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Example
Figure 1: Reduction in risk of progressing from IGT to diabetes as a result of changes in intensive
lifestyle [Paul Zimmet et al 2001].](https://image.slidesharecdn.com/mscpresentationplan-101103043016-phpapp02/85/Msc-presentation-plan-16-320.jpg)
Msc presentation plan
- 1. Defining the Health Needs of Patients with Type II Diabetes An approach based on a case cohort study George Karystianis School of Computer Science
- 2. 2 Motivation ● Complex health problem related with various diseases. ● Comprehend the diabetic needs from different health perspectives. ● Improve the quality of the provided health care.
- 3. 3 Aims To perform a preliminary analysis in a case cohort study: ● To observe the incidence of Type II diabetes. ●To understand the relation between diabetes, depression, CVDs, hypertension. ● To discover markers for the onset of diabetes or progression states. ● To examine the extent of polypharmacy.
- 4. 4 Objectives ● To suggest a relation between diabetes and depression, cardiovascular diseases, hypertension. ● To discover the number of diabetic patients, the number and the type of prescribed medications. ● To find any diseases before and after the diabetes onset.
- 5. 5 Diabetes (1) ● Diabetes Mellitus. ● Production of excessive sweet urine (“glycosuria”). ● Syndrome of disordered metabolism. ● Hereditary and environmental factors. ● Elevated levels of blood sugar (glucose). ● Controlled mainly by the hormone insulin.
- 6. 6 Insulin (1) ● Hormone. ● Produced from the β-cells in the isles of pancreas. ● Uptake of glucose from the blood to cells. ● Glucose the conversion product between carbohydrates.
- 7. 7 Insulin (2) Pangreas Insulin Isles of Langerlans β-cells Food Glucose Uptake glucose Cells Liver, Muscle cells Glucose used as fuel Storage Blood circulation Limited insulin production Storaged glucose re-enters blood stream Low glucose levels
- 8. 8 Diabetes (2) DIABETES TYPE I TYPE II Genetic Inheritance & Environmental triggers Sedentary Lifestyle & Obesity Lack of insulin Insulin resistance Risk factors Complications
- 9. 9 Diabetes Type I Symptoms Increased thrist Weight loss Increased appetite Frequent urination Weakness Cure Causes Environmental factors
- 10. 10 Diabetes Type II ● Worldwide problem. ● Part of the metabolic syndrome. ● Reduced insulin sensitivity or (rarely) decreased insulin secretion. ● High insulin levels in the blood (hyperglycemia).
- 11. 11 Diagnosis WHO criteria: ● fasting plasma glucose level >= 126mg/dL (7.0mmol/L), ● plasma glucose >= 200mg/dL (11.1mmol/L) two hours after a 75g oral glucose load, ● a glucose tolerance test, symptoms of hyperglycemia and casual plasma glucose >= 200mg/dL (11.1mmol/L). ● Fuzzy diabetes classification in children.
- 12. 12 Risk factors Obesity Genetic factor Lack of exercise Unhealthy diet Socioeconomical status Sedentary lifestyle Sex Insulin resistance Type II
- 13. 13 Symptoms Leg pain Slow healing Frequent urination Itching skin Blurred vision Excessive thirst Dry mouth Symptoms
- 14. 14 Treatment Oral antidiabetic medications Prevention Glibenclamide Metformin Delay Lifestyle interventionsHealthy diet Physical activity No definitive cure Golden standard treatment Cure Official guidelines Losing weight
- 15. 15 Impaired Glucose Tolerance (IGT) Impaired Fasting Glucose (IFG) IFGIGT High risk groups for diabetes onset plasma glucose >= 140 mg/dL (7.8mmol/L) 2hs after a 75g oral glucose load fasting glucose levels from 110 to 125mg/dL (6.1mmol/L – 7mmol/L). Prevention Lifestyle interventions
- 16. 16 Example Figure 1: Reduction in risk of progressing from IGT to diabetes as a result of changes in intensive lifestyle [Paul Zimmet et al 2001].
