Diabetic Management of the Cardiac Patient

Size: px
Start display at page:

Download "Diabetic Management of the Cardiac Patient"

Transcription

1 Diabetic Management of the Cardiac Patient Dr Peter A Senior BMedSci MBBS PhD FRCP(E) Associate Professor, Director Division of Endocrinology, University of Alberta

2 Disclosures Grants/Research Support: Boehringer-Ingelheim, BMS, GSK, ISIS, Lilly, Novo Speakers Bureau/Honoraria: Animas, Astra Zeneca, Bayer, BMS, Lilly, Novo Nordisk, Sanofi- Aventis, Servier Consulting Fees: Bayer, Janssen, Lilly, Medtronic, Novo Nordisk, GSK Other: Endocrinologist

3 Objectives Set appropriate Glycemic Targets for cardiac patients with diabetes Risks and benefits of glucose lowering therapies in the acute setting in the chronic setting

4 Financial Practice Guidelines Hypothesis: Investing in an RRSP is an effective strategy to ensure a financially secure retirement Recommendation: People should start an RRSP (grade A, level 1) 25 yr old Cardiology R1? 63 yr old Cardiologist?

5

6 Context Diabetes is bad for the cardiovascular system Hyperglycemia is bad for the CVS Good glycemic control is good for the CVS Hypoglycemia has CV risks Tight glycemic control by any means is good for the CVS

7 UKPDS+10 - glycemia

8 Vascular Protection Checklist 2013 A A1C optimal glycemic control (usually 7%) B BP optimal blood pressure control (<130/80) C Cholesterol LDL 2.0 mmol/l if decided to treat D Drugs to protect the heart A ACEi or ARB S Statin A ASA if indicated E Exercise regular physical activity, healthy diet, achieve and maintain healthy body weight S Smoking cessation guidelines.diabetes.ca BANTING ( ) diabetes.ca Copyright 2013 Canadian Diabetes Association

9

10 Case #1 64 yr Female, BMI 37 PMH MI 2004, angioplasty & stent LAD 2009 newly diagnosed T2DM, Dec 2013 HbA1c 8.2% metformin intolerant

11 Approach Glycemic target: <= 7.0% Diet & Lifestyle Metformin: try again at lower dose what next?

12 Case #2 56 year male, admitted with AMI T2DM x 8 years, HbA1c 10.4% EF 25%, Creatinine 263µmol/l post angiogram metformin 1g bid, glyburide 10mg od

13 Approach Diet & Lifestyle Metformin: hold until AKI resolves Glyburide: hold Start Insulin (MDI) while in-patient Glycemic target: % Discharge on Basal insulin + metformin + OHA

14 Sites of Action of Antidiabetic Agents Pancreas GLP-1 receptor agonist DPP-4i Liver Insulin SU/glinide Adipose tissue Metformin TZD Gut Blood glucose Kidney AGI Stimulatory or positive effect Inhibitory effect SGLT2i * * none licensed in Canada Adapted from Bailey CJ. Trends Pharmacol Sci Feb; 32(2):63-71

15 Metformin Biguanide, related to phenformin excreted unchanged by kidney reduces hepatic glucose production enhances insulin stimulated glucose uptake no weight gain, no hypoglycemia better outcomes in heart failure

16 Lower Mortality in Heart Failure Patients on Metformin

17 Secretagogues Dosing Metabolised Hypo Weight Gain Glyburide qd Liver active $ Gliclazide bid Liver inactive + ++ $ Glimepiride qd Liver partly active $$ Repaglinide ac meals Liver inactive + + $$

18 SU Monotherapy in T2D on ACM (Cochrane Database Review of 72 RCTS) First generation SU vs placebo 2 trials; 553 participants; high risk of bias (HRB) First generation SU vs insulin 2 trials; 1944 participants; HRB Second-generation sulphonylureas (SGS) vs metformin 6 trials; 3528 participants; HRB SGS vs TZDs 7 trials; 4955 participants; HRB SGS vs Insulin 4 trials; 1642 participants; HRB SGS vs meglitinides 7 trials; 2038 participants; HRB SGS vs incretin-based therapies 2 trials; 1503 participants; HRB RR CI P value P= P= P= P= P= P= P= RR (95% CI) Hemmingsen B et al. Cochrane Database of Systematic Reviews 2013 Apr 30;4

19 Acarbose Slows digestion of oligosaccharides to monosaccharides Slows delivery of glucose to circulation Prevents post-prandial hyperglycemia Reduced CV events Safe Modest reduction in A1c Poorly tolerated (gas++)

20 Probability of any CV event Adapted from Chiasson JL et al. JAMA 2003; 290: STOP NIDDM Acarbose and Development of CVD 0.06 Effect of Acarbose on the probability of remaining free of CV disease Effect of Acarbose on the development of CV disease P=0.04 (Log-rank test) P=0.03 (Cox proportional model) Placebo Coronary heart disease P value Myocardial infarction 0.02 Angina 0.13 Revascularization 0.18 Favors Acarbose Favors Placebo 0.02 Acarbose CV death 0.63 Cerebrovasc. event or stroke Peripheral vasc. Disease Any cardiovascular event 0.03 N at risk Placebo Acarbose Days after randomization The STOP NIDDM trial s primary endpoint was development of diabetes and therefore not powered for CVD, which was an a priori secondary objective Hazard ratio

