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Natural History of Type 2 Diabetes

Progressive Pancreatic Failure. Pancreas function. Insulin “efficiency”. “Pre-diabetes” “Metabolic Syndrome”. Insulin secretion. PLASMA GLUCOSE Normal: 99 mg/dl or less Pre-Diabetes: 100-125 mg/dl) Diabetes > 126 mg/dl fasting ); > 200 mg/dl )( PostPrandial ). Post-Meal glucose.

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Natural History of Type 2 Diabetes

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  1. Progressive Pancreatic Failure Pancreas function Insulin “efficiency” “Pre-diabetes” “Metabolic Syndrome” Insulin secretion PLASMA GLUCOSE Normal:99 mg/dlor less Pre-Diabetes:100-125 mg/dl) Diabetes>126 mg/dlfasting); >200 mg/dl )(PostPrandial) Post-Meal glucose Fasting glucose Natural History of Type 2 Diabetes Years from diagnosis 0 10 5 15 -10 -5 Onset Diagnosis Pre-diabetes Type 2 diabetes Ramlo-Halsted BA, Edelman SV. Prim Care. 1999;26:771-789 Nathan DM. N Engl J Med. 2002;347:1342-1349

  2. Diabetes 5.02 3.64 3.19 2.4 Cardiovascular Risk in Pre-diabetes Non-Diabetic 7 6 5 4 Relative Risk of MI or Stroke 3 2 1.0 1 0 NondiabeticThroughout 10-14.9 YrBefore Dx >15 YrBefore Dx <10 YrBefore Dx DiabeticThroughout Pre-Diabetes Hu FB, et al. Diabetes Care. 2002;25:1129-1134.

  3. Insulin “Efficiency” Pre-diabetes Plasma membrane Insulin receptor Chemical Signals Glucose (“sugar”) carriers Insulin Glucose carriers move to the surface Carriers insert into cell surface Blood Sugar Blood Sugar enters body GLUT4=glucose transporter 4

  4. “Metabolic” Syndrome Physical Inactivity Aging Insulin Efficient (“resistance”) High Cholesterol Heart Disease Blood Vessel Dysfunction Elevated Blood Pressure High Blood Sugar Obesity Modified from S. Grundy MD

  5. High Waist/Hip (0.95 in men) (0.80 in women) Body Shape Matters!!!“Central” obesity An Index of Abdominal vs Peripheral Obesity Low Waist/Hip (<0.95 in men) (<0.80 in women)

  6. 25 20 15 10 5 0 Waist Measurement and Diabetes Risk Upper 10% WHR Lower 10% WHR Risk (%) 54 55 56 57 58 59 60 61 62 63 64 65 66 67 Age Risk of diabetes mellitus during 13 years in relation to WHR at baseline. Comparison between these in upper and lower 10% of WHR distribution. Larsson. Acta Med Scand Suppl. 1988;723:45-51.

  7. Waist/Hip Ratio and Risk • Men: waist size >40 vs <37 inches • Women: waist size >34 vs <31 inches • ~4-fold greater risk for type 2 diabetes • ~3- to 4-fold greater risk for major cardiovascular event Lean et al. Lancet. 1998;351:853-856.

  8. 15 YES 10 NO 5 0 2 4 6 8 12 0 10 Death Increases with Metabolic Syndrome Heart Disease Deaths Metabolic Syndrome: Cumulative hazard (%) Follow-up (y)

  9. Visceral Fat Distribution: Normal vs Type 2 Diabetes Normal Type 2 Diabetes

  10. To diabetes Diabetes Metabolic Syndrome ? R. Heine MD

  11. Insulin Other Injected meds Combination (two) Medications Single Medication Nutritional Preventive Strategies Diet and exercise Increased Heart Disease Type 2 DiabetesPredicted Treatment Paradigm Years from diagnosis 10 0 5 15 -10 -5 Onset Diagnosis Pre-diabetes Type 2 diabetes

  12. NIH Funded Botanical Research Centers “Your Tax Dollars at work” • Botanical Center for Age-Related Disease • Purdue University/UAB • Botanical Dietary Supplements for Women’s Health • University of Illinois at Chicago • Botanical and Lipids (Cholesterol) • Harvard and Wake Forest Universities • Botanicals and Cancer • Memorial Sloan-Kettering Cancer Center/ • Rockefeller University • Botanicals and Metabolic Syndrome • PBRC-LSU/Rutgers

  13. Russian tarragon Tarragon and Diabetes • Extract of Artemisia dracunculus with antidiabetic properties • Produced from hydroponically grown plants under controlled conditions

  14. Clinical Research: BENCH to BEDSIDE! Years 1-4 Animal Testing to monitor Safety and effectiveness Human Testing in Several Phases Years 1-3 Years 3-5 Cells tested with Experimental Intervention

  15. Are Claims for “over the counter” supplements real?

  16. Botanicals Studied “Eat and Drink the Rainbow”

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