- 17. 17 Complications AcuteChronic Hyperglycemia Hypersmolar state Hypoglycemia Diabetic foot Carotid artery stenosis Diabetic Ketoacidosis Diabetic nephropathy
- 18. 18 Diabetes and depression ● Evidence about depression and Type II. ● 121 million depressed people worldwide. ● Risk factor for onset or progression state. ● Treatment for depression led to an earlier diagnosis. ● 37% increased risk of Type II.
- 19. 19 Diabetes and cardiovascular diseases ● Myocardial infarction, coronary heart disease, stroke related strongly. ● Limited studies – Susceptible diabetics in major CV events. ● Cause of death. ● Treatment of diabetic patients as non-diabetic patients with CV events? ● Study in Finland - treating diabetics as non diabetic.
- 20. 20 Diabetes and hypertension ● One of the most important CVD risk factors. ● Complex relationship with diabetes. ● 1 billion people worldwide. ● Antihypertensive medications increasing risk of diabetes onset ? ●Study in U.S disproving it but still not clear.
- 21. 21 Polypharmacy ● Successful treatment of a disease group through multiple medications. ● Probably necessary against chronic conditions. ● Adverse drug events. ● Multiple prescribers, existence of different therapies, psychological factors, adverse drug events. ● Decrease in health care quality, high medical costs, therapy duplication, adverse drug events.
- 22. 22 Overview of the methodology Case cohort Study 2003-06 QueriesServer Total Disease Medication Per year 2004 2005 2006 Diagrams Conclusions Returned results
- 23. 23 Research methods (1) First part. ● Use of diabetes diagnosis/drug read codes for queries. ● Definition of the diabetic population with the best result query. ● Discover the incidence of Type II in total with the query. ● Apply of diagnosis/drug read code queries for the diseases of interest. ● Selection of queries with the best results. QUERIES ABOUT DIABETES TYPE II READ CODES (DIAGNOSIS AND READ CODES) Diagnosed as diabetic Type II C10F.% Metformin f4% Glibenclamide (glyburide) f33% Sulfunylureas f3% Metformin and sulfonylureas f4% and f3% Rosiglitazone ft4% Pioglitazone ft5% Metformin and rosiglitazone f4% and ft4% Metformin and pioglitazone f4% and ft5% Metformin and pioglitazone ft4% and f3A% Rosiglitazone and glimepiride ft7% Metformin and repaglinide f4% and ft3% Metformin and nateglinide f4% and ft6% Repaglinide ft3% Nateglinide ft6% Metformin but not short-acting insulin and not medium/long lasting insulin f4% not f1% and not f2% Long lasting insulin f2% Short lasting insulin f1%
- 24. 24 Research methods (2) Query with the best returned results: Individuals diagnosed as diabetic Type II (C10F.%) or individuals prescribed with the drug Metformin (f4%) or with any other drug belonging to the sulfonylureas group (f3%).
- 25. 25 DISEASE READ CODE Coronary heart disease G340. Myocardial infarction G30.. Stroke G66% Hypertension (essential) G20.. Hypertensive disease G2… Depressed or symptoms of depression or neurotic depression or depression 1B17. or 1B1U. or Eu341 or Eu32z DRUG READ CODE DISEASE ACE inhibitors bi% common for stroke, myocardial infarction, hypertension, coronary heart disease Statins bx% common for stroke, myocardial infarction,coronary heart disease Aspirin bu2% common for stroke, myocardial infarction,coronary heart disease Beta Blockers bd% common for myocardial infarction,hypertension, coronary heart disease Nitrates bl1% or bl2% or bl3% common for myocardial infarction, coronary heart isease Clopidogrel bu5% common for stroke, myocardial infarction Thrombolytic agents bs% or br% common for stroke, myocardial infarction ACE inhibitors and Diuretics (thiazide group) bi% & b2% hypertension ACE inhibitors and angiotensin 2 receptor antagonists bi% & bk% hypertension Angiotensin 2 receptor antagonists bk% hypertension Alpha blockers bh% hypertension All Diuretics groups b3% or b2% or b4% or b9% or b5% hypertension Diuretics (Thiazide group) b2% hypertension SSRI antidepressants da% depression Tricyclic antidepressants d7% depression Diseases diagnosis read codes Medications read codes
- 26. 26 Research methods (3) Second part. ● Same methodology to be used for every year. Third part. ● Same methodology for the years 2004-06. ● Discover the diabetic group in each year. ● Search about diseases before and after the onset. ● Examination as markers or as progression states.
