Driving implementation Driving implementation of new guidelines – of new guidelines – an option for IDF an option for IDF Europe member Europe member organisations organisations www.easd.org www.escardio.org Joint ESC/EASD Guidelines supporting IDF members (Euro Heart J: 2007; 28: 88-136)
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Driving implementation Driving implementation of new guidelines –of new guidelines –
an option for IDF an option for IDF Europe member Europe member
Appointed by ESC and EASDAppointed by ESC and EASD
GUIDELINES ON DIABETES, PRE-DIABETESAND CARDIOVASCULAR DISEASES
1.1. IntroductionIntroduction
2.2. Definition, classification and screening of diabetes Definition, classification and screening of diabetes and and pre-diabetic glucose abnormalitiespre-diabetic glucose abnormalities
3.3. Epidemiology of diabetes, impaired glucose Epidemiology of diabetes, impaired glucose homeostasis and cardiovascular riskhomeostasis and cardiovascular risk
4.4. Identification of subjects at high risk for Identification of subjects at high risk for cardiovascular cardiovascular disease or diabetesdisease or diabetes
5.5. PathophysiologyPathophysiology
6.6. Treatment to reduce cardiovascular riskTreatment to reduce cardiovascular risk
7.7. Management of cardiovascular diseaseManagement of cardiovascular disease
New ESC/EASD Guidelines
Table of contents (1)Table of contents (1)
GUIDELINES ON DIABETES, PRE-DIABETESAND CARDIOVASCULAR DISEASES
1.1. Heart failure and diabetesHeart failure and diabetes
2.2. Arrhythmias – atrial fibrillation and sudden cardiac Arrhythmias – atrial fibrillation and sudden cardiac deathdeath
3.3. Peripheral and cerebrovascular diseasePeripheral and cerebrovascular disease
4.4. Intensive careIntensive care
5.5. Health economics and diabetesHealth economics and diabetes
6.6. ReferencesReferences
New ESC/EASD Guidelines
Table of contents (1)Table of contents (1)
Pocket guidelines Pocket guidelines available available
GUIDELINES ON DIABETES, PRE-DIABETESAND CARDIOVASCULAR DISEASES
New ESC/EASD Guidelines
Top 10 Recommendations (1)Top 10 Recommendations (1)
ESC Pocket Guidelines adapted from European Heart Journal (2007) 28, 88 - 136
• reach all treatment targets (e.g. for lipids, BP, glycemia) to reduce CV risk
• screen for diabetes and IGT in all CV patients with an oGTT, as in subjects with high risk scores
• Lifestyle counselling (150 min exercise/wk, weight loss 5-7%, no smoking) is the basis of any diabetes therapy and of prevention of diabetes and CV disease
• Patients with diabetes and acute coronary disease should be offered mechanical revascularisation together with all other guideline based therapy
GUIDELINES ON DIABETES, PRE-DIABETESAND CARDIOVASCULAR DISEASES
New ESC/EASD Guidelines
Top 10 Recommendations (2)Top 10 Recommendations (2)
ESC Pocket Guidelines adapted from European Heart Journal (2007) 28, 88 - 136
• Coronary revascularisation should favor bypass surgery over percutaneous intervention (PCI)
• when PCI is done, drug-eluting stents should be used
• specific risk assessment of diabetes patients with CV disease should screen for CAN, HF, arrhythmias, hypotension, PVD (Doppler), and (micro-) albuminuria
• strict BG control with intensive insulin therapy improves outcome of critically ill and cardiac surgery patients
GUIDELINES ON DIABETES, PRE-DIABETESAND CARDIOVASCULAR DISEASES
New ESC/EASD Guidelines
Top 10 Recommendations (3)Top 10 Recommendations (3)
ESC Pocket Guidelines adapted from European Heart Journal (2007) 28, 88 - 136
• multifactorial therapy (lipid normalisation, tight control of HBP, near-normal glycemic control, antipalatelet therapy) is cost effective in preventing complications in patients with diabetes and CV disease
• the joint approach of cardiologists and diabetologists is mandatory for the sake of the millions of patients with diabetes, prediabetes and CV disease in view of the huge overlap between cardiovascular and metabolic diseases
Pocket guidelines: dri-Pocket guidelines: dri-ving implementation ving implementation - big chance for IDF - big chance for IDF
member member organisations organisations
www.easd.orgwww.escardio.org
New ESC/EASD Guidelines (Euro Heart J: 2007; 28: 88-136)
The problem is huge and can be solved only in The problem is huge and can be solved only in interdisciplinary cooperationinterdisciplinary cooperation
Guideline implementation meetings on a national or Guideline implementation meetings on a national or regional level help strengthen the competence and regional level help strengthen the competence and
visibility of diabetes organisations visibility of diabetes organisations
The guidelines are a simple, but excellent tool to The guidelines are a simple, but excellent tool to diagnose many undiagnosed patients with diabetesdiagnose many undiagnosed patients with diabetes
Implementation of the guidelines should improve the Implementation of the guidelines should improve the quality of care and the outcome of the millions of people quality of care and the outcome of the millions of people
with diabeteswith diabetes
New ESC/EASD Guidelines
Big chance for IDF member Big chance for IDF member organisationsorganisations
A campaign of the International Diabetes Federation IDF, also supported by the German Diabetes Union DDU and the National Actionforum on Diabetes NAFDM