diabetes (FPG test)

NGT

Prediabetes

China Heart Survey dysglycaemia is

common in patients with CAD

Hu DY, Pan CY, Yu WM. Eur Heart J 2006;27:25739.

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Acute admission Elective admissionOGTT OGTTFPG

NGTIFGIGTType 2 diabetes

FPGProportionofpatien

ts(%)

020406080

100

China Heart Survey OGTTs diagnose

prediabetes and type 2 diabetes

Hu DY, Pan CY, Yu WM. Eur Heart J 2006;27:25739.

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Early diagnosis of prediabetes

is essential Early diagnosis and management of prediabetes can

reduce the risk of both type 2 diabetes andcardiovascular disease

Western Pacific Diabetes Declaration (WPDD)guidelines:The risk of complications is related to the

duration of diabetes, as well as the degree of

hyperglycaemia. However, due to delayed diagnosis,

these complications may already be present at

diagnosis

WPDD. www.wpdd.org/downloads/Diabetes_Book.pdf.

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WHO Technical Report

Definition and Diagnosis of Diabetes Mellitusand Intermediate Hyperglycaemia

IDF Congress 2006, Cape Town, South Africa

Risk might best be assessed by the use of prediction

scores which, in addition to plasma glucose, alsoinclude other risk factors

The poor reproducibility of IFG and IGT suggests thatabsolute FPG or 2hPG measurement might be more

informative than categorisation into IFG or IGT

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Tuomilehto J, et al. www.diabetes.fi.

Screening high-risk populations

in EuropeFINDRISC

1. Age

64 years (4p)

2. Body mass index

30kg/m2 (3p)

3. Waist circumference measured below the ribs (usually at the level of the navel)Men: 102cm (4p)

Women: 88cm (4p)

4. Do you usually have daily at least 30 minutes of physical activity at work and/or

during leisure time (including normal daily activity)?

Yes (0p); No (2p)

5. How often do you eat vegetables, fruit or berries?

Every day (0p); Not every day (1p)

6. Have you ever taken antihypertensive medication regularly?

No (0p); Yes (2p)

7. Have you ever been found to have high blood glucose (e.g. in a health

examination, during an illness, during pregnancy)?

No (0p); Yes (5p)

8. Have any of the members of your immediate family or other relatives been

diagnosed with diabetes (type 1 or type 2)?

No (0p); Yes grandparent, aunt, uncle or first cousin (but not own parent, brother,

sister or child) (3p); Yes parent, brother, sister or own child (5p)

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Recruit patients with >2 risk factors:

1. Family history of T2D

2. Hypertension

3. Obesity

4. History of gestational diabetes

5. Delivery of a baby >4kg6. Dyslipidaemia

7. >40 years old

Toll-free hotline provided

Screening high-risk populations

in China

hospital poster

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Totalpatients

Healthy IGT T2D

Guangzhou 10 4,585 2,854 592 1,13962% 13% 25%

Hangzhou 10 5,076 1,559 1,529 1,98831% 30% 39%

Beijing 11 5,166 2,631 452 2,083

51% 9% 40%Shanghai 10 3,810 2,289 516 1,005

60% 14% 26%

Total 41 18,637 9,333 3,089 6,215

50% 17% 33%

DiagnosisTotalhospitals

City

Results of 2002 screening campaign

in China

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IDF Congress 2006, Cape Town, South Africa

WHO Technical Report

Definition and Diagnosis of Diabetes Mellitusand Intermediate Hyperglycaemia

Recommendation 6

The OGTT should be retained as a diagnostic test forthe following reasons:

FPG alone fails to diagnose approximately 30% ofcases of previously undiagnosed diabetes

OGTT is the only means of identifying people with IGT

OGTT is frequently needed to confirm or excludean abnormality of glucose tolerance inasymptomatic people

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Conclusions

The China Heart Survey confirms that CVD isassociated with dysglycaemia in Chinese patients

Early diagnosis and management of dysglycaemia,with either lifestyle modification or pharmacotherapy,is essential

Simple risk-prediction tools are available that can be

used for routine screening to identify high-riskindividuals