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Identifying and Treating Patients with Insulin Resistance

Diagnosis of diabetes, IFG, and IGT. . . =200

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Identifying and Treating Patients with Insulin Resistance

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    2. Diagnosis of diabetes, IFG, and IGT =200 – 140 to 199 (ADA) >140 to <200 (AACE)

    3. Metabolic syndrome diagnosis: ATP III emphasizes clinical practice

    4. Plasma triglycerides >150 mg/dL* HDL-C <40 mg/dL* BP ?140/90 mm Hg* Fasting glucose ?100 mg/dL or previously diagnosed type 2 diabetes Metabolic syndrome diagnosis: IDF emphasizes central obesity

    5. European ?37 ?32 Sub-Saharan African Middle Eastern South Asian ?35 ?32 South/Central American Chinese ?35 ?32 Japanese ?34 ?35 IDF ethnic- and gender-specific criteria for central obesity

    6. Metabolic syndrome diagnosis: WHO emphasizes central role of insulin resistance

    7. Other markers of insulin resistance Family history of type 2 diabetes or CAD Overactive sympathetic nervous system ?Uric acid

    8. ABCs of coronary prevention

    9. Multidisciplinary consensus on managing metabolic syndrome Modify lifestyle (weight loss, physical activity) Assess risk Framingham Risk Score CRP (optional) Reduce risk factors (ATP III, JNC 7, ADA) Lipids, BP, thrombosis, glucose

    11. UKPDS: Comparison of tight control of BP vs glycemia on risk of diabetes complications

    12. HPS and CARDS: Benefits of lowering LDL-C in diabetes

    14. MICRO-HOPE, PERSUADE: Reduction in primary outcome with ACEI

    15. Steno-2 supports aggressive multifactorial intervention in type 2 diabetes Objective: Target-driven, long-term, intensified intervention aimed at multiple risk factors compared with conventional therapy Design: N = 160 patients with type 2 diabetes and microalbuminuria Intensive treatment targets: BP <130/80 mm Hg A1C <6.5% Total-C <175 mg/dL Triglycerides <150 mg/dL

    16. Steno-2: Effects of multifactorial intervention on CV outcomes

    17. Summary

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