2017 Hot topics in cardiometabolism: an interactive update

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "2017 Hot topics in cardiometabolism: an interactive update"

Transcription

1 14-15 July, Bogotà, Colombia 2017 Hot topics in cardiometabolism: an interactive update IMPROVING THE PATIENT S LIFE THROUGH MEDICAL EDUCATION

2 Nicola Napoli Department of Medicine, Unit of Endocrinology and Diabetes University Campus Bio-Medico Rome, Italy Disclosure Declared receipt of grants and contracts from Bruno Farmaceutici; receipt of honoraria or consultation fees from MSD, AMGEN, Lilly; to be member of a compoany advisory board, board of directors or other similar groups of AMGEN, Lilly and MSD. 2

3 Metformin beyond diabetes: future perspectives of an old molecule (PCOS, obesity, etc.) Nicola Napoli Italy 3

4 Topics - Crucial role of insulin resistance in PCOS - Insulin resistance and bone health - Metformin benefits in women with PCOS - Insulin sensitizers and bone health: are they the same

5 Clinical case A 23-year-old woman with known polycystic ovary syndrome visits her family physician. She has taken oral contraceptive pills in the past but did not tolerate them and is not currently receiving any treatment. She has three or four menstrual periods per year and is not interested in becoming pregnant now, but she will be getting married in a year. She has heard that the polycystic ovary syndrome is associated with diabetes and is concerned because both her mother and father have type 2 diabetes. Her body-mass index is 32, her waist circumference is 38 in. (96.5 cm), her serum total testosterone level is elevated at 0.9 ng per milliliter (90 ng per deciliter, or 2.9 nmol per liter), her plasma HDL is 35 mg/dl (0.9 mmol per liter), and her triglyceride level is 190 mg/dl (2.1 mmol per liter). Her serum glucose level 2 hours after the ingestion of 75 g of glucose is 158 mg/dl(7.7 mmol per liter). The physician wonders whether treatment with metformin would be beneficial and refers the patient to an endocrinologist

6 Metabolic derangements in PCOS The prevalence of type 2 diabetes in the United States is 10 times higher among young women with PCOS than normal women Impaired glucose tolerance or overt type 2 diabetes develops by the age of 30 years in 30 to 50% of obese women with PCOS. The prevalence of the metabolic syndrome is two to three times higher in women with PCOS than normal women matched for age and body-mass index 20% of women with PCOS who are younger than 20 years of age have the metabolic syndrome.

7 The majority of women with PCOS, regardless of weight, have a form of insulin resistance that is intrinsic to the syndrome and is poorly understood. The insulin resistance that is characteristic of PCOS appears to be responsible of higher risk of type 2 diabetes. Insulin resistance underlies the association of PCOS with recognized cardiovascular risk factors such as dyslipidemia and hypertension, as well as with cardiovascular derangements.

8

9

10

11 Human Reproduction Update, Vol.21, No.5 pp , 2015

12 Metabolic effects of metformi in PCOS insulin (20-30%) and testosterone (20%) SHBG Hirsutism: minimal/modest effect Acne: beneficial effect in one non-controlled study Menstrual regularity: restored in 25 to 70% of cases Pregnancy rates OR for metformin 1.7(CI )

13 Effects of metformin on inflamation and cardiovascolar parameters Improves endothelial dysfunction ( endothelin-1) Reduces intima-media thickness of carotid arteries (Orio2005)

14 Metformin and ovulation rate in PCOS

15 Metformin and ovulation rate in PCOS Metformin + clomiphene

16 Treating women with PCOS

17 Conclusions Women with PCOS, long-term treatment with metformin increase ovulation, improve menstrual cyclicity, and reduce serum androgen levels; Use of metformin may also improve hirsutism. Importantly, metformin prevents progression to glucose intolerance in affected women