- 27. 27 Data ● Case cohort study from health patient records. ● Hospitals, health communities, GPs. ● Salford, Manchester, U.K. ● Approximately 20.000 health records. Patient ID RubricGP codeRead CodeDate Record clinical Summary information Recorded date of medical procedures Distinction between patients Pseudonymized id for GPs distinction Free text describing the meaning of RC
- 28. 28 Read Codes ● Standardization of medical data recording. ● Developed within disease areas (chapters). ● Individuality, limit the amount of written stuff, help communication between IT systems. ● Max length: five characters. Example: G30.. Acute Myocardial Infarction G30y. Other Acute Myocardial Infarction G30y2 Acute Septal Infarction
- 29. 29 Quality Control ● Duplicate entries, wrong diagnosis/drug treatment. ● Different codes. ● Queries with only distinct patient id. ● Exclusion of a number of cases due to bad recording or wrong code.
- 30. 30 Ethical considerations ● Anonymous data. ● Protection of confidentiality and availability. ● limited access to a server. ● Written letter approval from ethics committee of University of Manchester. ●(Yeah!)
- 31. 31 Results (1) ● Diabetes an epidemic. ● Number of diabetics increasing through the years. ● More related to depression, hypertensive group. ● Hypertensive group had the biggest incidence. ● Steady rise in depression. ● Limited number of CV diseases. ● Decline through the years, especially those of coronary heart disease.
- 32. 32 2003-2006 diseases in total 0 500 1000 1500 2000 2500 3000 1 Number of patients with other diseases besides diabetes Type II myocardial infarction stroke Hypertensive diseases hypertension coronary heart disease depression Figure 1: Overview of the diabetic patients’ numbers with other diseases based on diagnosis read codes for all the years (2003-06).
- 33. 33 2003-2006 prescribed drugs in total 0 1000 2000 3000 4000 5000 6000 1 Drugs Number of drug prescriptions in diabetic patients in total ACE inhibitors statins aspirin beta blockers nitrates throm bolytic agents-clot busting drugs (anticoagulant or parental anticoagulant) clopidogrel SSRI depressants tricyclic antidepressants ACE inhibitors and diuretics (thiazide group) ACE inhibitors and angiotensin 2 receptor antagonists angiontensin 2 receptor antagonists alpha blockers diuretics (thiazide group) diuretics Figure 1: Overview of prescribed drugs in diabetic patients for all the years (2003-06).
- 34. 34 Progression of diabetes rates from 2003-06 0 1000 2000 3000 4000 5000 6000 7000 2003 2004 2005 2006 Progression of diabetes Type II from 2003 to 2006 diabetes Figure 1: Overview of diabetic patients through the years 2003-6 based on the diagnosis read code for diabetes Type II (C10F.%) and the read codes for the prescribed oral antidiabetic drugs such as the sulfolynurea group (f3%) and metformin (f4%).
- 35. 35 Diseases per year Overview of the progression for patients with diseases besides diabetes through the years 2003-06 0 100 200 300 400 500 600 700 800 2003 2004 2005 2006 Years Numberofpatients myocardial infarction stroke Hypertensive diseases hypertension coronary heart disease depression Figure 1: Progression of diseases in diabetic patients through the years 2003-2006 based on diagnosis codes.
