A.S.L. 14 Chioggia Verona !2-13 dicembre 2008 Verona !2-13 dicembre 2008 Limpatto del prediabete 1° Conferenza Regionale sul Diabete Mellito Dr. Angelo Boscolo Bariga Dr. Angelo Boscolo Bariga

Il diabete è un insieme di disordini caratterizzati da valori glicemici elevati che causano complicazioni renali,oculari e nervose uniche e aumentano il rischio di patologia cardiovascolare.

Prediabete e microangiopatia

Retinopatia Prevalenza nell IGT diabete 6-12 mesi 7.6% Hamman RF 65th annual meeting of ADA %

Engelgau MM diabetes care 20: Retinopatia Soglia glicemica per la retinopatia A digiuno mg/dl 2h dopo carico orale mg/dl

Microalbuminuria Non diabetici IGT 4% 16% Metcalf PA diabetes

Herman WH diabetes care 15: , 1998 Neuropatia Prevalenza della polineuropatia simmetrica in soggetti egiziani Normali 4% 10% 13.6% IGT Diabete neo diagnosticato

30-50% Singleton et al diabetes care 24: , 2001 Neuropatia Prevalenza dell IGT in soggetti con neuropatia sensoriale dolorosa idiopatica

Prediabete e macroangiopatia

NFG IFG % Cardiogenic shock Fasting BG mmol/l No Shock Shock P=0.011P=0.003 Impaired fasting glucose and cardiogenic shock in patients with acute myocardial infarction Zeller M et al, European Heart Journal 25: , pt with acute MI 38% DM, 15%IFG, 47% NFG Anche la condizione di IFG è a maggior rischio di shock cardiogeno post-IMA

2-hour PPG, Not FPG, Predicted All-cause Mortality Adjusted for age, centre, sex < – –11.0 <7.8 Fasting plasma glucose (mmol/L) 2-hour PPG, 75g OGTT (mmol/L) Hazard ratio Adapted from DECODE Study Group. Lancet 1999;354:617.

Epidemiological Evidence Linking High PPG * with CVD Risk & Mortality DECODE, DECODE, High PPG is associated with increased risk of death, independent of FPG Pacific and Indian Ocean, Pacific and Indian Ocean, High PPG with normal FPG doubles the risk of mortality Funagata Diabetes Study, Funagata Diabetes Study, IGT, but not IFG, is a risk factor for CVD Whitehall, Paris, Helsinki Study 1998 Whitehall, Paris, Helsinki Study Men in upper 2.5% of PPG distribution had significantly higher CHD mortality The Rancho-Bernardo Study, The Rancho-Bernardo Study, PPG more than doubles the risk of fatal CVD and heart disease in older adults Diabetes Intervention Study, Diabetes Intervention Study, PPG (1-hr post-breakfast), but not FPG, is associated with CHD 1 DECODE Study Group. Lancet 1999;354: Shaw JE et al. Diabetologia 1999;42: Tominaga M et al. Diabetes Care 1999;22: Balkau B et al. Diabetes Care 1998;21: Barrett-Connor E et al. Diabetes Care 1998;21: Hanefeld M et al. Diabetologia 1996;39:1577. *2-hour PPG after 75g OGTT, except where indicated

Mod. da Tominaga M, et al. Diabetes Care 1999; 22: La ridotta tolleranza ai carboidrati è un fattore di rischio cardiovascolare: The Funagata Diabetes Study NGT IGTDiabete anni 0,940 0,950 0,960 0,970 0,980 0,990 1,000 Mortalità cardiovascolare Mortalità per tutte le cause 0,880 0,900 0,920 0,940 0,960 0,980 1, anni * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Prevalence of Hyperglycemia in 181 Cardiac Patients Without Known Diabetes Norhammar A. Lancet. 2002;359: Percentage of Population (n = 1181) 66% of AMI patients have IGT or previously undiagnosed T2DM on 75 g OGTT (35% IGT; 31% DM) 66% of AMI patients have IGT or previously undiagnosed T2DM on 75 g OGTT (35% IGT; 31% DM)

Anche per la glicemia, come per il colesterolo si può dire: Lower is better?

Rischio relativo cardiovascolare in rapporto allo status di diabete Frank B. Hush et al. Diabetes Care – N. 13 – set. 2002

Rischio relativo cardiovascolare in base al tempo precedente la diagnosi di diabete Frank B. Hush et al. Diabetes Care – N. 13 – set. 2002

Earlier is better ?

Grazie per lattenzione