TREAT TO TARGET IN DIABETES: An Alternative pathway

1. TREAT TO TARGET IN DIABETES:An Alternative pathway ASSOC PROF DR AZIZ AL-SAFI ISMAIL Universiti Sains Malaysia Kubang Kerian, Kelantan.

2. MalaysiaTotal populations 26 million Lifespan 69.6 yrs Male, 74.5 yrs Female Main cause of death in hospital Heart disease Septicaemia Stroke Motor-vehicle accident Cancer

3. REGIONAL 5 leading cause of death (% of all deaths)SEAMIC 99

4. RISK FACTORS ReversibleIrreversible Diabetes Smoking age HPT sex - male Hypercholesterolemia family history Obesity DM Sedentary life Personality type

5. Top Ten Countries for Estimated Number of Adult with Diabetes, 1995 and 2025 -Diabetes Care 1998

6. CHRONIC COMPLICATIONS • Atherosclerosis • Diabetic eye disease • Diabetic nephropathy • Diabetic neuropathy • Foot ulceration and amputation

9. Prevalence of Diabetic complications in Malaysia National Diabetes Care Seminar 1998

10. In ideal situation • Prebreakfast blood glucose 3.5 – 5.3 mmol/l • HbA1c <6.5% • >50% on diet control • BMI <25 kg/m2 • Blood pressure <130/85 mmHg • Total cholesterol <5.2 mmol/l • HDL-cholesterol >1.1 mmol/l • Triglycerides <1.7 mmol/l 4

11. In reality • Mean HbA1c 9 - 10%, • 70-83% HbA1c >7.5% • 72.5 - 94% on either biguanide or sulphonylurea • Mean BMI 26 - 27 kg/m2, 57 – 63% >25 kg/m2 • Mean Sys Blood pressure 148 mmHg • Mean Dia Blood pressure 91 mmHg • Mean Total cholesterol 6 mmol/l • HDL-cholesterol 0.97 mmol/l • Mean Triglycerides 1.9 mmol/l 4

12. IGT Diabetes Microvascular complications Macrovascular complications Average 6.5 years Progressive nature of type 2 diabetes: insulin deficiency due to beta-cell failure Insulin resistance Endogenousinsulin Postprandial plasma glucose Fasting plasma glucose Normal insulin Plasma levels Normal blood glucose Modified from graphic developed by the International Diabetes Center

13. Better Control EqualsReduced Risk of Complications EVERY 1% reduction in HBA1C REDUCED RISK* 1% -21% Deaths from diabetes -14% Heart attacks -37% Microvascular complications Peripheral vascular disorders -43% *p<0.0001 UKPDS 35. BMJ 2000; 321: 405-12.

14. Treat to Target in Diabetes • BMI < 25 kg/m2 • BP < 130/80mmHg • HbA1C < 6.5% • Fasting blood sugar 4-6.0 mmol/l • Random blood sugar< 8.0 mmol/l • LDL-Chol < 2.6mmol/l

15. Treatment of Diabetes

16. ORAL HYPOGLYCAEMIC AGENTS • Sulfonilurea (Dimicron,daonil,amaryl) • Biguanid ( Metformin/ glucophage) • Meglitinide ( NOVONORM, STARLIX) • Glitazone (Avandia ) • Acarbose (Glucobay) • Januvia • Galvus/ Galvusmet

17. THE USE OF HERBS ESULIN IN CONTROLLING BLOOD GLUCOSE AND LIPIDS IN POORLY CONTROL TYPE 2 DIABETES MELLITUS PATIENTS

18. ACTIVE INGREDIENTS • RADIX OPHIOPOGON JAPONICUS 100MG • RHIZOMA ANEMARRHENA ASPHODELOIDES 40MG • RADIX REHMANNIA PREPARATA 120MG • RADIX GLEHNIA LITTORALIS 80MG • RHIZOMA DIOSCOREA OPPOSITA 60MG

19. METHODOLOGY • INCLUSION CRITERIA: KNOWN TYPE 2 DIABETES, POORLY CONTROLLED, MONOTHERAPY • EXCLUSION CRITERIA: RENAL FAILURE, MALIGNANCY • DURATION OF TREATMENT: 12 WEEKS • TREATMENT: + ESULIN 2 CAPS 2-3X/DAY

20. PATIENTS CHARACTERISTICS

24. THE EFFECT OF TREATMENT

25. ADVERSE EVENTS – 14 (46.67%) • Loose Stool – 10 • Hot Flush – 1 • Muscle ache – 2 • Headache - 1

26. DISCUSSIONS • ANIMAL STUDIES: IMPROVE IN PANCREATIC TISSUE AND NUMBER OF BETA CELLS, INCREASE IN INSULIN RECEPTOR • INCREASE INSULIN SENSITIVITY • COMBINATION TREATMENT: WITH OHA AND INSULIN WILL GIVE BEST RESULTS

27. Treat to Target in Diabetes • BMI < 25 kg/m2 • BP < 130/80mmHg • HbA1C < 6.5% • Fasting blood sugar 4-6.0 mmol/l • Random blood sugar< 8.0 mmol/l • LDL-Chol < 2.6mmol/l

28. Thank you