21 TZDs

22 Meta-analyses of Rosiglitazone or Pioglitazone vs Comparators on Risk of MI, Ischemic Heart Disease or a Composite of Major Macrovascular Events Rosiglitazone meta-analyses Friedrich et al. (MI) Selvin et al. (CV morbidity) GSK-ICT (MI) Friedrich et al. (IHD) Shuster et al. (MI) FDA (Serious IHD) Nissen & Wolski (MI) Singh et al. (MI) FDA (IHD) Paaty & Furberg (MI) Diamond et al. (MI, highest estimate) Dahabreh & Economopoulos (MI, highest estimate) GSK-ICT (IHD) Bracken (MI, excl. RECORD) Diamond et al. (MI, lowest estimate) Bracken (MI, incl. RECORD) Dahabreh & Economopoulos (MI, lowest estimate) Monami et al. (MI) FDA (CV death/mi/stroke) GSK-ICT (CV death/mi/stroke) Mannucci et al. (non-fatal coronary events) Mannucci et al. (non-fatal MI) Pioglitazone meta-analyses Selvin et al. (CV morbidity, incl. PROactive) Selvin et al. (CV morbidity, excl. PROactive) Nagajothi et al. (MI) Lincoff et al. (death/mi) Perez et al. (death/mi/stroke, incl. PROactive) Lincoff et al. (death/mi/stroke, incl. PROactive) Mannucci et al. (non-fatal coronary events) Lincoff et al. (MI) Lincoff et al. (death/mi/stroke, excl. PROactive) Perez et al. (death/mi/stroke, excl. PROactive) 3.5 Hazard or Odds or Risk Ratio Schernthaner G et al. Diabetes Obes Metab 2010;12:

23 Cumulative (%) Cumulative (%) Cumulative (%) RECORD: Components of the Primary Endpoint 10 All-cause death CV death HR 0.86 (95% CI ) Active control HR 0.84 (95% CI ) Active control 2 0 Rosiglitazone Rosiglitazone 10 Myocardial infarction Stroke HR 1.14 (95% CI ) Rosiglitazone HR 0.72 (95% CI ) Active control 2 0 Active control Rosiglitazone CV death, MI, and stroke HR 0.93 (95% CI ) Active control Rosiglitazone Heart failure HR 2.10 (95% CI ) Rosiglitazone Time (years) Time (years) Home PD et al. Lancet 2009; 373:

24 Incretin Therapies Inhibit GLP-1 breakdown alogliptin linagliptin (Trajenta) saxagliptin (Onglyza) sitagliptin (Januvia) vildagliptin resistant to breakdown albiglutide exenatide (Byetta) exenatide ER (Bydureon) liraglutide (Victoza) lixisenatide GLP-1 mimetics that are italicized agents are not licensed for use in Canada

25 Incretin Therapies DPP-IV inhibitors GLP-1 analogues administration tablets injection glucagon secretion insulin secretion inhibit gastric emptying N Y nausea & vomiting N Y weight loss N Y

26 Cumulative incidence of primary end-point events (%) EXAMINE: Primary Efficacy Endpoint* HR 0.96 (upper boundary of the one-sided repeated CI: 1.16) Placebo Events, No. (%) Placebo: 316 (11.8) Alogliptin: 305 (11.3) 12 Alogliptin Months EXAMINE: n = 5,380 patients (median age 61 years) with type 2 diabetes (median duration 7.1 to 7.3 years) and acute coronary syndrome within days of randomization. Median duration of follow-up: 18 months. *Primary endpoint: composite of CV death, non-fatal MI or non-fatal ischemic stroke. White WB, et al. N Engl J Med 2013; [epub ahead of print].

27 % of patients SAVOR TIMI-53: Primary Efficacy* HR % CI p (non-inferiority) < p (superiority) = Months 7.3% 3.7/100 person-yrs Saxagliptin Placebo 7.2% 3.7/100 person-yrs SAVOR TIMI-53: n = 16,492 patients (mean age 65 years) with type 2 diabetes (mean duration 10.3 years) and established CVD (78-79%) or multiple risk factors (21-22%). Median duration of follow-up: 2.1 years. *Primary endpoint: composite of CV death, non-fatal MI or non-fatal ischemic stroke. Scirica BM, et al. N Engl J Med 2013; [epub ahead of print].

28 Older Drugs lower glucose CV benefit Weight Hypo acarbose + Y 1 0 glitinides + neutral 2 + metformin + Y 3 0 sulphonylureas +?Y 4 + insulin +?Y STOP-NIDDM, 2 NAVIGATOR, 3 UKPDS, 4 UKPDS extension

29 Newer Drugs lower glucose CV benefit Weight Hypo DPP4i GLP1-RA + 0 SGLT2i * + 0 TZD +? / SAVOR, EXAMINE. 2 FDA / RECORD / PROACTIVE. * none licensed in Canada

30 Conclusions Diabetes Management is challenging Good glycemic control is important Glycemic targets must be individualized Clinical judgement required to safely use the tools available

Glucose Control and Prevention of Cardiovascular Disease

Glucose Control and Prevention of Cardiovascular Disease Glucose Control and Prevention of Cardiovascular Disease Dr Peter A Senior BMedSci MBBS PhD FRCP(E) Associate Professor, Director Division of Endocrinology, University of Alberta Diabetes Update+, March

More information

Very Practical Tips for Managing Type 2 Diabetes

Very Practical Tips for Managing Type 2 Diabetes Very Practical Tips for Managing Type 2 Diabetes Jean-François Yale, MD, FRCPC McGill University Health Centre, Montreal, Canada Jean-francois.yale@mcgill.ca www.dryale.ca OBJECTIVES DISCLOSURES The participant

More information

LATE BREAKING STUDIES IN DM AND CAD. Will this change the guidelines?

LATE BREAKING STUDIES IN DM AND CAD. Will this change the guidelines? LATE BREAKING STUDIES IN DM AND CAD Will this change the guidelines? Objectives 1. Discuss current guidelines for prevention of CHD in diabetes. 2. Discuss the FDA Guidance for Industry regarding evaluating

More information

Update on Cardiovascular Outcome Trials in Diabetes. Rury R. Holman, FMedSci NIHR Senior Investigator 11 th February 2013

Update on Cardiovascular Outcome Trials in Diabetes. Rury R. Holman, FMedSci NIHR Senior Investigator 11 th February 2013 Update on Cardiovascular Outcome Trials in Diabetes Rury R. Holman, FMedSci NIHR Senior Investigator 11 th February 2013 Residual Vascular Risk in People with Diabetes 2 Analyses based on 530,083 participants

More information

Diabete: terapia nei pazienti a rischio cardiovascolare

Diabete: terapia nei pazienti a rischio cardiovascolare Diabete: terapia nei pazienti a rischio cardiovascolare Giorgio Sesti Università Magna Graecia di Catanzaro Cardiovascular mortality in relation to diabetes mellitus and a prior MI: A Danish Population

