https://doi.org/10.1080/14740338.2021.1898585. Lancet. Of these, 54,783 were treated with OGLDs and 7729 with lifestyle modification only. Elliott A, Walters RK, Pirinen M, Kurki M, Junna N, Goldstein J, Reeve MP, Siirtola H, Lemmel S, Turley P; FinnGen; Palotie A, Daly M, Widn E. medRxiv. In this article, we review the glucocentric and cardiorenal risk reduction approaches to the management of T2D supplemented by real-world evidence from the Asia Pacific region. Practice guidelines, largely based on experience in the USA and Europe, may not apply to regions such as Asia Pacific, where differences in epidemiology, patient phenotypes, cultures, and socioeconomic status need to be considered. The IDF Diabetes Atlas also introduces readers to the pathophysiology of diabetes, its classification and its diagnostic criteria. GLP-1 receptor agonists and cardiorenal outcomes in type2 diabetes: an updated meta-analysis of eight CVOTs. Jia W, Weng J, Zhu D, et al. Accessed 20 Jan 2023. Araki E, Goto A, Kondo T, et al. 2018;41(1):1431. https://doi.org/10.1007/s13300-023-01386-5, DOI: https://doi.org/10.1007/s13300-023-01386-5. Before Zoungas S, Chalmers J, Ninomiya T, et al. In: StatPearls [Internet]. Although Asians were generally under-represented in these CVOTs [11], in a meta-analysis, Asian patients treated with SGLT2 inhibitors or GLP-1 receptor agonists were found to have lower hazard ratios (HR) of major events than their Caucasian counterparts [12]. https://doi.org/10.1111/dom.14192. Adjusting treatment options to real-world practice presented at the International Diabetes Federations Virtual Congress 2021 on 7December 2021. Positive legacy effect of intensive glycaemic control [32]. This number is predicted to rise to 643 million by 2030 and 783 million by 2045. 2020;17(10):e1003367. Adjusting treatment options to real-world practice' presented at the International Diabetes Federation's Virtual Congress 2021 on 7 December 2021. . 2021;23(1):24551. By clicking below to subscribe, you acknowledge that your information will be transferred to Mailchimp for processing. Siew Pheng Chan, Lee-Ling Lim, Juliana CN Chan and David R Matthews were all involved in the conception, drafting and final approval of this manuscript. Diabetes Care. Design and baseline characteristics of participants in the Researching cardiovascular Events with a Weekly INcretin in Diabetes (REWIND) trial on the cardiovascular effects of dulaglutide. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), A Target HbA1c Between 7 and 7.7% Reduces Microvascular and Macrovascular Events in T2D Regardless of Duration of Diabetes: a Meta-Analysis of Randomized Controlled Trials, https://doi.org/10.1038/s41574-022-00776-2, https://doi.org/10.2991/jegh.k.191028.001, https://doi.org/10.1007/s00125-019-05078-3, https://doi.org/10.1186/s12933-018-0728-6, https://doi.org/10.1186/s12933-021-01366-8, https://doi.org/10.1186/s12933-021-01386-4, https://idf.org/e-library/guidelines/128-idf-clinical-practice-recommendations-for-managing-type-2-diabetes-in-primary-care.html, https://doi.org/10.1007/s13340-020-00439-5, https://doi.org/10.1007/s13300-019-00733-9, https://doi.org/10.1371/journal.pone.0123116, https://doi.org/10.1111/j.1464-5491.2008.02581.x, https://doi.org/10.1007/s00125-011-2404-1, https://doi.org/10.2337/diacare.21.8.1271, https://doi.org/10.1016/j.molmet.2020.101102, https://doi.org/10.1016/S2213-8587(17)30327-3, https://doi.org/10.1016/j.kint.2020.08.012, https://doi.org/10.1016/S0140-6736(19)32131-2, https://doi.org/10.1016/j.ahj.2013.07.012, https://doi.org/10.1001/jamacardio.2020.4511, https://doi.org/10.1080/14740338.2021.1898585, https://doi.org/10.1016/S2213-8587(19)30068-3, https://doi.org/10.1016/j.eclinm.2022.101751, https://doi.org/10.1016/j.kint.2022.06.013, https://doi.org/10.1371/journal.pmed.1003367, https://www.who.int/publications/i/item/9789241565257, https://doi.org/10.1016/S0140-6736(20)32374-6, http://creativecommons.org/licenses/by-nc/4.0/. Diabetes Care. The opinions expressed in the manuscript are those of the authors. 