- 36. 36 Prescribed medications per year Drug prescriptions in diabetic patients through the years 2003-6 0 500 1000 1500 2000 2500 3000 3500 4000 4500 5000 2003 2004 2005 2006 Years Numberofprescriptions ACE inhibitors statins aspirin beta blockers nitrates thrombolytic agents-clot busting drugs (anticoagulant or parental anticoagulant) clopidogrel SSRI depressants tricyclic antidepressants ACE inhibitors and diuretics (thiazide group) ACE inhibitors and angiotensin 2 receptor antagonists angiontensin 2 receptor antagonists alpha blockers diuretics (thiazide group) diuretics Figure 1: Progression of the drug prescriptions in diabetic patients though the years 2003-2006 based on drug read codes.
- 37. 37 Results (2) ● Low increase before the onset. ● Least possible to be considered as a marker for diabetes. ● Coronary heart disease possible no existing association. ● Escalation of rates before the onset - possible marker. ● Early treatment may lead to early diabetes diagnosis. ● Prevalent disease group. ● Increased before onset - possible marker. Depression Hypertensive group CVDs
- 38. 38 Results (3) Depression Hypertensive group CVDs ● Limited rates after the onset. ● Rise of myocardial infarction.-possible complication (highest rates). ● Highest prescriptions. ● Stroke and coronary heart low rates. ● Stable rates tended to increase. ● High prescriptions after the onset. ● More as a marker and less as a complication. ● Large decrease. ● Among the most prescribed drugs. ● More as a marker.
- 39. 39 Disease cases before and after the onset of Type II Number of diabetic patients with diseases developed a year before and after their diabetes onset 0 50 100 150 200 250 300 350 400 450 500 a year before year of onset a year after Numberofpatients Depression Hypertensive disease hypertension Myocardial infarction Coronary heart disease Stroke Figure 1: Figure presenting the number of diabetic patients with other diseases one year before, during and after their classification as diabetic based on diagnosis read codes.
- 40. 40 Prescribed medications before and after the onset of Type II Number of medications prescribed on diabetic patients a year before and after their diabetes onset 0 200 400 600 800 1000 1200 1400 1600 a year before year of onset a year after Numberofprescriptions thrombolytic agents-clot busting drugs (anticoagulant or parental anticoagulant) clopidogrel nitrates ace inhibitors aspirin statins beta blockers SSRI antidepressants tricyclic antidepressants diuretics angiotensin receptor II antagonists alpha blockers Diuretics thiazide group ACE inhibitors and diuretics (thiazide group) ACE inhibitors and angiotensin receptor II antagonists Figure 1: Diagram of the prescribed medications in diabetic patients for one year before their classification as diabetic, for the year diagnosed with diabetes and for one year their diabetes onset based on medication read codes.
- 41. 41 Conclusions (1) ● Diabetes related depression or hypertension rather CVDs. ● Escalation of depression rates yearly. ● Hypertensive diseases possible marker. ● Myocardial infarction slow increase. ● Stroke, coronary heart disease no possible pattern. ● Application of polypharmacy.
- 42. 42 Conclusions (2) ● Large population research aiming depression and hypertensive diseases. ● Recording of diagnosis and prescribed medications. ● Careful implementation of polypharmacy. ● Review and evaluation of patient’s drug list. ● Creation of detailed diabetic guidelines. ● Diabetes a part of an underlying disease. ● Aggressive treatment.
- 43. 43 Thank you for attending and for listening. I hope you enjoyed it as much i did. Shoot.file:///C:/Users/son%20of%20odin/Desktop/Pictures/Movies/Ice%20age%203-dawn%20of%20the%20dinosaurs/2009_ice_age_3_003.jpg Chill out Stay cool Ice age Ice to see you