18 Type 2 DM and hip fracture RR (95% CI) Heath, (0.6, 1.02) Meyer, (3.4, 24.9) Forsen, (1.1, 2.9) Ivers, (0.2, 2.2) Nicodemus and Folsom, (1.2, 2.4) Schwartz, (1.2, 2.7) Ottenbacher, (1.0, 2.3) de Liefde, (0.8, 2.3) Vestergaard, (1.2, 1.6) Holmberg, (1.7, 9.4) Ahmed, (1.02, 3.5) Janghorbani, (1.8, 2.7) All studies 1.7 (1.3, 2.2) RR any fracture 1.2 ( ) RR hip fracture 1.7 ( ) Test for heterogeneity: Q = 58.1; p < Relative risk RR=relative risk Janghorbani M et al. Am J Epidemiol 2007;166:

19 NAPOLI ET AL, NATURE ENDOCRINOLOGY

20 Negative correlation between glucose control and bone formation Vestergaard,oi 2014 and Bone 2016

21 % % % So why more fractures? Bone turnover? Histomorphometry shows reduced mineralizing surface, osteoid surface, and osteoblast surface (pilot study) Osteoid Surface * T2DM Rubin MR. Curr Osteoporos Rep 2015;13: Control Mineralizing Surface * T2DM Control Osteoblast Surface * T2DM Control *p<.05

22 Low Bone Formation in Diabetics Rubin et al. JCEM, 2012

23

24 Utilising data from the Osteoporotic Fractures in Men (MrOS) study, a large multicentre prospective observational study examining the incidence and predictors of fractures in older men

25 Men using insulin had a higher risk of all non-vertebral fractures Model Diabetes, all a IFG b Diabetes, insulin use HR (95% CI) HR (95% CI) HR (95% CI) Unadjusted model 1.08 (0.91, 1.28) 0.93 (0.79, 1.08) 1.94 (1.35, 2.80) 2. Adjusted for age, race, clinic 1.12 (0.94, 1.34) 0.95 (0.81, 1.10) 2.24 (1.53, 3.27) 3. Adjusted for Model 1 plus total hip BMD 1.30 (1.09, 1.54) 1.04 (0.89, 1.21) 2.46 (1.69, 3.59) 4. Adjusted for Model 1 plus falls in the year before baseline 1.08 (0.91, 1.29) 0.95 (0.82, 1.11) 1.98 (1.34, 2.15) 5. Multivariable 1.00 model c (0.85, 1.18) 1.74 (1.13, 2.69) Napoli & Schwartz, Diabetologia, 2014

26 Risk factors for non-vertebral fracture in older men with diabetes Napoli & Schwartz, Diabetologia, 2014

27 SULFONYLUREAs result in significantly more hypoglycaemic events than other treatments Meta-analysis of head-to-head studies 1 Authors Type of therapy RR (95% CI) % weight Hypoglycaemic events* Burant et al 2 Monotherapy 5.37 (1.26, 22.85) 8.30 Simonson et al 3 Monotherapy 4.20 (0.25, 71.96) 3.03 DeFronzo and Goodman 4 Combination 9.37 (3.40, 25.78) Feinglos et al 5 Combination 4.50 (1.01, 19.98) 8.01 Horton et al 6 Combination 6.03 (0.73, 49.67) 4.92 Kabadi et al 7 Insulin 0.50 (0.05, 4.67) 4.50 Riddle et al 8 Insulin 1.36 (0.28, 6.56) 7.49 Riddle and Schneider 9 Insulin 1.39 (0.96, 2.02) Stenman et al 10 Insulin 1.63 (0.94, 2.80) Stuart et al 11 Insulin 1.67 (0.77, 3.61) Subtotal (I 2 =61.0%, p=0.006) 2.41 (1.41, 4.10) Favours sulfonylurea Favours comparator *Defined as either patient-reported symptoms or blood glucose levels below a threshold of mmol/l [55 60 mg/dl] 1. Hirst JA, et al. Diabetologia 2013;56: Burant CF, et al. Lancet 2012;379: Simonson DC, et al. Diabetes Care 1997;20: DeFronzo RA, Goodman AM. N Engl J Med 1995;333: Feinglos M, et al. Diabetes Res Clin Pract 2005;68: Horton ES, et al. Diabetes Care 1998;21: Kabadi UM, et al. Diab Med J Brit Diabet Assoc 1995: Riddle M, et al. Am J Med Sci 1992;303: Riddle MC, Schneider J. Diabetes Care 1998;21: Stenman S, et al. Diabetologia 1988;31: Stuart CA, et al. Endocr Pract 1997;3:

28 Palermo A, Napoli et al. Osteoporos Int 2015;26: Drugs for T2DM may affect fracture risk Bone biomarkers Bone formation Bone resorption BMD Fracture Metformin Sulphonylureas Thiazolidinediones Incretin GLP-1 analogue DPP-4 inhibitor b a SGLT2 inhibitor a The latest evidence of Bone and colleagues showed no effects of pioglitazone on BMD (Bone HG et al. J Clin Endocrinol Metab 2013;98: ) b GLP-2 administration. BMD=bone mineral density; DPP-4=dipeptidyl peptidase-4; GLP-1=glucagon-like peptide-1; GLP-2=glucagon-like peptide-2; SGLT2=sodium glucose cotransporter 2

29 Skeletal effects of pharmacological treatments for T2DM Metformin increases the differentiation of osteoblasts through its actions on RUNX2. Glitazones simultaneously suppress RUNX2 and activate PPARγ, which drives differentiation of MSCs into adipocytes, thereby reducing osteogenesis. Bone, sweet bone - Osteoporotic fractures in diabetes mellitus Nature Reviews Endocrinology 2012

Diabetes and Cardiovascular Risks in the Polycystic Ovary Syndrome

Diabetes and Cardiovascular Risks in the Polycystic Ovary Syndrome Diabetes and Cardiovascular Risks in the Polycystic Ovary Syndrome John E. Nestler, M.D. William Branch Porter Professor of Medicine Chair, Department of Internal Medicine Virginia Commonwealth University

More information

Diabetes update - Diagnosis and Treatment

Diabetes update - Diagnosis and Treatment Diabetes update - Diagnosis and Treatment Eugene J Barrett, MD,PhD Madge Jones Professor of Medicine Director, University of Virginia Diabetes Center Disclosures - None Case 1 - Screening for Diabetes

More information

Disclosures. Learning Objectives. Effects of Hormone Therapy on the Metabolic Syndrome and Cardiovascular Disease. None

Disclosures. Learning Objectives. Effects of Hormone Therapy on the Metabolic Syndrome and Cardiovascular Disease. None Effects of Hormone Therapy on the Metabolic Syndrome and Cardiovascular Disease Micol S. Rothman, MD Associate Professor of Medicine Endocrinology, Diabetes and Metabolism Clinical Director Metabolic Bone

More information

Current evidence on the effect of DPP-4 inhibitor drugs on mortality in type 2 diabetic (T2D) patients: A meta-analysis

Current evidence on the effect of DPP-4 inhibitor drugs on mortality in type 2 diabetic (T2D) patients: A meta-analysis Current evidence on the effect of DPP-4 inhibitor drugs on mortality in type 2 diabetic (T2D) patients: A meta-analysis Raja Chakraverty Assistant Professor in Pharmacology Bengal College of Pharmaceutical

More information

CREATING A PCOS TREATMENT PLAN. Ricardo Azziz, M.D., M.P.H., M.B.A. Georgia Regents University

CREATING A PCOS TREATMENT PLAN. Ricardo Azziz, M.D., M.P.H., M.B.A. Georgia Regents University CREATING A PCOS TREATMENT PLAN Ricardo Azziz, M.D., M.P.H., M.B.A. Georgia Regents University PCOS: CREATING A TREATMENT PLAN Good treatment plans are based on sound and complete evaluations History of

More information

Diabetes Day for Primary Care Clinicians Advances in Diabetes Care

Diabetes Day for Primary Care Clinicians Advances in Diabetes Care Diabetes Day for Primary Care Clinicians Advances in Diabetes Care Elliot Sternthal, MD, FACP, FACE Chair New England AACE Diabetes Day Planning Committee Welcome and Introduction This presentation will:

More information

The Metabolic Syndrome Update The Metabolic Syndrome Update. Global Cardiometabolic Risk

The Metabolic Syndrome Update The Metabolic Syndrome Update. Global Cardiometabolic Risk The Metabolic Syndrome Update 2018 Marc Cornier, M.D. Professor of Medicine Division of Endocrinology, Metabolism & Diabetes Anschutz Health and Wellness Center University of Colorado School of Medicine

More information

Multiple Factors Should Be Considered When Setting a Glycemic Goal

Multiple Factors Should Be Considered When Setting a Glycemic Goal Multiple Facts Should Be Considered When Setting a Glycemic Goal Patient attitude and expected treatment effts Risks potentially associated with hypoglycemia, other adverse events Disease duration Me stringent

More information

Optimal glucose control. DM Treatment. Glucose Control one out of many. Many guidelines: Confusing. Theorectically easy

Optimal glucose control. DM Treatment. Glucose Control one out of many. Many guidelines: Confusing. Theorectically easy DM Treatment How to Achieve Optimal Glycaemic Control The Tung Wah Eastern Hospital Experience of DM Share Care Experience Optimal glucose control Theorectically easy More challenging in the real world

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

The Tsunami of Prediabetes: What is It, Why Do We Care?

The Tsunami of Prediabetes: What is It, Why Do We Care? The Tsunami of Prediabetes: What is It, Why Do We Care? Carol H. Wysham, MD Rockwood Center for Diabetes and Endocrinology Clinical Professor of Medicine University of Washington School of Medicine Disclosures

More information

Novel anti-diabetic therapies

Novel anti-diabetic therapies Prof. Manfredi Rizzo, MD, PhD ASSOCIATE PROFESSOR OF INTERNAL MEDICINE School of Medicine University of Palermo, Italy & ASSOCIATE PROFESSOR OF INTERNAL MEDICINE School of Medicine University of South

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

The Metabolic Syndrome Update The Metabolic Syndrome: Overview. Global Cardiometabolic Risk

The Metabolic Syndrome Update The Metabolic Syndrome: Overview. Global Cardiometabolic Risk Update 2013 Marc Cornier, M.D. Associate Professor of Medicine Division of Endocrinology, Metabolism & Diabetes Anschutz Health and Wellness Center University of Colorado School of Medicine Denver Health

More information

Empagliflozin (Jardiance ) for the treatment of type 2 diabetes mellitus, the EMPA REG OUTCOME study

Empagliflozin (Jardiance ) for the treatment of type 2 diabetes mellitus, the EMPA REG OUTCOME study Empagliflozin (Jardiance ) for the treatment of type 2 diabetes mellitus, the EMPA REG OUTCOME study POSITION STATEMENT: Clinicians should continue to follow MHRA advice and NICE technology appraisal guidance

More information

Diabetes: What is the scope of the problem?

Diabetes: What is the scope of the problem? Diabetes: What is the scope of the problem? Elizabeth R. Seaquist MD Division of Endocrinology and Diabetes Department of Medicine Director, General Clinical Research Center Pennock Family Chair in Diabetes

More information

Francesca Porcellati

Francesca Porcellati XX Congresso Nazionale AMD Razionali e Benefici dell Aggiunta del GLP-1 RA Short-Acting all Insulina Basale Francesca Porcellati Dipartimento di Medicina Interna, Sezione di Medicina Interna, Endocrinologia

More information

Update on Insulin-based Agents for T2D

Update on Insulin-based Agents for T2D Update on Insulin-based Agents for T2D Injectable Therapies for Type 2 Diabetes Mellitus (T2DM) and Obesity This presentation will: Describe established and newly available insulin therapies for treatment

More information

Risks, benefits size and clinical implications of combined oral contraceptive use in women with polycystic ovary syndrome

Risks, benefits size and clinical implications of combined oral contraceptive use in women with polycystic ovary syndrome de Medeiros Reproductive Biology and Endocrinology (2017) 15:93 DOI 10.1186/s12958-017-0313-y REVIEW Open Access Risks, benefits size and clinical implications of combined oral contraceptive use in women

