NDP 2012 – 2022 Annex 2 RESERVES IN THE CARE FOR DIABETIC PATIENTS IN THE CZECH REPUBLIC Data on mortality and data on treatment of diabetes and its comorbidities (including hypertension, dyslipidemia and obesity), use of recommended examination and achieving the target values in the Czech Republic are obtained from IHIS data, General Health Insurance Company data, epidemiological study of CDS, Valetudo project and IDN micro project. 1. Mortality The total mortality of diabetic patients is reducing in the Czech Republic. However, the mortality appears to be still higher in some age groups in comparison with mortality of the general population (table 1+2). Table 1 – patients with detected antidiabetic therapy according to data of the General Health Insurance Company in 2006 who died in 2006 – comparison of mortality according to age of population data in men Table 2 Patients with detected antidiabetic therapy according to GHI company data in 2006 who died in 2006 – comparison with mortality according to age to population data in women 2. Hyperglycaemia treatment Glycated hemoglobin (HbA1c) is the basic indicator for successful treatment of hyperglycaemia. The total overview of number of glycated hemoglobin examination in all diabetes mellitus patients in 2002-2006 can be seen in graph 1. The graph depicts that HbA1c is examined only 0,8 times a year in average. It means that there is insufficient number of recommended frequency- 2-4x per year and 50% of patients has not been examined at all (see graph 2). The situation concerning diabetic patients treated by insulin is much better (see graph 3). Education is not use sufficiently in the hyperglycaemia treatment (graph 6). Graph 1 – the total overview of glycated hemoglobin examinations according to the General Health Insurance Company in 2002-2006 Graph 2- the total overview of glycated hemoglobin examination in all diabetes mellitus patients according to the General Health insurance company data in 2002-2006 Graph 3 - The total overview of glycated hemoglobin examinations in diabetes mellitus patients treated by insulin according to data of the General Health Insurance Company in 2002-2006 Metformin is the basic oral glucose-lowering drug in treatment of patients with 2 type diabetes. It should be used immediately after diabetes diagnosis. Graph 4 shows the structure of hyperglycaemia treatment according to IHIS data in which 21% of patients are treated by diet and the treatment is not probably sufficient. Graph 4 3. Screening diabetes complications and other risk factors Data of the General Health Insurance Company (graph 5) show that the other risk factors are not examined in sufficient frequency (lipids should be examined 1x a year in each diabetic patient) and active screening of incipient stages of late diabetes complications (microalbuminuria) is not performed. Graph 5 Graph 6 Complications screening (nephropathy and retinopathy) of diabetes is not sufficient. Risk factors are not examined. Pharmacotherapy of comorbidities Other risk factors are not examined at sufficient frequency as well (lipids should be examined 1x a year in each diabetic patient as well as microalbuminuria) and active screening of incipient stages of late diabetes complications (microalbuminuria) is not examined as well. Finally, intervention of risk factors from the standpoint of quantity does not correspond with expert recommendation in all cases – 70 – 80% of patients should be treated by hypolipidemic therapy (graph 7). There is insufficient pharmacotherapy of diabetes comorbidities Graph 7 – patients treated by glucose-lowering drugs: the total overview of patient treatment by medicals influencing cardiovascular system 4. Average values of HbA1c, blood pressure, plasma lipids and weight in diabetic patients in the Czech Republic The results of epidemiological investigation initiated by CDS and data registered of DEPAC etc. show insufficient control of hyperglycaemia, plasma lipids, hypertension in diabetic patients. Graph 8 shows that only 5% of diabetic patients reach the required values in all monitored parameters in the Czech Republic. However, there is still a noticeable improvement in comparison with the year of 2002. Graph 8 5. Conclusions HbA1c has not been examined sufficiently. Education and pharmacotherapy are not used consistently in the treatment of hyperglycaemia. Screening of complications (nephropathy and retinopathy) of diabetes is not sufficient. Risk factors (hypertension and dyslipidemia) are not examined and treated consistently. In the Czech Republic, only 5% of patients with type 2 diabetes reach satisfactory values of HbA1c, serial lipids and blood pressure.