More information

Navigating the New Options for the Management of Type 2 Diabetes

Navigating the New Options for the Management of Type 2 Diabetes Navigating the New Options for the Management of Type 2 Diabetes Clinical Associate Professor Mark Kennedy Department of General Practice, University of Melbourne Chair, Primary Care Diabetes Society of

More information

Management of Type 2 Diabetes Cardiovascular Outcomes Trials Tom Blevins MD Texas Diabetes and Endocrinology Austin, Texas

Management of Type 2 Diabetes Cardiovascular Outcomes Trials Tom Blevins MD Texas Diabetes and Endocrinology Austin, Texas Management of Type 2 Diabetes Cardiovascular Outcomes Trials 2018 Tom Blevins MD Texas Diabetes and Endocrinology Austin, Texas Speaker Disclosure Dr. Blevins has disclosed that he has received grant support

More information

Oral Hypoglycemics and Risk of Adverse Cardiac Events: A Summary of the Controversy

Oral Hypoglycemics and Risk of Adverse Cardiac Events: A Summary of the Controversy Oral Hypoglycemics and Risk of Adverse Cardiac Events: A Summary of the Controversy Jeffrey Boord, MD, MPH Advances in Cardiovascular Medicine Kingston, Jamaica December 7, 2012 VanderbiltHeart.com Outline

More information

Alia Gilani Health Inequalities Pharmacist

Alia Gilani Health Inequalities Pharmacist Alia Gilani Health Inequalities Pharmacist THE SOUTH ASIAN HEALTH FOUNDATION (U.K.) (Registered Charity No. 1073178) 1. Case Study 2. Factors influencing prescribing 3. Special Considerations 4. Prescribing

More information

The Flozins Quest for Clarity?

The Flozins Quest for Clarity? The Flozins Quest for Clarity? Choosing Wisely with Academic Detailing 2018 ARE THEY THE REAL DEAL Disclosure statements The Academic Detailing Service is operated by Dalhousie Continuing Professional

More information

Vascular complications

Vascular complications Vascular complications December 8, 2018 Faculty Disclosure Faculty: Kim Connelly, MBBS, PhD, FRACP Associate Professor of Medicine, University of Toronto Cardiologist, St. Michael s Hospital Relationships

More information

ESC GUIDELINES ON DIABETES AND CARDIOVASCULAR DISEASES

ESC GUIDELINES ON DIABETES AND CARDIOVASCULAR DISEASES ESC GUIDELINES ON DIABETES AND CARDIOVASCULAR DISEASES Pr. Michel KOMAJDA Institute of Cardiology - IHU ICAN Pitie Salpetriere Hospital - University Pierre and Marie Curie, Paris (France) DEFINITION A

More information

Preventing Serious Health Consequences of Type 2 Diabetes

Preventing Serious Health Consequences of Type 2 Diabetes Preventing Serious Health Consequences of Type 2 Diabetes The Evidence Hertzel C. Gerstein MD MSc FRCPC Professor and Population Health Institute Chair in Diabetes Research McMaster University and Hamilton

More information

Type 2 Diabetes: Where Do We Start with Treatment? DIABETES EDUCATION. Diabetes Mellitus: Complications and Co-Morbid Conditions

Type 2 Diabetes: Where Do We Start with Treatment? DIABETES EDUCATION. Diabetes Mellitus: Complications and Co-Morbid Conditions Diabetes Mellitus: Complications and Co-Morbid Conditions ADA Guidelines for Glycemic Control: 2016 Retinopathy Between 2005-2008, 28.5% of patients with diabetes 40 years and older diagnosed with diabetic

More information

6/1/2018. Lou Haenel, IV, DO, FACE, FACOI Endocrinology Roper St Francis Charleston, SC THE OMINOUS OCTET: HOW PATHOPHYSIOLOGY AND THERAPY MERGE

6/1/2018. Lou Haenel, IV, DO, FACE, FACOI Endocrinology Roper St Francis Charleston, SC THE OMINOUS OCTET: HOW PATHOPHYSIOLOGY AND THERAPY MERGE Lou Haenel, IV, DO, FACE, FACOI Endocrinology Roper St Francis Charleston, SC THE OMINOUS OCTET: HOW PATHOPHYSIOLOGY AND THERAPY MERGE 1 2 3 Sulfonylureas Glipizide Glyburide Glimeperide 4 Metformin Gold

More information

Case Studies in Type 2 Diabetes Mellitus: Focus on Cardiovascular Outcomes Trials

Case Studies in Type 2 Diabetes Mellitus: Focus on Cardiovascular Outcomes Trials Case Studies in Type 2 Diabetes Mellitus: Focus on Cardiovascular Outcomes Trials Louis Kuritzky MD Clinical Assistant Professor Emeritus Department of Community Health and Family Medicine College of Medicine

More information

Update on Diabetes Cardiovascular Outcome Trials

Update on Diabetes Cardiovascular Outcome Trials Update on Diabetes Cardiovascular Outcome Trials Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of Miami Miller School of Medicine

More information

Diabetes Mellitus: Implications of New Clinical Trials and New Medications

Diabetes Mellitus: Implications of New Clinical Trials and New Medications Diabetes Mellitus: Implications of New Clinical Trials and New Medications Estimates of Diagnosed Diabetes in Adults, 2005 Alka M. Kanaya, MD Asst. Professor of Medicine UCSF, Primary Care CME October

More information

MANAGING DIABETES IN 2016 WHAT TO ADD, WHEN AND WHY?