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

PCOS across the Lifespan: An Update on Diagnosis and Management

PCOS across the Lifespan: An Update on Diagnosis and Management PCOS across the Lifespan: An Update on Diagnosis and Management Heather Gibson Huddleston, MD Assistant Professor University of California San Francisco PCOS: Overview Most common endocrine disorder reproductive

More information

Polycystic Ovary Disease: A Common Endocrine Disorder in Women

Polycystic Ovary Disease: A Common Endocrine Disorder in Women Polycystic Ovary Disease: A Common Endocrine Disorder in Women Paul Kaplan, M.D. Clinical Professor of Reproductive Endocrinology - OHSU Courtesy Senior Research Associate, Human Physiology University

More information

Targeting simultaneously GLP-1, GIP and glucagon receptors : a new paradigm for treating obesity and diabetes

Targeting simultaneously GLP-1, GIP and glucagon receptors : a new paradigm for treating obesity and diabetes SHORT COMMENT FOR NATURE REVIEWS ENDOCRINOLOGY Targeting simultaneously GLP-1, GIP and glucagon receptors : a new paradigm for treating obesity and diabetes André J. SCHEEN (1), Nicolas PAQUOT (2) (1)

More information

Type 2 Diabetes Mellitus 2011

Type 2 Diabetes Mellitus 2011 2011 Michael T. McDermott MD Director, Endocrinology and Diabetes Practice University of Colorado Hospital Michael.mcdermott@ucdenver.edu Diabetes Mellitus Diagnosis 2011 Diabetes Mellitus Fasting Glucose

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

PCOS & Diet Therapy. Dr. Ladan Giahi Immunonutritionist Avicenna Research Institute October 2015

PCOS & Diet Therapy. Dr. Ladan Giahi Immunonutritionist Avicenna Research Institute October 2015 PCOS & Diet Therapy Dr. Ladan Giahi Immunonutritionist Avicenna Research Institute October 2015 Questions to be discussed: 1) Why dietary modification is considered as first line of treatment? 2) What

More information

What is PCOS? PCOS THE CONQUER PCOS E-BOOK. You'll be amazed when you read this...

What is PCOS? PCOS THE CONQUER PCOS E-BOOK. You'll be amazed when you read this... PCOS What is PCOS? You'll be amazed when you read this... What is PCOS?. Who is at risk? How to get tested? What are the complications. Is there a cure? What are the right ways to eat? What lifestyle changes

More information

Polycystic Ovary Syndrome: What Every Dermatologist Needs to Know

Polycystic Ovary Syndrome: What Every Dermatologist Needs to Know A major teaching hospital of Harvard Medical School Polycystic Ovary Syndrome: What Every Dermatologist Needs to Know Rachel Reynolds, MD Assistant Professor of Dermatology Harvard Medical School Beth

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

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

Can Sex hormone Binding Globulin Considered as a Predictor of Response to Pharmacological Treatment in Women with Polycystic Ovary Syndrome?

Can Sex hormone Binding Globulin Considered as a Predictor of Response to Pharmacological Treatment in Women with Polycystic Ovary Syndrome? www.ijpm.in www.ijpm.ir Can Sex hormone Binding Globulin Considered as a Predictor of Response to Pharmacological Treatment in Women with Polycystic Ovary Syndrome? Ferdous Mehrabian, Maryam Afghahi Department

More information

Diabetes in pregnancy

Diabetes in pregnancy Diabetes in pregnancy Bipin Sethi Department of Endocrinology Care Hospitals Hyderabad, India Declared no potential conflict of interest Diabetes in pregnancy Bipin Kumar Sethi Department of Endocrinology,

More information

CANA DAPA EMPA. Change in Baseline Body Weight (kg) *Doses evaluated in studies cited: CANA=100 or 300 mg, DAPA=5 or 10 mg, EMPA=10 or 25 mg.

