AstraZeneca Boehringer Ingelheim Eli Lilly Janssen Merck Novo Nordisk Sanofi Takeda Grant Support Boehringer Ingelheim Novo Nordisk Merck 2 Type 2 diabetes is increasingly prevalent Globally 387 million people are living with diabetes ID: 645572
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1Slide2
DisclosureConsultations and Honoraria
AstraZeneca, Boehringer Ingelheim, Eli Lilly, Janssen, Merck,
Novo Nordisk, Sanofi, Takeda
Grant SupportBoehringer Ingelheim, Novo Nordisk, Merck
2Slide3
Type 2 diabetes is increasingly prevalent
Globally, 387 million people are living with diabetes
1
3
At least 68% of people >65 years with diabetes die of heart disease
2
This will rise to 592 million by 2035
1
1. IDF Diabetes Atlas 6th Edition 2014
http://www.idf.org/diabetesatlas
; 2. Centers for Disease Control and Prevention 2011; 3. Seshasai et al. N Engl J Med 2011;364:829-41
Mortality risk associated with diabetes (n=820,900)
3Slide4
Diabetes is associated with significant loss of life years
Seshasai et al. N Engl J Med 2011;364:829-41
4
.
0
7
6
5
4
3
2
1
0
40
50
60
70
80
90
Age (years)
Years of life lost
Men
7
6
5
4
3
2
1
0
40
50
60
70
80
90
0
Age (years)
Women
Non-vascular deaths
Vascular deaths
On average, a 50-year-old individual with diabetes and no history of vascular disease will die 6 years earlier compared to someone without diabetesSlide5
Number
of events
More
intensive
Less
intensive
Difference
in HbA1c (%)
HR (95% CI)
Stroke
378
370
-0.88
0.96 (0.83, 1.10)
Myocardial
infarction
730
745
-0.88
0.85
(0.76, 0.94)
Hospitalisation
for or death from heart failure
459
446
-0.88
1.00 (0.86, 1.16)
Meta-analysis of intensive glucose control in T2DM: major CV events including heart failure
5
Favours more intensive
Favours less intensive
Meta-analysis of
27,049 participants and 2370 major
vascular events from:
ADVANCE
UKPDS
ACCORD
VADT
HR, hazard ratio; CV, cardiovascular
Turnbull FM et al. Diabetologia 2009;52:2288–2298 Slide6
Number
of events
More
intensive
Less
intensive
Difference
in HbA1c (%)
HR (95% CI)
All-cause
mortality
980
884
-0.88
1.04 (0.90,1.20)
CV death
497
441
-0.88
1.10 (0.84,1.42)
Non-CV
death
476
432
-0.88
1.02 (0.89,1.18)
Meta-analysis of intensive glucose control in T2DM: mortality
6
Favours more intensive
Favours less intensive
Meta-analysis of
27,049 participants and 2370 major
vascular events from
ADVANCE
UKPDS
ACCORD
VADT
HR, hazard ratio; CV, cardiovascular
Turnbull FM et al. Diabetologia 2009;52:2288–2298Slide7
Recent trials of newer glucose-lowering agents have been neutral on the primary CV outcome
7
SAVOR-TIMI 53
EXAMINE
HR: 1.0
(95% CI: 0.89, 1.12)
HR: 0.96
(95% CI: UL ≤1.16)
TECOS
HR: 0.98
(95% CI: 0.88, 1.09)
EMPA-REG OUTCOME
®
ELIXA
HR: 1.02
(95% CI: 0.89, 1.17)
Empagliflozin
DPP-4 inhibitors*
Lixisenatide
CV, cardiovascular;
HR, hazard ratio;
DPP-4, dipeptidyl peptidase-4
*Saxagliptin, alogliptin, sitagliptin
Adapted from Johansen OE. World J Diabetes 2015;6:1092-96
2013
2014
2015