MANAGING DIABETES IN 2016 WHAT TO ADD, WHEN AND WHY? MANAGING DIABETES IN 2016 WHAT TO ADD, WHEN AND WHY? Faculty: Maria Wolfs MD, MHSc, FRCPC Assistant Professor, University of Toronto Staff Endocrinologist, St. Michael's Hospital Relationships with commercial

More information

Glycemic control a matter of life and death

Glycemic control a matter of life and death Glycemic control a matter of life and death Linda Garcia Mellbin MD PhD Specialist in Cardiology & Internal medicine Dep of Cardiology Karolinska University Hospital /Karolinska Institutet Mortality (%)

More information

Chief of Endocrinology East Orange General Hospital

Chief of Endocrinology East Orange General Hospital Targeting the Incretins System: Can it Improve Our Ability to Treat Type 2 Diabetes? Darshi Sunderam, MD Darshi Sunderam, MD Chief of Endocrinology East Orange General Hospital Age-adjusted Percentage

More information

Management of Type 2 Diabetes

Management of Type 2 Diabetes Management of Type 2 Diabetes Pathophysiology Insulin resistance and relative insulin deficiency/ defective secretion Not immune mediated No evidence of β cell destruction Increased risk with age, obesity

More information

The Death of Sulfonylureas? A Review of New Diabetes Medications

The Death of Sulfonylureas? A Review of New Diabetes Medications The Death of Sulfonylureas? A Review of New Diabetes Medications Kelly Hoenig, Pharm.D., BCPS Cedar Rapids Family Medicine Residency 2/4/17 Objectives Review GLP-1 Agonists, DPP-IV Inhibitors and SGLT-2

More information

Diabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable?

Diabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable? Diabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable? Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of

More information

Wayne Gravois, MD August 6, 2017

Wayne Gravois, MD August 6, 2017 Wayne Gravois, MD August 6, 2017 Americans with Diabetes (Millions) 40 30 Source: National Diabetes Statistics Report, 2011, 2017 Millions 20 10 0 1980 2009 2015 2007 - $174 Billion 2015 - $245 Billion

More information

Drug Class Monograph

Drug Class Monograph Drug Class Monograph Class: Dipeptidyl-Peptidase 4 (DPP-4) Inhibitors Drugs: alogliptin, alogliptin/metformin, Januvia (sitagliptin), Janumet (sitagliptin/metformin), Janumet XR (sitagliptin/metformin),

More information

MANAGING DIABETES IN 2017 WHAT TO ADD, WHEN AND WHY? December 8, 2017 Maria Wolfs MD MHSc FRCPC

MANAGING DIABETES IN 2017 WHAT TO ADD, WHEN AND WHY? December 8, 2017 Maria Wolfs MD MHSc FRCPC MANAGING DIABETES IN 2017 WHAT TO ADD, WHEN AND WHY? December 8, 2017 Maria Wolfs MD MHSc FRCPC Faculty Disclosure Faculty: Maria Wolfs MD, MHSc, FRCPC Assistant Professor, University of Toronto Endocrinologist,

More information

Beyond A1C. Non-glycemic Effects of GLP-1 Receptor Agonists. Olga Astapova MD, PhD Luis Chavez MD URMC Endocrinology Fellows

Beyond A1C. Non-glycemic Effects of GLP-1 Receptor Agonists. Olga Astapova MD, PhD Luis Chavez MD URMC Endocrinology Fellows Beyond A1C Non-glycemic Effects of GLP-1 Receptor Agonists Olga Astapova MD, PhD Luis Chavez MD URMC Endocrinology Fellows Disclosures No conflicts of interest. Learning Objectives 1. Understand the physiological

More information

Early treatment for patients with Type 2 Diabetes

Early treatment for patients with Type 2 Diabetes Israel Society of Internal Medicine Kibutz Hagoshrim, June 22, 2012 Early treatment for patients with Type 2 Diabetes Eduard Montanya Hospital Universitari Bellvitge-IDIBELL CIBERDEM University of Barcelona

More information

Incretin-based Therapies for Type 2 Diabetes Comparisons Between Glucagon-like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors

Incretin-based Therapies for Type 2 Diabetes Comparisons Between Glucagon-like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors Incretin-based Therapies for Type 2 Diabetes Comparisons Between Glucagon-like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors Timothy Bailey, MD, FACE, CPI Director, AMCR Institute,

More information

Du gusts is megl che one. Edoardo Mannucci

Du gusts is megl che one. Edoardo Mannucci Du gusts is megl che one Edoardo Mannucci Conflitti di interessi Negli ultimi due anni, E. Mannucci ha ricevuto compensi per relazioni e/o consulenze da: Abbott, AstraZeneca, Boehringer Ingelheim, Eli

More information

CURRENT CONTROVERSIES IN DIABETES CARE

CURRENT CONTROVERSIES IN DIABETES CARE CURRENT CONTROVERSIES IN DIABETES CARE Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest Diabetes Mellitus: U.S. Impact

More information

Overview T2DM medications. Winnie Ho

Overview T2DM medications. Winnie Ho Overview T2DM medications Winnie Ho Diabetes in Australia 1.7 million Australians with diabetes, of these 85% have T2DM 2-fold excess risk CV death in patients with diabetes Risk factor for progression

More information

Oral Agents. Ian Gallen Consultant Community Diabetologist Royal Berkshire Hospital Reading UK

Oral Agents. Ian Gallen Consultant Community Diabetologist Royal Berkshire Hospital Reading UK Oral Agents Ian Gallen Consultant Community Diabetologist Royal Berkshire Hospital Reading UK What would your ideal diabetes drug do? Effective in lowering HbA1c No hypoglycaemia No effect on weight/ weight

More information

The Many Faces of T2DM in Long-term Care Facilities

The Many Faces of T2DM in Long-term Care Facilities The Many Faces of T2DM in Long-term Care Facilities Question #1 Which of the following is a risk factor for increased hypoglycemia in older patients that may suggest the need to relax hyperglycemia treatment

More information

Drug Class Monograph

Drug Class Monograph Class: Dipeptidyl-Peptidase 4 (DPP-4) Inhibitors Drug Class Monograph Drugs: alogliptin, Januvia (sitagliptin), Janumet (sitagliptin/metformin), Janumet XR (sitagliptin/metformin), Jentadueto (linagliptin/metformin),

More information

Can We Reduce Heart Failure by Treating Diabetes? CVOT Data on SGLT2 Inhibitors and GLP-1Receptor Agonists

Can We Reduce Heart Failure by Treating Diabetes? CVOT Data on SGLT2 Inhibitors and GLP-1Receptor Agonists Can We Reduce Heart Failure by Treating Diabetes? CVOT Data on SGLT2 Inhibitors and GLP-1Receptor Agonists Robert R. Henry, MD Professor of Medicine University of California, San Diego Relevant Conflict

More information

Stephen Clement M.D. CDE Medical Director, Endocrine Services Inova Fairfax Hospital

