Insulin Therapy in the Inpatient and Outpatient Setting.ppt

Insulin Therapy in the Inpatient and Outpatient Setting Agustin Busta, MD Assistant Professor Albert Einstein College of Medicine Association of DM with total life expectancy and life expectancy with and without cardiovascular disease Women with diabetes had more than double the risk of developing cardiovascular disease and, 2.2 times higher risk of dying among those with CVD, compared with non-diabetic women,“ Diabetic men, compared with non-diabetic men, had more than double the risk of developing CVD and a 1.7 times higher risk of dying once CVD was present. Among those age 50 and older, diabetic men lived an average of 7.5 years less than men without diabetes, and diabetes reduced womens life expectancy by an average of 8.2 years. Life expectancy free of cardiovascular disease was reduced by 7.8 years in men and 8.4 years in women with diabetes. Associations of Diabetes Mellitus with Total Life Expectancy and Life Expectancy with and without Cardiovascular Disease Glycemia Macrovascular Disease inNon-Diabetic Subjects UKPDS 10 yr Follow-Up Study- insulin/sulfonylurea group Differences in A1C between intensive standard glycemic control treatment groups were lost after one year Relative risk reductions at 10 yr in intensive insulin/sulfonylurea group: 9% for any diabetes end point (P=0.04) 24% microvascular disease (P=0.001) 15% myocardial infarction (P=0.01) 13% death from any cause (P=0.007) UKPDS 10 yr Follow-Up Study-Metformin group Differences in A1C between intensive standard glycemic control treatment groups were lost after one year Relative risk reductions at 10 yr in intensive metformin group: 21% for any diabetes end point (P=0.01) 33% myocardial infarction (P=0.005) 21% death from any cause (P=0.002) DCCT- EDIC Post ad-hoc analysis shows a decreased of macrovascular complications on patients who received intensive insulin therapy in the DCCT trial. Epidemiology of Diabetes Interventions and Complications Study (EDIC) Observ