1, 2 Recent global estimates indicate that 537 million adults have diabetes, of whom 80% live in low-income and middle-income countries (LMICs). https://doi.org/10.1016/j.kint.2020.08.012. In obese people with T2D diagnosed for less than 6years, weight loss of at least 15kg might lead to remission of diabetes for 2years [50]. IDF Diabetes Atlas 2021 IDF Guide for Epidemiology Studies Atlas presentation IDF Diabetes Atlas 2022 Reports Factsheets Previous editions 9th edition 8th edition 7th edition 6th edition 5th edition 4th edition 3rd edition 2nd edition 1st edition Scientific papers and posters Citation usage Copyright requests Selected studies Citation usage Article Marso SP, Poulter NR, Nissen SE, et al. However, the majority of patients with T2D, especially those with long disease duration, will need medications to control glycaemia. IDF is the global reference for accurate, up-to-date estimates of the prevalence of diabetes and its impact on individuals and health economies. ACEi angiotensin-converting enzyme inhibitor, ACR albumin/creatinine ratio, ARB angiotensin receptor blocker, ASCVD atherosclerotic cardiovascular disease, CGM continuous glucose monitoring, CKD chronic kidney disease, CV cardiovascular, CVD cardiovascular disease, CVOT cardiovascular outcomes trial, DPP-4i dipeptidyl peptidase4 inhibitor, eGFR estimated glomerular filtration rate, GLP-1 RA glucagon-like peptide1 receptor agonist, HbA1c glycated haemoglobin, HF heart failure, HFpEF heart failure with preserved ejection fraction, HFrEF heart failure with reduced ejection fraction, HHF hospitalization for heart failure, MACE major adverse cardiovascular events, MI myocardial infarction, SDOH social determinants of health, SGLT2i sodiumglucose cotransporter2 inhibitor, T2D type2 diabetes, TZD thiazolidinedione. Among overweight patients treated with metformin, there was also persistent risk reduction for any diabetes-related endpoint (21%, p=0.01), myocardial infarction (33%, p=0.005), and death from any cause (27%, p=0.002) [32]. HHS Vulnerability Disclosure, Help Intensive glucose control improves kidney outcomes in patients with type2 diabetes. 2013;166(5):823-30 e5. Arlington: American Diabetes Association; 2020. 2019 Nov;157:107843. doi: 10.1016/j.diabres.2019.107843. Evolution of Type 2 Diabetes Management from a Glucocentric Approach to Cardio-Renal Risk Reduction: The New Paradigm of Care, Portuguese-Brazilian evidence-based guideline on the management of hyperglycemia in type 2 diabetes mellitus, Cardiovascular outcomes trials: a paradigm shift in the current management of type 2 diabetes, Inadequate Use of Newer Treatments and Glycemic Control by Cardiovascular Risk and Sociodemographic Groups in US Adults with Diabetes in the NIH Precision Medicine Initiative All of Us Research Program, Redefining diabetes mellitus treatments according to different mechanisms beyond hypoglycaemic effect, Glycemic Control and Prevention of Diabetic Complications in Low- and Middle-Income Countries: An Expert Opinion, 2019 update to: Management of hyperglycaemia in type 2 diabetes, 2018. During that period, it cost around 966 billion US dollars for control and treatment expenses, an amount that has increased by around 316% in the last 15 years (IDF Diabetes Atlas 2021 10th Edition and other resources). https://doi.org/10.2337/dci17-0057. https://doi.org/10.1016/S0140-6736(20)32374-6. 2023 Springer Nature Switzerland AG. Thus, in patients without cardiorenal complications, physicians should consider selecting GLDs with the lowest acquisition cost to increase accessibility and affordability, even in patients with multiple risk factors or complications, such as those enrolled in the CVOTs, in which the benefits of newer GLDs were evaluated against background therapies, such as metformin, SUs, statins, and reninangiotensinaldosterone system inhibitors. That said, not all data in patients with T2D supported the legacy effect of early glycaemic control on cardiovascular outcomes, likely owing to differences in study design, settings, interventions, and patient profiles. Giugliano D, Maiorino MI, Bellastella G, Chiodini P, Esposito K. Glycemic control, preexisting cardiovascular disease, and risk of major cardiovascular events in patients with type2 diabetes mellitus: systematic review with meta-analysis of cardiovascular outcome trials and intensive glucose control trials. 2023;25(1):20821. Diabetes Res Clin Pract. The Federation has been leading the global diabetes community . Diabetologia. One in 10 adults worldwide currently has diabetes, accounting for an estimated global health expenditure of $966 billion in US dollars in 2021, according to the new International Diabetes. Arch Gynecol Obstet. https://doi.org/10.1136/bmj.321.7258.405. It represents the interests of the growing number of people with diabetes and those at risk. Diabetes is responsible for 6.7 million deaths in 2021 - 1 every 5 seconds. PMC 2013;36(11):375965. 