1 / 11

Therapy of Type 2 Diabetes Mellitus: UPDATE

Therapy of Type 2 Diabetes Mellitus: UPDATE. Glycemic Goals in the Care of Patients with Type 2 Diabetes- 2013 ADA and AACE Guidelines: Room For Improvement (Be HAPPY/ Avoid Burnout, While Caring for Patients with DM). Stan Schwartz MD, FACP, FACE Affiliate, Main Line Health System

patty
Download Presentation

Therapy of Type 2 Diabetes Mellitus: UPDATE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Therapy of Type 2 Diabetes Mellitus: UPDATE Glycemic Goals in the Care of Patients with Type 2 Diabetes- 2013 ADA and AACE Guidelines: Room For Improvement (Be HAPPY/ Avoid Burnout, While Caring for Patients with DM) Stan Schwartz MD, FACP, FACE Affiliate, Main Line Health System Clinical Associate Professor of Medicine, Emeritus, U of Pa. Part 3

  2. Treatment of Type 2 Diabetes:PathophysiologicApproaches

  3. Prevention Age 0-15 15-40+ 15-50+ 25-70+ Envir.+ Other Disease Genes Macrovascular Complications Obesity (visceral) Poor Diet Inactivity IR phenotypeAtherosclerosisobesityhypertensionHDL,TG, HYPERINSULINEMIA Endothelial dysfunctionPCO,ED Disability Insulin Resistance MICVAAmp pp>7.8 DEATH IGT – OMINOUS OCTET Type II DM 8 mechanisms of hyperglycemia  Beta Cell Secretion EyeNerveKidney BlindnessAmputationCRF Disability Risk of Dev. Complications ETOHBPSmoking Microvascular Complications

  4. 70 62% Finnish-Diet+ Exercise 58% 58% 60 55% Da Qing – Diet + Exercise 50 42% 41% DPP-Lifestyle Diabetes Mellitus Reduction (%) 40 31% DPP-Metformin 30 25% STOP-NIDDM 20 TRIPOD XENDOS 10 DREAM 0 Diabetes Prevention Clinical Trials Treat Pre-Diabetes to Prevent DM:Delay/ Prevent/ Reverse Beta-Cell Dysfunction 72% 80 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

  5. Prevention Increased with Use of Incretin 9 m, 105 pts

  6. IN DPP TRIAL- if Achieve Normal Glucose Tolerance--Markedly Delay Future Overt Diabetes 10 % / YEAR PROGRESS TO DM IF NO TREATMENT ~50% reduction in risk = 5%/ YEAR IF DON’T REACH NGT BUT Only ~18% risk 6 years after study ie: only 3%/yr incidence IF GET TO NORMAL GLUCOSE TOLERANCE

  7. Clinical Consequences of Abnormal First- phase Secretion and Elevated Post-Prandial Sugars, ie: treat PPG • PPG increases • Variability • Microvasular disease and adverse pregnancy outcomes • ASVD risk factors • adverse CV outcomes • Treating elevated PPG leads to • Reduce Pregnancy Outcomes • Reduce micro/macrovascular risk// CV Outcomes • Prevent Diabetes

  8. Alter the Natural History of Diabetes 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

  9. ADOPT: Treatment effect on primary outcome N = 4351 Hazard ratio (95% CI) Rosiglitazone vs metformin, 0.68 (0.55–0.85), P < 0.001 Rosiglitazone vs glyburide, 0.37 (0.30–0.45), P < 0.001 40 Glyburide 30 Cumulative incidence of mono-therapy failure*(%) Metformin 20 Rosiglitazone 10 0 0 1 2 3 4 5 Years *Time to FPG >180mg/dL Kahn SE et al. N Engl J Med. 2006;355:2427-43.

  10. Natural History of Type 2 DiabetesInsulin Resistance Age 0-15 15-40+ 15-50+ 25-70+ Envir.+ Other Disease Genes Macrovascular Complications Obesity (visceral) Poor Diet Inactivity IR phenotypeAtherosclerosisobesityhypertensionHDL,TG, HYPERINSULINEMIA Endothelial dysfunctionPCO,ED Disability Insulin Resistance MICVAAmp pp>7.8 DEATH IGT – OMINOUS OCTET Type II DM 8 mechanisms of hyperglycemia  Beta Cell Secretion EyeNerveKidney BlindnessAmputationCRF Disability Risk of Dev. Complications ETOHBPSmoking Microvascular Complications

More Related