Stephen Clement M.D. CDE Medical Director, Endocrine Services Inova Fairfax Hospital Stephen Clement M.D. CDE Medical Director, Endocrine Services Inova Fairfax Hospital Financial Disclosures Consulting Panel for GSK on Hepatitis Vaccines Case Study BH is a 67 y/o female with T2 DM for

More information

Disclosure. Learning Objectives. Case. Diabetes Update: Incretin Agents in Diabetes-When to Use Them? I have no disclosures to declare

Disclosure. Learning Objectives. Case. Diabetes Update: Incretin Agents in Diabetes-When to Use Them? I have no disclosures to declare Disclosure Diabetes Update: Incretin Agents in Diabetes-When to Use Them? I have no disclosures to declare Spring Therapeutics Update 2011 CSHP BC Branch Anar Dossa BScPharm Pharm D CDE April 20, 2011

More information

Multiple Small Feedings of the Mind: Diabetes. Sonja K Fredrickson, MD, BC-ADM March 7, 2014

Multiple Small Feedings of the Mind: Diabetes. Sonja K Fredrickson, MD, BC-ADM March 7, 2014 Multiple Small Feedings of the Mind: Diabetes Sonja K Fredrickson, MD, BC-ADM March 7, 2014 Question 1: Setting A1c Goals Describe the evidence based approach to determining the target HgbA1c in different

More information

Canadian Society of Internal Medicine Annual Meeting 2016 Montreal, QC

Canadian Society of Internal Medicine Annual Meeting 2016 Montreal, QC Canadian Society of Internal Medicine Annual Meeting 2016 Montreal, QC Choosing the Right Agent for your Patient with diabetes: Individualizing type 2 diabetes management in light of the expanding therapies

More information

Cardiovascular Impact of Medications for Treating Type 2 Diabetes

Cardiovascular Impact of Medications for Treating Type 2 Diabetes Friday CME Breakfast Lecture Cardiovascular Impact of Medications for Treating Type 2 Diabetes Thomas Blevins, MD Endocrinologist, Private Practice Texas Diabetes and Endocrinology Austin, Texas Educational

More information

Newer and Expensive treatment of diabetes. Endocrinology Visiting Associate Professor Institute of Medicine TUTH

Newer and Expensive treatment of diabetes. Endocrinology Visiting Associate Professor Institute of Medicine TUTH Newer and Expensive treatment of diabetes Jyoti Bhattarai MD Endocrinology Visiting Associate Professor Institute of Medicine TUTH Four out of every five people with diabetes now live in developing countries.

More information

GLP 1 agonists Winning the Losing Battle. Dr Bernard SAMIA. KCS Congress: Impact through collaboration

GLP 1 agonists Winning the Losing Battle. Dr Bernard SAMIA. KCS Congress: Impact through collaboration GLP 1 agonists Winning the Losing Battle Dr Bernard SAMIA KCS Congress: Impact through collaboration CONTACT: Tel. +254 735 833 803 Email: kcardiacs@gmail.com Web: www.kenyacardiacs.org Disclosures I have

More information

SIMPLICITY IN T2DM MANAGEMENT WITH DPP4 INHIBITORS: SPECIAL POPULATION

SIMPLICITY IN T2DM MANAGEMENT WITH DPP4 INHIBITORS: SPECIAL POPULATION SIMPLICITY IN T2DM MANAGEMENT WITH DPP4 INHIBITORS: SPECIAL POPULATION DR ROSE ZHAO-WEI TING ( 丁昭慧醫生 ) MBBS (HK), MRCP (UK), FHKCP, FHKAM (MEDICINE) Specialist in Endocrinology, Diabetes and Metabolism

More information

Management of Type 2 Diabetes. Why Do We Bother to Achieve Good Control in DM2. Insulin Secretion. The Importance of BP and Glucose Control

Management of Type 2 Diabetes. Why Do We Bother to Achieve Good Control in DM2. Insulin Secretion. The Importance of BP and Glucose Control Insulin Secretion Management of Type 2 Diabetes DG van Zyl Why Do We Bother to Achieve Good Control in DM2 % reduction 0-5 -10-15 -20-25 -30-35 -40 The Importance of BP and Glucose Control Effects of tight

More information

Should Psychiatrists be diagnosing (and treating) metabolic syndrome

Should Psychiatrists be diagnosing (and treating) metabolic syndrome Should Psychiatrists be diagnosing (and treating) metabolic syndrome David Hopkins Clinical Director, Diabetes King s College Hospital, London Diabetes prevalence (thousands) Diabetes in the UK: 1995-2010

More information

Pharmacology Updates. Quang T Nguyen, FACP, FACE, FTOS 11/18/17

Pharmacology Updates. Quang T Nguyen, FACP, FACE, FTOS 11/18/17 Pharmacology Updates Quang T Nguyen, FACP, FACE, FTOS 11/18/17 14 Classes of Drugs Available for the Treatment of Type 2 DM in the USA ### Class A1c Reduction Hypoglycemia Weight Change Dosing (times/day)

More information

Management of Diabetes

Management of Diabetes Management of Diabetes Mellitus: Which Drugs for Which Patients? Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine baron@medicine.ucsf.edu Disclosure No relevant financial relationships

More information

Oral and Injectable Non-insulin Antihyperglycemic Agents

Oral and Injectable Non-insulin Antihyperglycemic Agents Appendix 5: Diabetes Education and Medical Management in Adults with Diabetes Oral and Injectable Non-insulin s This directive will be implemented by RPhs, RNs or RDs who have been deemed authorized implementers.

