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Type 2 Diabetes – A Global Epidemic

Type 2 Diabetes – A Global Epidemic. Arya M Sharma, MD, FRCP(C) Professor of Medicine Research Chair for Obesity Research & Management University of Alberta Medical Director Edmonton Weight Wise Program Edmonton, AB, Canada www.drsharma.ca.

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Type 2 Diabetes – A Global Epidemic

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  1. Type 2 Diabetes – A Global Epidemic Arya M Sharma, MD, FRCP(C) Professor of Medicine Research Chair for Obesity Research & Management University of AlbertaMedical DirectorEdmonton Weight Wise Program Edmonton, AB, Canada www.drsharma.ca

  2. An estimated 285 million people worldwide are affected by diabetes. With a further 7 million people developing diabetes each year, this number is expected to hit 438 million by 2030.

  3. More than 3 million Canadians have diabetes and this number is expected to reach 3.7 million by 2020.

  4. Diabetes is a contributing factor in the deaths of approximately 41,500 Canadians each year.

  5. 50% of Canadians diagnosed with type 2 diabetes do not achieve the CDA Guidelines target level of blood glucose. DICE Study

  6. Abdominal obesity increases the risk of developing type 2 diabetes 24 20 16 Relative risk 12 8 4 0 <71 71–75.9 76–81 81.1–86 86.1–91 91.1–96.3 >96.3 Waist circumference (cm) Carey V, 1997

  7. The Double-Edged Sword: Weight Gain With Diabetes Treatment UKPDSWeight gain up to 8 kg over 12 years 8 7 6 5 4 Change in weight (kg) 3 2 1 0 Conventional treatment (n = 411)* 0 3 6 9 12 Insulin (n = 409) Glyburide (n = 277) Years from randomization Metformin (n = 342) *Diet initially then sulphonylureas, insulin, and/or metformin if FPG > 15 mmol/L FPG = fasting plasma glucose UKPDS 34. Lancet 1998:352:854; Kahn SE, et al. N Engl J Med 2006;355:2427

  8. Health Consequences of Obesity Pseudotumor cerebri Depression Obstructive sleep apnea Heart failure Coronary artery disease GE-Reflux disease Fatty liver Diabetes Gallbladder disease Hypertension Incontinence Cancer Intertrigo Infertility Osteoarthritis Thrombosis Gout Sharma 2006

  9. Surgery Pharmacotherapy Lifestyle Modification Diet Physical Activity Obesity Treatment Pyramid

  10. Diabetes Prevention StudyMean Weight Change Placebo Metformin Lifestyle The DPP Research Group, NEJM 346:393-403, 2002

  11. Diabetes Prevention Study Incidence of Diabetes Placebo (n=1082) Metformin (n=1073, p<0.001 vs. Placebo) Lifestyle (n=1079, p<0.001 vs. Metformin , p<0.001 vs. Placebo) Risk reduction 31% by metformin 58% by lifestyle The DPP Research Group, NEJM 346:393-403, 2002

  12. The Dilemma Kg decades

  13. Weight Curves in Obese and Never-Obese Rats MacLean PS et al. Am J Physiol 2004

  14. +/- +/- Energy In Energy Out Isn’t Obesity Simple? Genetics Environmental Determinants Environmental Determinants Energy Regulation is Complex! Sharma AM 2007

  15. Central Control of Energy Metabolism

  16. Principal Sites of Synthesis of GI Peptides Implicated in the Regulation of Food Intake Cummings & OverduinJ Clin Invest. 2007;117:13

  17. Phase II (Weight-Loss Maintenance) When you stop treatment, the disease comes back! Indefinitely Phases of Obesity Treatment Phase I (Weight Loss) Weight 3-6 months

  18. Treatment Success Lifestyle (LS) ~ 3-5% LS+Pharmacotherapy ~ 5-15% Change in Weight LS+Surgery ~ 20-30% Years

  19. Randomized Controlled Trial of Weight-Loss Maintenance Svetky LP et al., JAMA 2008;299:1139

  20. STORM Mean bodyweight changes duringweight loss and weight maintenancephases over 2 years Weight loss Weight maintenance 104 Control 102 100 98 Bodyweight (kg) 96 94 92 90 Sibutramine 88 0 2 4 6 8 10 12 14 16 18 20 22 24 Month Same diet and exercise for both sibutramine and control James WPT, Lancet 2001

  21. Bariatric Surgery Reduces Mortality in Swedish Obese Subjects(n=2010 vs. 2037) 30% Reduction in All Cause Mortality Sjostrom L et al. NEJM 2007;357:741-52

  22. 62% 70% 77% 86% Bariatric SurgeryEffect on Cardiovascular RiskA Systematic Review and Meta-Analysis of 22,090 Patients Hypertension Dyslipidemia Sleepapnea Diabetes % resolved Buchwald H, et al. JAMA 2004;292:1724

  23. , 2004

  24. Key Points • We currently have a “diabesity” epidemic in Canada • Conventional treatment of “diabesity” is limited and expensive • New thinking is required to better manage this epidemic

  25. My Obesity Blog: www.drsharma.ca

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