Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we...
-
Upload
kamryn-paddock -
Category
Documents
-
view
213 -
download
0
Transcript of Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we...
![Page 1: Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b1c2e5503465e7d8b65e1/html5/thumbnails/1.jpg)
« Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes
SFD Congress-Geneva
Reported by
Dr Ramona Abi Gerges
![Page 2: Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b1c2e5503465e7d8b65e1/html5/thumbnails/2.jpg)
Publications :1. N Engl J Med 2011;364:818-282. N Engl J Med 2003;348:383-933. N Engl J Med 2011;364:829-414. The Lancet 2010, vol.375,issue 9713, Pages 481 -
4895. Diabetes Care 2010,April 28 vol. 33 no. 5 983-9906. Diabetologia 2010, 53:2079–20857. Diabetologia 2009,52:2288–22988. BMJ 2010; 340:b5444 9. BMJ 2000; 321:405-1210.Annals of Internal Medicine 2009, Vol.151 • Nbr
6-396
![Page 3: Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b1c2e5503465e7d8b65e1/html5/thumbnails/3.jpg)
• No epidemiologic argument in favor of poor glycemic control
• Paradoxical results in ACCORD showed that mortality increases when
HBA1C<6% and >8%
• UKPDS: reduction in micro-vascular , microalbuminuria complications when HBA1C<8%
![Page 4: Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b1c2e5503465e7d8b65e1/html5/thumbnails/4.jpg)
• Reasons for increased mortality
• Rapid decrease in HBA1c ?• Severe hypoglycemia ?• Uncontrolled hyperglycemia
itself?• Drug interactions,
polymedications?
![Page 5: Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b1c2e5503465e7d8b65e1/html5/thumbnails/5.jpg)
VADT ADVANCE
ACCORD
Baseline HBA1c 9,4% 7,2% 8,1%
∆HBA1C -2,5 -0,9 -1,7
Insulin used 89% 40% 77%
Duration of diabetes
11,5 y 8 y 10 y
Severe Hypoglycemia intensive v/s standard
21,2% v/s 9,9
2,7% v/s 1,5 16,2 % v/s 5,1
cardiovascular mortality /y
2,1 v/s 1,7 4,5 v/s 5,2 2,6 v/s 1,8
All cause of Mortality
8,9 v/s 9,6 5,0 v/s 4,0
![Page 6: Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b1c2e5503465e7d8b65e1/html5/thumbnails/6.jpg)
![Page 7: Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b1c2e5503465e7d8b65e1/html5/thumbnails/7.jpg)
![Page 8: Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b1c2e5503465e7d8b65e1/html5/thumbnails/8.jpg)
![Page 9: Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b1c2e5503465e7d8b65e1/html5/thumbnails/9.jpg)
![Page 10: Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b1c2e5503465e7d8b65e1/html5/thumbnails/10.jpg)
![Page 11: Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b1c2e5503465e7d8b65e1/html5/thumbnails/11.jpg)
![Page 12: Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b1c2e5503465e7d8b65e1/html5/thumbnails/12.jpg)
Epidemiologic Relationships Between A1C and All-Cause Mortality During a Median 3.4-Year Follow-up of Glycemic Treatment in the ACCORD Trial
Diabetes Care doi: 10.2337/dc09-1278
![Page 13: Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b1c2e5503465e7d8b65e1/html5/thumbnails/13.jpg)
![Page 14: Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b1c2e5503465e7d8b65e1/html5/thumbnails/14.jpg)
![Page 15: Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b1c2e5503465e7d8b65e1/html5/thumbnails/15.jpg)
![Page 16: Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b1c2e5503465e7d8b65e1/html5/thumbnails/16.jpg)
Conclusion
1. Hba1c is a marker of risk of complication
2. Hypoglycemia is a marker of risk of mortality rather than reason
3. The objective of the treatment is not to bring down HBA1C but to prevent complications micro and macro-vascular, irreversible once installed
![Page 17: Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b1c2e5503465e7d8b65e1/html5/thumbnails/17.jpg)
Conclusion 1. The target HbA1c varies between 6,5 % and 8 %
according to the patients
2. The individualization of the therapeutic way remains
the best daily approach in our clinical practice
3. « Earlier ? Probably»
« More extremely ? Probably not
»
![Page 18: Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard CHARBONNEL - Nantes « Should we reconsider our therapeutic goals in 2011 ? » Pr. Bernard.](https://reader035.fdocuments.net/reader035/viewer/2022070307/551b1c2e5503465e7d8b65e1/html5/thumbnails/18.jpg)
Thank you