More information

New and Emerging Therapies for Type 2 DM

New and Emerging Therapies for Type 2 DM Dale Clayton MHSc, MD, FRCPC Dalhousie University/Capital Health April 28, 2011 New and Emerging Therapies for Type 2 DM The science of today, is the technology of tomorrow. Edward Teller American Physicist

More information

Treatment Options for Diabetes: An Update

Treatment Options for Diabetes: An Update Treatment Options for Diabetes: An Update A/Prof. Marg McGill Manager, Diabetes Centre Dr. Ted Wu Staff Specialist Endocrinologist Diabetes Centre Centre of Health Professional Education Education Provider

More information

Cardiovascular Management of a Patient with Diabetes

Cardiovascular Management of a Patient with Diabetes Cardiovascular Management of a Patient with Diabetes Dr Jeremy Krebs Clinical Leader Endocrinology and Diabetes Wellington Hospital Summary People with diabetes take a lot of medication Compliance and

More information

Side Effects of: GLP-1 agonists DPP-4 inhibitors SGLT-2 inhibitors. Bryce Fukunaga PharmD April 25, 2018

Side Effects of: GLP-1 agonists DPP-4 inhibitors SGLT-2 inhibitors. Bryce Fukunaga PharmD April 25, 2018 Side Effects of: GLP-1 agonists DPP-4 inhibitors SGLT-2 inhibitors Bryce Fukunaga PharmD April 25, 2018 Objectives For each drug class: Identify the overall place in therapy Explain the mechanism of action

More information

Dipeptidyl-Peptidase 4 (DPP-4) Inhibitors Drug Class Prior Authorization Protocol

Dipeptidyl-Peptidase 4 (DPP-4) Inhibitors Drug Class Prior Authorization Protocol Dipeptidyl-Peptidase 4 (DPP-4) Inhibitors Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed

More information

Medical therapy advances London/Manchester RCP February/June 2016

Medical therapy advances London/Manchester RCP February/June 2016 Medical therapy advances London/Manchester RCP February/June 2016 Advances in medical therapies for diabetes mellitus Duality of interest: The speaker or institutions with which he is associated has received

More information

Terapia con agonisti GLP1 e outcome cardiovascolare. Edoardo Mannucci

Terapia con agonisti GLP1 e outcome cardiovascolare. Edoardo Mannucci Terapia con agonisti GLP e outcome cardiovascolare Edoardo Mannucci Conflitti di interessi Negli ultimi due anni, E. Mannucci ha ricevuto compensi per relazioni e/o consulenze da: Abbott, AstraZeneca,

More information

CONTROLLO GLICEMICO E RISCHIO CARDIOVASCOLARE. AGOSTINO CONSOLI DMSI - Università d Annunzio CHIETI ITALY. sul Paziente ad alto rischio CV*

CONTROLLO GLICEMICO E RISCHIO CARDIOVASCOLARE. AGOSTINO CONSOLI DMSI - Università d Annunzio CHIETI ITALY. sul Paziente ad alto rischio CV* CONTROLLO GLICEMICO E RISCHIO CARDIOVASCOLARE AGOSTINO CONSOLI DMSI - Università d Annunzio CHIETI ITALY sul Paziente ad alto rischio CV* Does reducing hyperglycemia protect against cardiovascular risk?

More information

What s New in Type 2? Peter Hammond Consultant Physician Harrogate District Hospital

What s New in Type 2? Peter Hammond Consultant Physician Harrogate District Hospital What s New in Type 2? Peter Hammond Consultant Physician Harrogate District Hospital Therapy considerations in T2DM Thiazoledinediones DPP IV inhibitors GLP 1 agonists Insulin Type Delivery Horizon scanning

More information

Disclaimers 22/03/2018. Role of DPP-4 Inhibitors, GLP-1 Agonists, and SGLT-2 Inhibitors in the treatment of Diabetes Mellitus Type 2

Disclaimers 22/03/2018. Role of DPP-4 Inhibitors, GLP-1 Agonists, and SGLT-2 Inhibitors in the treatment of Diabetes Mellitus Type 2 Disclaimers Role of DPP-4 Inhibitors, GLP-1 Agonists, and SGLT-2 Inhibitors in the treatment of Diabetes Mellitus Type 2 I have not received money or gifts from medical device companies or from the pharmaceutical

More information

Glucagon-like peptide-1 (GLP-1) Agonists Drug Class Prior Authorization Protocol

Glucagon-like peptide-1 (GLP-1) Agonists Drug Class Prior Authorization Protocol Glucagon-like peptide-1 (GLP-1) Agonists Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed

More information

La lezione dei trials di safety cardiovascolare. Edoardo Mannucci

La lezione dei trials di safety cardiovascolare. Edoardo Mannucci La lezione dei trials di safety cardiovascolare Edoardo Mannucci Conflitti di interessi Negli ultimi due anni, E. Mannucci ha ricevuto compensi per relazioni e/o consulenze da: Abbott, AstraZeneca, Boehringer

More information

Cardiovascular Benefits of Two Classes of Antihyperglycemic Medications

Cardiovascular Benefits of Two Classes of Antihyperglycemic Medications Cardiovascular Benefits of Two Classes of Antihyperglycemic Medications Nathan Woolever, Pharm.D., Resident Pharmacist Pharmacy Grand Rounds November 6 th, 2018 Franciscan Healthcare La Crosse, WI 2017

More information

Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology

Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology Diabetes and Cardiovascular Risk Management Denise M. Kolanczyk, PharmD, BCPS-AQ Cardiology Disclosures In compliance with the accrediting board policies, the American Diabetes Association requires the

More information

In compliance with the accrediting board policies, the American Diabetes Association requires the following disclosure to the participants:

In compliance with the accrediting board policies, the American Diabetes Association requires the following disclosure to the participants: In compliance with the accrediting board policies, the American Diabetes Association requires the following disclosure to the participants: Entity Activity Financial Consideration Comments Novo Nordisk

More information

CURRENT ISSUES IN DIABETES MANAGEMENT. Screening for Diabetes Advantages of HbA1c as a Diagnostic Test. Diagnosis of Diabetes 2013

CURRENT ISSUES IN DIABETES MANAGEMENT. Screening for Diabetes Advantages of HbA1c as a Diagnostic Test. Diagnosis of Diabetes 2013 CURRENT ISSUES IN DIABETES MANAGEMENT Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest Screening for Diabetes 2013 BMI

More information

GLP-1 Receptor Agonists and SGLT-2 Inhibitors. Debbie Hicks

GLP-1 Receptor Agonists and SGLT-2 Inhibitors. Debbie Hicks GLP-1 Receptor Agonists and SGLT-2 Inhibitors Debbie Hicks Prescribing and Adverse Event reporting information is available at this meeting from the AstraZeneca representative The views expressed by the

