BP DM Duration
Proteinuria Gender
Smoking Ethnicity
UKPDS and Legacy Effect
Meta-analysis:
Effect of Intensive Glucose control on Macrovascular Outcomes
n = 27,049
4 Trials (ACCORD, ADVANCE, UKPDS, VADT); Average duration 4.4 yrs
2370 Vascular events
Confidence
For every 1% HbA1c HR
Interval
Major CV events 0.91 0.84 0.99
Stroke 0.91
p = 0.39
0.73 1.13
0.82
Peripheral vascular disease 1.19 p = 0.29
0.56
0.76
Microvascular disease 0.64 0.89 p = 0.001
-
-
-
Data represent point estimate and 95% CI 0.1 0.5 1 5 10
Intensive better Conventional better
Intensive = SU or insulin in 5-year UKPDS. Median
HbA1c at end of UKPDS 7.9%
Conventional = diet only in 5-year UKPDS. Median Holman RR, et al. 10-year follow-up of intensive glucose control in
type 2 diabetes. N Engl J Med. 2008; 359: 1577-89.
HbA1c at end of UKPDS 8.5%
Asian Diabetic Patients Profile
Asian Phenotypes T2DM Patients
Younger Onset
Of Diabetes
Lower Rates Of
Higher Rate Of Type 1 Diabetes
Renal Complications
and Stroke compare to
CV Death &
Major Coronary Event Lower BMI But
High Visceral Fat
Adapted from Chan JCN, Yeung R, Luk A. Diabetes Voice 2014. March 14, Volume 59
An Alarmingly High Prevalence of Diabetic Nephropathy in
Asian T2DM : The Micro Albuminuria Prevalence
Microalbuminuria
Macroalbuminuria
Normoalbuminuria
Prevalence of microalbuminuria and macroalbuminuria (and 95% CI) by country in the per-protocol population
The dotted line represents the average prevalence of microalbuminuria (39.8%)
TRIVIA
QUIZ
15 16.2%
10
9.9%
ADVANCE3
5
5.1%
2.7% 1.5%
0
P <0.001 P <0.001 HR = 1.86
(95% CI 1.40-2.40)
% HbA1c at study end 6.9 8.4 6.4 7.5 6.5 7.3
Reaching up to -3.76%
HbA1c Reduction
Satoh study
Retrospective study (1981-2000) conducted in Japan.
Aim: to evaluate a possible difference in time until
start of insulin treatment between
T2DM treated with gliclazide and glibenclamide.
Patients: 274 type 2 diabetic patients
Moreover, the mean HbA1c during treatment was significantly lower with
gliclazide compared with glibenclamide (6.8% vs 7.4%)
-65%
Lowering HbA1c to 6.5% for 5 years, using regimen including gliclazide MR, leads
to further renal protection over 10 years
Prof V. Perkovic
Australia
Gliclazide MR
Figure 1. Reduction of risk of end-stage renal disease (ESRD) in patients achieving glycemic control
GUIDE Study
GLICLAZIDE:
No Limitation When Renal Function Declines
Antidiabetic Drug
Dose Reduction
Metformin
Dose Reduction
Glimepiride
Gliclazide
Glibenclamide
Dose Reduction
Sitagliptin
Saxagliptin
Vildagliptin
Linagliptin
Pioglitazone
Acarbose
Dapagliflozin
Liraglutide
Dose Reduction
Exenatide
Exenatide LAR
Dose Reduction
Insulin