DAROC-TADE DAROC-TADE Joint Symposium

DAROC-TADE-1

Diabetes is a common non-communicable disease that affects hundreds of millions of people up of a large cohort of 256,036 diabetes patients for up to 7 years from 1995 to 2001, diabetes patients suffered from a 1.63-fold higher risk of mortality while compared to the general population. However, the cause of death was not ascribed to “diabetes” in more than 70% of the patients. Approximately 48.6% of the patients died of causes probably ascribed to cardiovascular diseases and 18.5% died of cancer. An extension of the follow-up period of a subcohort of 89,056 type 2 diabetes patients who had been interviewed with a structured questionnaire for up to a period of 12 years or to the end of 2016 suggested that the lowest mortality rate was observed in patients with a body mass index within 25 in type 2 diabetes patients with mild obesity. A recent follow-up of 92,567 diabetes patients including type 1 and type 2 diabetes until the end of 2011 (up to 17 years) showed that 10.9% of the patients died at an age <60 years. Men with diabetes consistently showed a higher mortality rate than their female counterparts and types of diabetes was not predictive for mortality. Insulin and smoking were consistently predictive for either cancer- or non-cancer-related deaths. However, diabetes duration, hypertension, glycemic control and dyslipidemia were only associated with non-cancer deaths. Patients living in rural areas had a higher risk of mortality than patients living in urbanized areas. Additionally, screen-detected diabetes and obesity provided survival advantage for non-cancer-related deaths.

DAROC-TADE-2

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(P4P ) ( P4P ) P4P 2003 2003

DAROC-TADE-3

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In order to optimize the glycemic control, most of the patients with type 1 diabetes need to perform self-monitoring of blood glucose. These glucose profiles sometimes confuse the patients and even the care providers, if they are erratic or in an irregular distribution. Continuous glucose monitoring (CGM), especially the real-time CGM, makes sense for these dilemmas. It has been proved to be effective in reducing glycated hemoglobin level and occurrence of hypoglycemia for type 1 diabetic patients treated with continuous subcutaneous insulin infusion or multiple daily insulin injections. However, the clinical utilities of CGM are still limited. Barriers to clinical implementation, including its reimbursement and the experiences of care providers, should be addressed. Moreover, standardizing the report and analysis of CGM output to optimize clinical decision making is also critical. On March 1st, the health insurance administration had approved reimbursement for retrospective CGM for people with T1DM in Taiwan. There is a need for Diabetes association of Taiwan and Taiwan association of diabetes educators to provide postgraduate training courses for the clinical care providers. The detail will be discussed in the forum.