More information

Content Development Committee

Content Development Committee 1 Content Development Committee Cardiologists: Family Physicians: Shaun Goodman, MD, MSc, FRCPC, FACC, FESC, FAHA, FCCS (Chair) Associate Head, Division of Cardiology, St. Michael s Hospital Professor,

More information

Update on Cardiovascular Outcome Trials in Diabetes Jay S. Skyler, MD, MACP

Update on Cardiovascular Outcome Trials in Diabetes Jay S. Skyler, MD, MACP Update on Cardiovascular Outcome Trials in Diabetes Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research InsAtute University of Miami Miller School of Medicine

More information

What s New in Type 1 and Type 2 Diabetes? Updates from 2013 CDA CPGs and Advancements in Insulin Therapy

What s New in Type 1 and Type 2 Diabetes? Updates from 2013 CDA CPGs and Advancements in Insulin Therapy What s New in Type 1 and Type 2 Diabetes? Updates from 2013 CDA CPGs and Advancements in Insulin Therapy 2013 Rocky Mountain/ACP Internal Medicine Conference November 15, 2013 David C.W. Lau, MD, PhD,

More information

Update on Therapies for Type 2 Diabetes: Angela D. Mazza, DO July 31, 2015

Update on Therapies for Type 2 Diabetes: Angela D. Mazza, DO July 31, 2015 Update on Therapies for Type 2 Diabetes: 2015 Angela D. Mazza, DO July 31, 2015 Objectives To present the newer available therapies for the management of T2D To discuss the advantages and disadvantages

More information

IDF Regions and global projections of the number of people with diabetes (20-79 years), 2013 and Diabetes Atlas -sixth Edition: IDF 2013

IDF Regions and global projections of the number of people with diabetes (20-79 years), 2013 and Diabetes Atlas -sixth Edition: IDF 2013 IDF Regions and global projections of the number of people with diabetes (20-79 years), 2013 and 2035 Diabetes Atlas -sixth Edition: IDF 2013 Diabetes Atlas -sixth Edition: IDF 2013 Chronic complications

More information

Glucose Control drug treatments

Glucose Control drug treatments Glucose Control drug treatments It should be noted that glitazones are under suspicion of precipitating acute cardiac events and current recommendations contraindicate the use of glitazones in patients

More information

Management of Type 2 Diabetes Mellitus. Heather Corn, MD, MS Endocrinology, Diabetes, and Metabolism

Management of Type 2 Diabetes Mellitus. Heather Corn, MD, MS Endocrinology, Diabetes, and Metabolism Management of Type 2 Diabetes Mellitus Heather Corn, MD, MS Endocrinology, Diabetes, and Metabolism Disclosures Working for Intermountain Healthcare Some of the views represented are the opinion of ABIM-certified

More information

Non-insulin treatment in Type 1 DM Sang Yong Kim

Non-insulin treatment in Type 1 DM Sang Yong Kim Non-insulin treatment in Type 1 DM Sang Yong Kim Chosun University Hospital Conflict of interest disclosure None Committee of Scientific Affairs Committee of Scientific Affairs Insulin therapy is the mainstay

More information

Professor Rudy Bilous James Cook University Hospital

Professor Rudy Bilous James Cook University Hospital Professor Rudy Bilous James Cook University Hospital Rate per 100 patient years Rate per 100 patient years 16 Risk of retinopathy progression 16 Risk of developing microalbuminuria 12 12 8 8 4 0 0 5 6

More information

Current principles of diabetes management

Current principles of diabetes management Current principles of diabetes management Prof. Martin Haluzík, MD, DSc. 3 Department of Medicine, General University Hospital and 1st Faculty of Medicine, Charles University in Prague, Czech Republic

More information

DM Fundamentals Class 4 Meds for Type 2

DM Fundamentals Class 4 Meds for Type 2 DM Fundamentals Class 4 Meds for Type 2 Beverly Thomassian, RN, MPH, BC ADM, CDE President, Diabetes Education Services Copyright 1999 2015, Diabetes Education Services, All Rights Reserved. Diabetes Meds

More information

Achieving and maintaining good glycemic control is an

Achieving and maintaining good glycemic control is an Glycemic Efficacy, Weight Effects, and Safety of Once-Weekly Glucagon-Like Peptide-1 Receptor Agonists Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE; Kathleen Wyne, MD, PhD, FACE, FNLA; Anthony Cannon,

More information

Metformin. Sulfonylurea. Thiazolidinedione. Insulin

Metformin. Sulfonylurea. Thiazolidinedione. Insulin 동아의대내분비내과박미경 Metformin Sulfonylurea Thiazolidinedione Insulin 요약 markers of inflammation (hs-crp, TNF-a) markers of impaired endothelial function (VFW, scams, tpa, PAI-1) LDL-C, fasting and postprandial

More information

Management of Diabetes Mellitus: A Primary Care Perspective. Screening for Diabetes Advantages of HbA1c as a Diagnostic Test

Management of Diabetes Mellitus: A Primary Care Perspective. Screening for Diabetes Advantages of HbA1c as a Diagnostic Test Management of Diabetes Mellitus: A Primary Care Perspective Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest Screening

More information

CURRENT ISSUES IN DIABETES MANAGEMENT

CURRENT ISSUES IN DIABETES MANAGEMENT CURRENT ISSUES IN DIABETES MANAGEMENT Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest Screening for Diabetes 2011 BMI

More information

Pharmacology Update for the Adult Patient - Newer Oral Medications for Diabetes

Pharmacology Update for the Adult Patient - Newer Oral Medications for Diabetes Pharmacology Update for the Adult Patient - Newer Oral Medications for Diabetes Brooke Hudspeth, PharmD, CDE, MLDE Director of Diabetes Prevention, Kroger Pharmacy Adjunct Assistant Professor, University

More information

Management of Diabetes Mellitus: A Primary Care Perspective

Management of Diabetes Mellitus: A Primary Care Perspective Management of Diabetes Mellitus: A Primary Care Perspective Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest Screening

More information

Quick Reference Guide

Quick Reference Guide 2013 Clinical Practice Guidelines Quick Reference Guide (Updated November 2016) 416569-16 guidelines.diabetes.ca diabetes.ca 1-800-BANTING (226-8464) Copyright 2016 Canadian Diabetes Association SCREENING

More information

DIABETES DEBATE - IS NEW BETTER?

