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1、DrugTreatmentsin Type2DiabetesDrRichardBriceMBBChMAMRCGPGPSIinDiabetesChairman,WhitstableMedicalPracticeUKTrendsforDiabetesNationaldiabetesprevalenceForecastDiabetesUKReport“DiabetesintheUK”(2009)Equivalentto3.9%ofthepopulationPrevalence(%ofpopulation)?2005.Americ
2、anCollegeofPhysicians.AllRightsReserved.?2005.AmericanCollegeofPhysicians.AllRightsReserved.Diabetes:AnNHSpriorityUK/LR/0809/0366Dateofpreparation:August2009TheCostofDiabetestothe NHSBudgetCostsareincreasingasaresultoftheobesityepidemic,sedentarylifestylesandanage
3、ingpopulation10%=￡1mperhourDiabetesUKReport“DiabetesintheUK”(2009)TheBurdenforPeoplewithT2D60-70%willdieofcardiovasculardisease1Almost1in3willdevelopovertkidneydisease2Commonestcauseofblindnessintheworkingpopulation3Upto50%willdevelopneuropathy4Commonestcauseoflow
4、erlimbamputation5Depressiontwiceascommoncomparedwiththegeneralpopulation6Sexualdysfunctionisaproblem7,8(prevalencenotknown)1DuckworthetalNEJM,2009;360:129-39;2DoH(2006);3Hamiltonetal.Managementofdiabeticretinopathy,London1996:BMJPublishing;4Boulton,ClinDiabetes200
5、5;23:9–15;5NationalDiabetesSupportTeam(2006).Diabeticfootguide;6KatonetalDiabetesCare2004;27:914–920.7Al-Hunayanetal.BrJUrolInt2007;99(1):130–134;8DiabetesintheUK2009:KeyStatisticsin Diabetes.DiabetesUKLifeExpectancyandDiabetesLifeexpectancyisdecreasedby5–10yrsint
6、ype2diabetesGoodkin,JOccupMed1975;17:716–721;Donnellyetal.BMJ2000;320:1062–1066T2D:theChallengeInsulinResistanceHyperinsulinaemiaTargetsAmenabletoPharmacotherapyHbA1c<7.0%(53mmol/ml)BP<130/80Totalcholesterol<4.0,LDL<2.012NICEBPAlgorithm2008NICEClinicalGuideline66T
7、ype2Diabetes(update)2008LipidManagementGetthemonastatin,usuallysimvastatin40mgAimfortotalcholesterol<4.0andLDL<2.0Instatinintolerance,encourageseveraldifferentstatinsEvenalowdoseofastatinisbetterthananyotherlipidloweringRxPlantsterolsetcshouldbeanadjuncttostatintr
8、eatment,notasubstituteRelationbetweentheproportionalreductionin MAJORVASCULAREVENTSandmeanabsoluteLDLreductionin14statintrialsCholesterolTreatmentTriali
