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The Obesity/Diabetes Epidemic: Perspectives, Consequences, Prevention, Treatment

The Obesity/Diabetes Epidemic: Perspectives, Consequences, Prevention, Treatment. Part 6. Stan Schwartz MD, FACP, FACE Private Practice, Ardmore Obesity Program Cardiometabolic Diabetes Center and Affiliate, Main Line Health System Emeritus, Clinical Associate Professor

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The Obesity/Diabetes Epidemic: Perspectives, Consequences, Prevention, Treatment

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  1. The Obesity/Diabetes Epidemic:Perspectives, Consequences,Prevention, Treatment Part 6 Stan Schwartz MD, FACP, FACE Private Practice, Ardmore Obesity Program Cardiometabolic Diabetes Center and Affiliate, Main Line Health System Emeritus, Clinical Associate Professor University of Pennsylvania

  2. Clinical Consequences of Abnormal First- phase Secretion and Elevated Post-Prandial Sugars • PPG increases • Variability • Microvasular disease and adverse pregnancy outcomes • ASVD risk factors • adverse CV outcomes • Treating elevated PPG leads to • Reduce Pregnancy Outcomes • Reduce CV Markers and Outcomes • Prevent Diabetes

  3. Incidence 4-10%/year

  4. Purest proof of benefit in treating PPG elevations is that , without treating pathophysiology, just treating ppg, with acarbose, decreases CV risk

  5. Prevention DM Age 0-15 15-40+ 15-50+ 25-70+ Envir.+ Other Disease Genes Macrovascular Complications Disability Obesity(visceral) Poor Diet Inactivity IR PhenotypeAtherosclerosisObesityHypertensionHDL,TG, HYPERINSULINEMIA Endothelial DysfunctionPCO,ED Insulin Resistance MICVAAmp pp>7.8 DEATH IGT Type 2 DM  -Cell Secretion BlindnessAmputationCRF EyeNerveKidney ETOHBPSmoking Risk of Complications Disability Microvascular Complications

  6. Outline • Epidemiology and Economics of obesity/diabetes • Perspectives on Obesity • Consequences of Obesity, Prediabetes, Obesity • Obesity/ Diabetes Risk Factors, • Obesity/ Diabetes Onset can be Prevented or Delayed – Early Risk Identification and Intervention. • Medical Benefits to Weight Loss • Treatment-CDC’s diabetes prevention program and other Evidence-Based Interventions- • Basics, • Next Lecture in Series

  7. Genetic Clues to PREVENTION of TYPE 2 DIABETES • STRONGLY GENETIC- twin studies • BUT Diabetes skips generations • EVEN IF HAVE GENES, eg: NO INCREASED RESISTANCE, IMPROVE FIRST PHASE INSULIN RELEASE; b-CELLS DON’T WEAR OUT: So if a generation or individual patient stays Ideal Body Weigh PREVENT DIABETES

  8. Lifestyle Changes Malmo Study Da Qing Study Finnish Diabetes Prevention Study Diabetes Prevention Program Medications Diabetes Prevention Program: metformin, (troglitazone) TRIPOD: troglitazone STOP-NIDDM: acarbose NAVIGATOR: nateglinide and valsartan DREAM: rosiglitazone and ramipril XENDOS: orlistat ORIGIN: glargine insulin ACT NOW: pioglitazone Trials to Prevent / Delay Progression From IGT to Type 2 Diabetes TRIPOD = Troglitazone in Prevention of Diabetes Study; STOP-NIDDM = Study to Prevent Non–Insulin-Dependent Diabetes Mellitus; NAVIGATOR = Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research; DREAM = Diabetes Reduction Approaches with Ramipril and Rosiglitazone; XENDOS = Xenical in the Prevention of Diabetes in Obese Subjects; ORIGIN = Outcomes Reduction with Initial Glargine Introduction.

  9. 70 62% Finnish-Diet+ Exercise 58% 60 55% Da Qing – Diet + Exercise 58% 50 42% 41% DPP-Lifestyle 40 Diabetes Mellitus Reduction (%) 31% DPP-Metformin 30 25% STOP-NIDDM 20 TRIPOD XENDOS 10 DREAM 0 Diabetes Prevention Clinical Trials Is it Possible to Delay the Onset of Type 2 DM? 80% 80 74% >5% loss 55% PIOPOD ActNOW FINNISH=Tuomilehto J, et al. N Engl J Med 2001; 344: 1343-50 DA QING=Pan XR, et al. Diabetes Care. 1997; 20: 537-44 DPP=Diabetes Prevention Program. Nathan DM, et al. N Engl J Med 2002; 346:393-403 STOP-NIDDM=Study TO Prevent Non-Insulin-Dependent Diabetes Mellitus. Chiasson JL, et al. Lancet 2002; 359:2072–77 TRIPOD=Troglitazone in the Prevention of Diabetes. Buchanan T, et al. Diabetes 2002; 51(9): 2796-2803 XENDOS=XEnical in the Prevention of Diabetes in Obese Subjects. Torgerson JS, et al. Diabetes Care 2004; 27 (1): 155-61 DREAM=Diabetes Reduction Assessment with Ramipril & Rosiglitazone Medication. Gerstein H, et al. Lancet 2006; 368:1096-1105

  10. Diabetes Prevention Program An example of effectiveness Modest Weight Loss and Lifestyle Changes Can Have a Positive Health Impact Placebo Metformin Lifestyle 58% 5% /year instead of 10% / year by lifestyle intervention DPP Research Group. N Engl J Med 2002;346:393-403

  11. And if Achieve Normal Glucose Tolerance--Markedly Delay Future Overt Diabetes ~50% reduction in risk; Only ~18% risk 6 years after study ie: only 3%/yr incidence

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