DIABETES DEBATE - IS NEW BETTER? DIABETES DEBATE - IS NEW BETTER? WHAT MEDICATION CLASS AFTER METFORMIN TO CONTROL BLOOD SUGAR Dr. Lydia Hatcher, MD, CCFP, FCFP, CHE, D-CAPM Associate Clinical Professor of Family Medicine, McMaster Chief

More information

Soo LIM, MD, PHD Internal Medicine Seoul National University Bundang Hospital

Soo LIM, MD, PHD Internal Medicine Seoul National University Bundang Hospital Soo LIM, MD, PHD Internal Medicine Seoul National University Bundang Hospital Agenda Association between Cardiovascular Disease and Type 2 Diabetes Importance of HbA1c Management esp. High risk patients

More information

Drug Class Review Newer Diabetes Medications and Combinations

Drug Class Review Newer Diabetes Medications and Combinations Drug Class Review Newer Diabetes Medications and Combinations Final Update 2 Report July 2016 The purpose reports is to make available information regarding the comparative clinical effectiveness and harms

More information

GLP-1 agonists. Ian Gallen Consultant Community Diabetologist Royal Berkshire Hospital Reading UK

GLP-1 agonists. Ian Gallen Consultant Community Diabetologist Royal Berkshire Hospital Reading UK GLP-1 agonists Ian Gallen Consultant Community Diabetologist Royal Berkshire Hospital Reading UK What do GLP-1 agonists do? Physiology of postprandial glucose regulation Meal ❶ ❷ Insulin Rising plasma

More information

How they work and when to take them. Diabetes Medications

How they work and when to take them. Diabetes Medications How they work and when to take them Diabetes Medications BIGUANIDES Metformin Actions Slows down the release of glucose from the liver. Helps the bodies cells become more sensitive to insulin. Pros Weight

More information

FARXIGA (dapagliflozin) Jardiance (empagliflozin) tablets. Synjardy (empagliflozin and metformin hydrochloride) tablets. GLUCOPHAGE* (metformin)

FARXIGA (dapagliflozin) Jardiance (empagliflozin) tablets. Synjardy (empagliflozin and metformin hydrochloride) tablets. GLUCOPHAGE* (metformin) Type 2 Medications Drug Class How It Works Brand and Generic Names Manufacturers Usual Starting Dose The kidneys filter sugar and either absorb it back into your body for energy or remove it through your

More information

CV outcomes Studies and Implications for diabetes management. Seraj Abualnaja, MD, FRCPC Consultant Interventional cardiologist DSFH

CV outcomes Studies and Implications for diabetes management. Seraj Abualnaja, MD, FRCPC Consultant Interventional cardiologist DSFH CV outcomes Studies and Implications for diabetes management Seraj Abualnaja, MD, FRCPC Consultant Interventional cardiologist DSFH Case 49 y female with the following medical problems DM typ2 Hypertension

More information

Multi-factor approach to reduce cardiovascular risk in diabetes

Multi-factor approach to reduce cardiovascular risk in diabetes Multi-factor approach to reduce cardiovascular risk in diabetes Prof. Nicola Napoli, MD PhD Division of Endocrinology and Diabetes Università Campus Bio-Medico di Roma Washington University in St Louis

More information

Table 1. Antihyperglycemic agents for use in type 2 diabetes

Table 1. Antihyperglycemic agents for use in type 2 diabetes Table 1. Antihyperglycemic agents for use in type 2 diabetes DRUG IN ALPHA-GLUCOSIDASE INHIBITOR: inhibits pancreatic alpha-amyle and intestinal alpha-glucoside Acarbose (Glucobay) 0.6% Negligible Not

More information

What s New in Type 2 Diabetes? 2018 Diabetes Updates

What s New in Type 2 Diabetes? 2018 Diabetes Updates What s New in Type 2 Diabetes? 2018 Diabetes Updates Gretchen Ray, PharmD, PhC, BCACP, CDE Associate Professor, UNM College of Pharmacy January 28, 2018 gray@salud.unm.edu OBJECTIVES Describe the most

More information

Why is Earlier and More Aggressive Treatment of T2 Diabetes Better?

Why is Earlier and More Aggressive Treatment of T2 Diabetes Better? Blood glucose (mmol/l) Why is Earlier and More Aggressive Treatment of T2 Diabetes Better? Disclosures Dr Kennedy has provided CME, been on advisory boards or received travel or conference support from:

More information

Faculty/Presenter Disclosure

Faculty/Presenter Disclosure DIABETES UPATE 2016 Faculty/Presenter Disclosure Faculty/Presenter: tina kader Relationships with commercial interests: Grants/research support: BI; Sanofi Speaker s bureau/honoraria: eli lilly sanofi;

More information

Insulin Initiation and Intensification. Disclosure. Objectives

Insulin Initiation and Intensification. Disclosure. Objectives Insulin Initiation and Intensification Neil Skolnik, M.D. Associate Director Family Medicine Residency Program Abington Memorial Hospital Professor of Family and Community Medicine Temple University School

More information

10/27/2011. Challenges in Anti-diabetic Global Drug Development A Shift from Surrogate to Outcome Trials. Disclaimer

10/27/2011. Challenges in Anti-diabetic Global Drug Development A Shift from Surrogate to Outcome Trials. Disclaimer Challenges in Anti-diabetic Global Drug Development A Shift from Surrogate to Outcome Trials Eckhard Leifke, MD PhD Senior Medical Director Takeda Global Research Development Center, Inc. Presentation

More information

Cardiologists and HbA1c: Novel Diabetes Drugs and Cardiovascular Disease Outcomes

Cardiologists and HbA1c: Novel Diabetes Drugs and Cardiovascular Disease Outcomes Biomarkers 2018 Cardiologists and HbA1c: Novel Diabetes Drugs and Cardiovascular Disease Outcomes Gregg C. Fonarow, MD, FACC, FAHA, FHFSA Elliot Corday Professor of Cardiovascular Medicine UCLA Division

More information