Projekt DiaNerve Tidlig Opsporing af Nerveskade giver ny Viden og forebygger Amputationer

Transkript

1 Velfærdsløftet er lige om hjørnet København den 23. oktober 2013 Projekt DiaNerve Tidlig Opsporing af Nerveskade giver ny Viden og forebygger Amputationer

2 PLATFORM Fondsgiver UNIK Partnerskabet Teknologi Siemens A/S Health Sector DK Regnskab Aarhus Universitet Forskning Dansk Diabetes Akademi Klinik Aarhus Universitetshospital Data-analyse Aalborg Universitet Rådgivning Odense Universitetshospital

3 Type 1 Diabetes

4 Type 2 Diabetes

5 Diabetes i Danmark T1D: T2D: T2D: T2D: diagnostiserede ikke-diagnostiserede forstadier T1D+T2D: ~ T2D inkl forstadier: ~

6 Type 2 diabetes nye tilfælde / år 64 nye tilfælde / dag

7 Sundhedsstyrelsen Øget mortalitet for T2DM - men faldende: 1.93 (1997) ( 2.01; 1.85) 1.69 (2009) ( 1.78; 1.61)

8 Sundhedsstyrelsen Øget mortalitet for T2DM - men faldende: 1.93 (1997) ( 2.01; 1.85) 1.69 (2009) ( 1.78; 1.61) - svarer til død 10 år før ikke-diabetiker.

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13 1 af 7 diabetikere får et fodsår

14 1000 større amputationer i DK årligt 500 amputationer kunne undgås

15 Nedsat følesans er den stærkeste risikofaktor for fodsår og amputation

16 Undersøgelser nerver Følesans Let berøring Smerte Vibrationssans Nerveledningshastighed Nervebiopsi Ultralyd MR-scanning

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18 Nervefibre

19 Peripheral nerve [1]A.G. Filler et al Neurol Clin 2004 Dept. of Neurology Aarhus University Hospital, Denmark, MSc Michael Vaeggemose 19

20 MR Neurography 1. T2w MR imaging of the hyperintense low-protein endoneurial fluid 2. Suppression of fat signal around nerves and from within nerves 3. Image resolution < 0.6x0.6mm 4. High quality surface coils [1] M. Pham et al. Diabetes Care 2011 Dept. of Neurology Aarhus University Hospital, Denmark, MSc Michael Vaeggemose 20

21 Methodology Patients and controls 4 type II diabetic patients with polyneuropathy (DPN) 2 type II diabetic patients (ndpn) without neuropathy 4 healthy control (HC) subjects. T2w SPAIR (0.6x0.6x3mm), 3Tesla Presence of neuropathy was determined based on the clinical examination 1. Neuropathy impairment score 2. Neuropathy symptom score and nerve conduction studies Dept. of Neurology Aarhus University Hospital, Denmark, MSc Michael Vaeggemose 21

22 Results A B T2w SPAIR MRI A) Diabetic patient with severe neuropathy B) Diabetic patient without neuropathy Dept. of Neurology Aarhus University Hospital, Denmark, MSc Michael Vaeggemose 22

23 Results +Neuropathy -Neuropathy Controls p-value N Male sex (%) 4(100%) 1(50%) 3(75%) 0.37 Age (yrs) 64(17) 69(6) 59(21) 0.24 BMI (kg/m 2 ) 26.50(5) 23(2) 23(7) 0.12 Nerve SI 0.19(0.13) 0.21(0.03) 0.14(0.07) 0.21 Muscle SI 0.25(0.09) 0.20(0.13) 0.15(0.01) 0.12 Vessel SI 0.69(0.15) 0.64(0.32) 0.68(0.12) 0.71 Volume (cm 3 ) 5.91(3.91) 3.15(0.91) 3.58(1.27) 0.03 Kruskal Wallis one-way analysis of variance Dept. of Neurology Aarhus University Hospital, Denmark, MSc Michael Vaeggemose 23

24 Konklusion MR-scanning viste en signifikant øgning I volumen af nervus ischiadicus hos patienter med diabetisk nervesygdom MR-scanning af hele nervesystemet er mulig (total nerve lesion load) MR-scanning kan anvendes til dybtliggende nervestrukturer

25 Tak

26 Magnetic resonance imaging for volumetric evaluation of diabetic polyneuropathy: a pilot study Michael Vaeggemose MSc 1, Steffen Ringgaard PhD 2, Niels Ejskjaer MD PhD 3, Knud Yderstraede MD PhD 4, Henning Andersen Prof 1 1 Department of Neurology, 2 Department of Diagnostic Imaging: MR Research Centre, 3 Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Denmark, 4 Department of Endocrinology and Internal Medicine, Odense University Hospital, Denmark Dept. of Neurology Aarhus University Hospital, Denmark, MSc Michael Vaeggemose 26

27 Aims To examine magnetic resonance imaging (MRI) signal intensities (SI) of the sciatic nerve, muscle and blood vessels in diabetic patients with and without polyneuropathy, and healthy control subjects. To determine the volume of the sciatic nerve in diabetic patients with and without polyneuropathy, and healthy control subjects. Dept. of Neurology Aarhus University Hospital, Denmark, MSc Michael Vaeggemose 27

28 Thank You! Dept. of Neurology Aarhus University Hospital, Denmark, MSc Michael Vaeggemose 28

29 Dept. of Neurology Aarhus University Hospital, Denmark, MSc Michael l Vaeggemose 29

30 MRI vs Biopsy M. Pham et al. Diabetes Care 2011:v34:i3:p missinglink.ucsf.edu Dept. of Neurology Aarhus University Hospital, Denmark, MSc Michael Vaeggemose 30

31 Sonography of diabetic polyneuropathy [1]Sheila Riazi et al Diabetes care 2012 Dept. of Neurology Aarhus University Hospital, Denmark, MSc Michael Vaeggemose 31

32 Klassiske Senkomplikationer SMÅ BLODKAR Øjensygdom STORE BLODKAR Blodprop eller blødning Nyresygdom Hjertesygdom Følesans Dårlig blodomløb til benene

33 PLATFORM: 1.15 mio kr UNIK Partnerskabet 1.15 mio kr Siemens A/S Health Sector DK 0.6 mio kr Dansk Diabetes Akademi 0.6 mio kr Aarhus Universitet 0.4 mio kr Aarhus Universitetshospital Aalborg Universitet Odense Universitetshospital

34 30 50 % af første-gangs amputerede kræver gentaget amputation indenfor 1 3 år National hospital survey, USA

35 58 % af diabetikere dør indenfor 5 år efter amputation De Lucca Prostet Ortostat Int