Post Prandial Hyperglycemia: A Significant Cardiovascular Risk Factor 21:141431. Developed countries Developing countries World total Prevalence (%) 0 2 4 6 8 20252000 CVD drives the economic burden of type 2 diabetes CVD: cardiovascular disease Nichols GA, Brown JB. Diabetes Care 2002;25:4826. Copyright 2002 American Diabetes Association; reprinted with permission from The American Diabetes Association. 10 8 6 4 2 0 Cost in 1999 (x1,000 US$) No CVD, no diabetes n=13,286 No CVD, diabetes n=11,130 CVD, no diabetes n=2,894 CVD and diabetes n=5,050 $2,562 $4,402 $6,396 $10,172 31.9% 48.1% 20.0% 28.6% 40.3% 31.2% 17.2% 31.8% 51.0% 21.1% 28.0% 50.9% PharmacyOutpatientInpatient Pathophysiology of type 2 diabetes Janka HU. Fortschr Med 1992;110:63741. Macro- vascular disease Insulin sensitivity Insulin secretion Plasma glucose Micro- vascular disease Impaired glucose toleranceHyperglycemia Diagnosing glucose intolerance criteria reflect a need for early intervention *Determined post 75g glucose load 2h-PG: 2-hour postchallenge plasma glucose, FPG: fasting plasma glucose, IFG: impaired fasting glucose, IGT: impaired glucose tolerance World Health Organization, 1999. Diagnosis Venous plasma glucose concentration (mmol/L) Diabetes FPG or 7.0 2h-PG* 11.1 IGT FPG (if measured) and 7.8 and 6.1 and 7.0 2h-PG* (if measured) 30 30 Favours placebo Reduction in incidence Acarbose increases the reversion of IGT to NGT NGT IGT Diabetes At baseline Acarbose group (%) Placebo group (%) 32 42 28 25 35 31 At end of treatment 100% * * *No post-randomisation data IGT: impaired glucose tolerance, NGT: normal glucose tolerance Chiasson JL, et al. Lancet 2002;359:20727. STOP NIDDM Acarbose an exceptional safety profile *Events starting on the first day and up to 7 days after last day of treatment Bayer AG, data on file 2002. Adverse events 155 (21.7)277 160 (22.4)260 experienced Body as a whole56 (7.8)77 58 (8.1)72 Cardiovascular33 (4.6)48 39 (5.5)61 Endocrine4 (0.6)5 5 (0.7)5 Haemic2 (0.3)2 4 (0.6)4 and lymphatic Metabolic and 2 (0.3)2 1 (0.1) 1 nutritional Adverse events* Acarbose (n=714) Patients Events No. (%) No. Placebo (n=715) Patients Events No. (%) No. STOP NIDDM Acarbose reduces the risk of cardiovascular disease STOP NIDDM *Reduction in risk of developing hypertension Data were analysed using the Cox proportional hazar