MD Conference Express ADA 2011 - (Page 6)

n F E A T U R E The SHIELD Trial: Final Results and Epidemiological and Public Policy Implications Written by Lori Alexander An estimated 25.6 million adults in the United States (US) have diabetes mellitus [Centers for Disease Control and Prevention, Prevalence of diagnosed diabetes among adults aged 18 years and over: United States, 1997–2010, 2011]. In patients with newly diagnosed type 2 diabetes mellitus (T2DM), complications are often present at the time of diagnosis, suggesting that clinical onset of the disease occurred years prior to diagnosis [Koopman RJ et al. Ann Fam Med 2006]. Harold Bays, MD, Louisville Metabolic and Atherosclerosis Research Center, Louisville, Kentucky, USA, discussed the prevalence of metabolic risk among individuals with defined metabolic risk factors and T2DM and shared results from the Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD) study. SHIELD was a 5-year longitudinal observational study of individuals with or at risk for diagnosis of diabetes mellitus. Following an initial screening phase, follow-up questionnaires were mailed to a stratified random sample of individuals (n=22,001) with type 1 or type 2 diabetes or at high (3 to 5 American Diabetes Association risk factors) or low (0 to 2 risk factors) risk for diabetes [Clark NG et al. Diabetes Care 2007]. The population-based survey was designed to better understand the risk for the development of diabetes mellitus, as well as the disease burdens that are associated with it. The study sample was representative of the United States population with respect to age, gender, geographic region, household size, and income. Year-to-year from 2005–2009, the response rate to SHIELD (a survey-only study) was 68% to 80%. Outcomes were compared with 1999–2002 National Health and Nutrition Examination Survey (NHANES; a study that involved surveys and laboratory confirmation). While the prevalence of diabetes mellitus (8% in SHIELD and 9% in NHANES; p<0.01) and hypertension (23% in SHIELD and 29% in NHANES; p<0.01) was similar, dyslipidemia was reported only half as frequently in SHIELD (26%) than in NHANES (53%; p<0.01). Components of dyslipidemia were also uniformly lower in SHIELD than NHANES: high triglycerides (TG)=17% versus 35%; high low-density lipoprotein cholesterol=10% versus 14%; high TG=7% versus 17%; and low high-density lipoprotein cholesterol= 5% versus 24% (p<0.01 for all). The self-reported nature of SHIELD likely accounted for this difference when compared with NHANES [Bays HE Curr Med Res Opin 2008]. Individuals with diabetes or cardiometabolic risk factors and body mass index (BMI) ≥28 kg/m2 are considered at high risk [Green AJ et al. Int J Clin Pract 2007]. According to Dr. Bays, NHANES 1999–2002 results showed that among patients with diabetes mellitus, 21.7% had a BMI of 27 to 29.99 kg/m2 (overweight) and 50.9% had a BMI >30 kg/m2 (obese; Figure 1) [Bays HE et al. Int J Clin Pract 2007; Bays HE et al. Am J Med 2009]. Figure 1. BMI Distribution Among Patients with Metabolic Diseases. Diabetes Mellitus 0.4% Peer-Reviewed Highlights from the Hypertension 1.7% 7.6% 11.7% 21.9% Dyslipidemia 0.9% 5.1% 13.8% 13.9% 17.1% 9.9% 9.5% 25.5% 23.0% 23.2% 21.7% 20.7% 13.4% 21.5% 22.3% 15.1% Body Mass Index (kg/m2) <18.5 18.5 - 24.9 25 - 26.9 27 - 29.9 30 - 34.9 35 - 39.9 ≥40 Lean Normal Overweight Obese Reproduced with permission from Excerpta Medica Inc., from “Sick Fat,” Metabolic Disease, and Atherosclerosis 2008,Bays HE et al, vol. 122 no. 1: S27-S37; permission conveyed through Copyright Clearance Center, Inc. 6 August 2011 www.mdconferencexpress.com  http://www.mdconferencexpress.com http://professional.diabetes.org/Congress_Display.aspx?TYP=9&CID=82452 http://www.mdconferencexpress.com

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MD Conference Express ADA 2011

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