8600 Rockville Pike Persistent effects of intensive glycemic control on retinopathy in type2 diabetes in the Action to Control CardiOvascular Risk in Diabetes (ACCORD) follow-on study. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published. C. Patterson, S. Karuranga, +4 authors G. Ogle Published 1 November 2019 Medicine Diabetes research and clinical practice View on PubMed N Engl J Med. PLoS ONE. This site needs JavaScript to work properly. Patients with T2D are at increased risk of developing microvascular and macrovascular complications, which are driven by hyperglycaemia and other cardiometabolic risk factors, notably hypertension, dyslipidaemia, and obesity [4]. Data from the Diabetes Control and Complications Trial (DCCT) and post-trial Epidemiology of Diabetes Interventions and Complications (EDIC) study also confirmed the legacy effects of early versus late glycaemic control in patients with type1 diabetes (T1D) [38]. Conclusions: Prolonged exposure to HbA1c levels8.0% was associated with substantial increase in risk of microvascular events and mortality. JAMA Cardiol. A global perspective. Epub 2018 Feb 26. ADVANCE Collaborative Group, Patel A, MacMahon S, et al. Diabetes Obes Metab. Lee-Ling Lim reported receiving grants and/or honoraria for consultancy or giving lectures from Abbott, AstraZeneca, Boehringer Ingelheim, Merck Sharp & Dohme, Novo Nordisk, Pfizer, Procter & Gamble Health, Roche, Sanofi, Servier and Zuellig Pharma. Used with permission of American Diabetes Association and the European Association for the Study of Diabetes, from Management of Hyperglycemia in Type2 Diabetes, 2022. https://doi.org/10.1056/NEJMoa1414266. While newer GLDs have been proven to reduce cardiorenal events in high-risk patients, older GLDs such as metformin and SUs (e.g. https://doi.org/10.2337/dci19-0003. Diabetes Care. The global diabetes prevalence in 20-79 year olds in 2021 was estimated to be 10.5% (536.6 million people), rising to 12.2% (783.2 million) in 2045. Reducing glycated haemoglobin has been proven to reduce the risk of these complications while early attainment of glycaemic goal can have a legacy effect in later life. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA. Real-world usage of sulphonylureas in Asian patients with type2 diabetes using the Joint Asia Diabetes Evaluation (JADE) register. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. Download the IDF Diabetes Atlas 10th Edition and other resources. The https:// ensures that you are connecting to the https://doi.org/10.1056/NEJMoa1407963. Elley CR, Kenealy T, Robinson E, Drury PL. CN112985358A . Khunti K, Bellary S, Karamat MA, et al. During this time, the publication has established itself as the most cited and trusted source on the global impact of diabetes and an indispensable tool for diabetes advocacy. official website and that any information you provide is encrypted This is associated with high risk of premature mortality related to diabetes and its complications [2]. Effects of anti-diabetes medications on cardiovascular and kidney outcomes in Asian patients with type2 diabetes: a rapid evidence assessment and narrative synthesis. The objective of T2D management is to prevent complications and premature mortality and improve quality of life [13, 14]. Pastakia SD, Njuguna B, Onyango BA, Washington S, Christoffersen-Deb A, Kosgei WK, Saravanan P. BMC Pregnancy Childbirth. info@idf.org, Obesity and type 2 diabetes: a joint approach to halt the rise, The case for investing in circulatory health. In the post-trial ACCORDION Study, prior intensive glycaemic control during the ACCORD study was associated with a sustained 58% risk reduction in progression diabetic retinopathy compared with standard therapy despite similar HbA1c levels in the post-trial period [39]. Diabetol Int. Among the three World Bank country income groups, high income countries had the highest standardized prevalence of GDM. All patients with diabetes should receive a structured education program on lifestyle modification, notably diet and exercise, and self-management. Relative risk reductions persisted over the 10-year post-trial period for any diabetes-related endpoints and microvascular complications in patients with type2 diabetes treated intensively with sulfonylureainsulin versus conventional treatment in the UKPDS, while risk reductions for myocardial infarction and death from any cause emerged over time, as more events occurred. Brussels: International Diabetes Federation; 