CANA DAPA EMPA. Change in Baseline Body Weight (kg) *Doses evaluated in studies cited: CANA=100 or 300 mg, DAPA=5 or 10 mg, EMPA=10 or 25 mg. CANA DAPA EMPA Change in Baseline Body Weight (kg) 2 1 0-1 -2-3 -4-5 PBO SGLT2 inhibitor (low dose)* SGLT2 inhibitor (high dose)* *Doses evaluated in studies cited: CANA=100 or 300 mg, DAPA=5 or 10 mg,

More information

1/28/2014. The Metabolic Syndrome: Early History. Insulin Resistance: Early Diagnosis and Treatment to Prevent Cardiovascular Disease

1/28/2014. The Metabolic Syndrome: Early History. Insulin Resistance: Early Diagnosis and Treatment to Prevent Cardiovascular Disease : Early Diagnosis and Treatment to Prevent Cardiovascular Disease Henry N. Ginsberg, M.D. Irving Professor of Medicine Columbia University College of Physicans and Surgeons The Metabolic Syndrome: Early

More information

Type 2 Diabetes in Adolescents

Type 2 Diabetes in Adolescents Type 2 Diabetes in Adolescents Disclosures Paid consultant, Eli Lilly, Inc, Pediatric Type 2 Diabetes Clinical Trials Outline The burden of diabetes Treatment and Prevention Youth Diabetes Prevention Clinic

More information

Diabetes mellitus. Treatment

Diabetes mellitus. Treatment Diabetes mellitus Treatment Recommended glycemic targets for the clinical management of diabetes(ada) Fasting glycemia: 80-110 mg/dl Postprandial : 100-145 mg/dl HbA1c: < 6,5 % Total cholesterol: < 200

More information

Sitagliptin. Agreed by Clinical Priorities Group

Sitagliptin. Agreed by Clinical Priorities Group New Medicine Report Document Status Sitagliptin Agreed by Clinical Priorities Group Traffic Light Decision Blue- Primary Care Prescriber s Rating Offers an advantage - The product has some value but does

More information

Endocrine Update Mary T. Korytkowski MD Division of Endocrinology University of Pittsburgh

Endocrine Update Mary T. Korytkowski MD Division of Endocrinology University of Pittsburgh Endocrine Update 2016 Mary T. Korytkowski MD Division of Endocrinology University of Pittsburgh Disclosure of Financial Relationships Mary Korytkowski MD Honoraria British Medical Journal Diabetes Research

More information

F REQUENTLY A SKED Q UESTIONS

F REQUENTLY A SKED Q UESTIONS Polycystic heart, blood vessels, and appearance. Women with PCOS have these characteristics: Ovarian high levels of male hormones, also called androgens an irregular or no menstrual cycle Syndrome may

More information

The promise of the thiazolidinediones in the management of type 2 diabetes-associated cardiovascular disease

The promise of the thiazolidinediones in the management of type 2 diabetes-associated cardiovascular disease The promise of the thiazolidinediones in the management of type 2 diabetes-associated cardiovascular disease Steve Smith, Group Director Scientific Affairs, Diabetes & Metabolism GlaxoSmithKline R & D

More information

Polycystic Ovary Syndrome

Polycystic Ovary Syndrome Polycystic Ovary Syndrome Kathleen Colleran, MD Professor of Medicine University of New Mexico HSC Presented for COMM-TC May 4, 2012 Objectives Understand the pathophysiology of PCOS Understand how to

More information

Diabetes Risk Assessment and Treatment

Diabetes Risk Assessment and Treatment Diabetes Risk Assessment and Treatment Todd T. Brown, MD, PhD Professor of Medicine and Epidemiology Division of Endocrinology, Diabetes, & Metabolism Johns Hopkins University Baltimore, Maryland, USA

More information

Current Status of Incretin Based Therapies in Type 2 Diabetes

Current Status of Incretin Based Therapies in Type 2 Diabetes Current Status of Incretin Based Therapies in Type 2 Diabetes DR.M.Mukhyaprana Prabhu Professor of Internal Medicine Kasturba Medical College, Manipal, Manipal University, India 2 nd International Endocrine