2021. Japanese clinical practice guideline for diabetes 2019. Teo ZL, Tham YC, Yu M, Cheng CY, Wong TY, Sabanayagam C. Eye (Lond). Epub 2020 Jan 28. A sub-analysis suggested that GLP-1 receptor agonists might confer greater therapeutic benefits in patients with CVD, who had a relative risk reduction of 16% compared with 6% in those without CVD [9]. Diabetes Care. The impact of diabetes mellitus and corresponding HbA1c levels on the future risks of cardiovascular disease and mortality: a representative cohort study in Taiwan. Would you like email updates of new search results? More recent cardiovascular outcome trials (CVOTs) further confirmed the cardiorenal benefits of sodiumglucose cotransporter2 (SGLT2) inhibitors and glucagon-like peptide1 (GLP-1) receptor agonists in patients with T2D who had multiple risk factors and/or complications [1, 8,9,10]. 2012;55(3):63643. https://doi.org/10.2337/dc21-1331. Yang A, Shi M, Lau ESH, et al. Epidemiology of type2 diabetesglobal burden of disease and forecasted trends. Due to the high prevalence of TB and DM, the double burden of TB and DM constitutes a global public health concern. In the Japan Diabetes Optimal Treatment study for three major risk factors of CVD (J-DOIT3), researchers compared the effects of intensive versus conventional control of multiple risk factors in Japanese patients with T2D (including glycaemia, hypertension, and/or dyslipidaemia) on clinical outcomes [30]. Laiteerapong N, Ham SA, Gao Y, et al. Management of type2 diabetes in developing countries: balancing optimal glycaemic control and outcomes with affordability and accessibility to treatment. McGuire DK, Shih WJ, Cosentino F, et al. Diabetes Care. Use of glucose-lowering medications in the management of T2D [14]. Diabetes Care. 2021. 2019;35(6):e3158. Meanwhile, results from ACCORD have emphasized the importance of individualized treatment that takes into consideration the risk-to-benefit ratio, especially in high-risk patients. We have been publishing global estimates of the prevalence of diabetes for just over 20 years. Toxics. Presenting new epidemiological and diabetes-related impact data. Glycemic targets: Standards of medical care in diabetes-2022. In this multicentre study, 11,140 patients (32% with CVD) received either standard glycaemic control or intensive glycaemic control, the latter using modified release gliclazide plus other GLDs, as required, in a 1:1 ratio. Factsheets. Both gliclazide and glimepiride were equally used in China, while glibenclamide and glipizide were commonly used in Thailand. Lancet. Kidney Int. Durability of a primary care-led weight-management intervention for remission of type2 diabetes: 2-year results of the DiRECT open-label, cluster-randomised trial. Unauthorized use of these marks is strictly prohibited. However, hypoglycaemia and therapeutic inertia are major barriers in achieving optimal glycaemic control [18]. In 2021, according to the 10th edition of the International Diabetes Federation's Diabetes Atlas, 537 million people worldwide had diabetes, accounting for one in ten adults with diabetes [1]. https://doi.org/10.1111/dme.13103. 10-year follow-up of intensive glucose control in type2 diabetes. RRR relative risk reduction, UKPDS United Kingdom Prospective Diabetes Study. Accessibility Servier supports the Tseu Fellows in low- and middle-income countries. The incidence of myocardial infarction in white, South Asian, and Afro-Caribbean patients with type2 diabetes (U.K. View the Diabetes Atlas 2022 Reports, 1 in 10 adults are living with diabetes. International Diabetes Federation will use the information you provide in this form to be in touch with you. Federal government websites often end in .gov or .mil. sharing sensitive information, make sure youre on a federal The .gov means its official. Unable to load your collection due to an error, Unable to load your delegates due to an error. Chan JCN, Lim LL, Luk AOY, et al. IDF Diabetes Atlas 10th Edition and other resources. 31. IDF Diabetes Atlas: Worldwide Estimates of Incidence, Prevalence and Mortality of Type 1 Diabetes in Children and Adolescents: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Learn more about Mailchimp's privacy practices here. 2016;39(7):1089100. International Diabetes Federation.IDF Diabetes Atlas, 10th edn. N Engl J Med. Historical HbA1c values may explain the type2 diabetes legacy effect: UKPDS 88. This highlights the urgent need to improve the ability to diagnose people with diabetes, many of whom are unaware they have diabetes, and provide appropriate and timely care for all people with diabetes as early as possible. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. https://doi.org/10.1038/ki.2012.401. Epub 2020 May 9. J Epidemiol Glob Health. Both glucocentric and cardiorenal-centric treatment strategies have complementary effects in reducing the trajectory of cardiorenal diseases. PubMed Central Cardiovasc Diabetol. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). https://doi.org/10.2337/dc16-0024. Since 2007, the JADE Register had enrolled at least 120,000 patients from 11 Asian countries/areas, including China, India, Thailand, Malaysia, Singapore, Korea, Taiwan, Hong Kong, Vietnam, Philippines, and Indonesia [59]. In a meta-analysis of recent CVOTs, a 1% decrement in HbA1c achieved with GLP-1 receptor agonists was associated with a 30% risk reduction of major adverse cardiovascular events (MACE; Fig. This tailored approach is also supported by the recommendations of the Japanese [17], Chinese [16], and Korean [55] practice guidelines (Table2). HbA1c glycated haemoglobin, UKPDS United Kingdom Prospective Diabetes Study, yr(s) year(s). Design of the liraglutide effect and action in diabetes: evaluation of cardiovascular outcome results (LEADER) trial. The International Diabetes Federation (IDF) is an umbrella organization of over 230 national diabetes associations in 170 countries and territories. MeSH Front Endocrinol (Lausanne). 2018;17(1):83. https://doi.org/10.1186/s12933-018-0728-6. In 2021, the estimated numbers of people with diabetes living in urban and rural areas were 360.0 million and 176.6 million, with prevalence estimated at 12.1% and 8.3%, respectively. Kidney Int. Hyperglycaemia in diabetes causes microvascular and macrovascular complications, along with an increased risk of premature mortality. One in 10 adults worldwide are living with diabetes, 90% of whom have T2D [2]. An official website of the United States government. https://doi.org/10.2337/dc20-2439. https://doi.org/10.1016/j.ahj.2013.07.012. Ueki K, Sasako T, Okazaki Y, et al. Zoungas S, Chalmers J, Neal B, et al. Association between foetal sex and adverse neonatal outcomes in women with gestational diabetes. https://doi.org/10.1056/NEJMoa0802987. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045 Diabetes Res Clin Pract. B-1160 Brussels, Belgium First published in 2000, the IDF Diabetes Atlas is produced by IDF in collaboration with a committee of scientific experts from around the world. We use Mailchimp as our marketing platform. Updated ADA practice guidelines are shown in Fig. Bethesda, MD 20894, Web Policies 2017 Jul 14;17(1):226. doi: 10.1186/s12884-017-1415-4. 2008;358(24):254559. David R Matthews reported receiving financial support for giving lectures from Servier, Novo Nordisk, Merck, Boehringer Ingelheim and Lilly. The International Diabetes Federation (IDF) has adopted a pragmatic approach by reviewing available guidelines and integrating the recommendations applicable to primary care settings around the world [15]. 2021 clinical practice guidelines for diabetes mellitus of the Korean Diabetes Association. 2023 Feb 2;13:1039643. doi: 10.3389/fendo.2022.1039643. B-1160 Brussels, Belgium 2022 Jan;183:109050. doi: 10.1016/j.diabres.2021.109050. Despite the availability of new treatment classes, glycaemic control in patients with diabetes remains suboptimal globally. The Federation has been leading the global diabetes community since 1950. In a sub-analysis of the VERIFY study, the benefit of early combination therapy was observed in both patients with early or late onset of diabetes [34]. A deeper look into the state of type 2 diabetes in Indigenous Peoples, type 1 diabetes in children and adults, the impact of COVID-19, and diabetes foot-related complications Treasure Island (FL): StatPearls Publishing; 2022 Jan. Please enable it to take advantage of the complete set of features! https://doi.org/10.2337/dc10-1658. Presenting new epidemiological and diabetes-related impact data. It is also estimated that over 6.7 million people aged 20-79 will die from diabetes-related causes in 2021. Methods Citations. Every person with diabetes has a unique risk profile, highlighting the need for individualization of glucose-lowering regimens and treatment targets, as recommended by most practice guidelines, including those from Asia where treatment affordability is an important consideration. 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