More information

Diabetes: Definition Pathophysiology Treatment Goals. By Scott Magee, MD, FACE

Diabetes: Definition Pathophysiology Treatment Goals. By Scott Magee, MD, FACE Diabetes: Definition Pathophysiology Treatment Goals By Scott Magee, MD, FACE Disclosures No disclosures to report Definition of Diabetes Mellitus Diabetes Mellitus comprises a group of disorders characterized

More information

GLP-1 (glucagon-like peptide-1) Agonists (Byetta, Bydureon, Tanzeum, Trulicity, Victoza ) Step Therapy and Quantity Limit Criteria Program Summary

GLP-1 (glucagon-like peptide-1) Agonists (Byetta, Bydureon, Tanzeum, Trulicity, Victoza ) Step Therapy and Quantity Limit Criteria Program Summary OBJECTIVE The intent of the GLP-1 (glucagon-like peptide-1) s (Byetta/exenatide, Bydureon/ exenatide extended-release, Tanzeum/albiglutide, Trulicity/dulaglutide, and Victoza/liraglutide) Step Therapy

More information

Prediabetes & Type 2 Diabetes Prevention. Jacob M. Haus, PHD

Prediabetes & Type 2 Diabetes Prevention. Jacob M. Haus, PHD Prediabetes & Type 2 Diabetes Prevention Jacob M. Haus, PHD Disclosures In compliance with the accrediting board policies, the American Diabetes Association requires the following disclosure to the participants:

More information

SESSION 4 12:30pm 1:45pm

SESSION 4 12:30pm 1:45pm SESSION 4 12:30pm 1:45pm Addressing Renal-Mediated Glucose Homeostasis: Diabetes and the Kidney SPEAKER Davida Kruger, MSN, BC-ADM, APRN Presenter Disclosure Information The following relationships exist

More information

Rotterdam Criteria 9/30/2017. A Changing Paradigm in PCOS. Polycystic Ovary Syndrome - Is the Cardiometabolic Risk Increased After Menopause?

Rotterdam Criteria 9/30/2017. A Changing Paradigm in PCOS. Polycystic Ovary Syndrome - Is the Cardiometabolic Risk Increased After Menopause? Disclosure Polycystic Ovary Syndrome - Is the Cardiometabolic Risk Increased After Menopause? Fractyl laboratories, Inc Anuja Dokras, MD., Ph.D. Professor of Obstetrics and Gynecology Director PENN PCOS

More information

INSULIN RESISTANCE, POLYCYSTIC OVARIAN SYNDROME An Overview

INSULIN RESISTANCE, POLYCYSTIC OVARIAN SYNDROME An Overview INSULIN RESISTANCE, POLYCYSTIC OVARIAN SYNDROME An Overview University of PNG School of Medicine & Health Sciences Division of Basic Medical Sciences PBL MBBS III VJ Temple 1 Insulin Resistance: What is

More information

Effective Health Care Program

Effective Health Care Program Comparative Effectiveness Review Number 173 Effective Health Care Program Diabetes Medications for Adults With Type 2 Diabetes: An Update Executive Summary Condition and Therapeutic Strategies Type 2 diabetes

More information

Metabolic Syndrome and Chronic Kidney Disease

Metabolic Syndrome and Chronic Kidney Disease Metabolic Syndrome and Chronic Kidney Disease Definition of Metabolic Syndrome National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III Abdominal obesity, defined as a waist circumference

More information

Research Article Risk of Type 2 Diabetes Mellitus following Gestational Diabetes Pregnancy in Women with Polycystic Ovary Syndrome

Research Article Risk of Type 2 Diabetes Mellitus following Gestational Diabetes Pregnancy in Women with Polycystic Ovary Syndrome Hindawi Diabetes Research Volume 2017, Article ID 5250162, 5 pages https://doi.org/10.1155/2017/5250162 Research Article Risk of Type 2 Diabetes Mellitus following Gestational Diabetes Pregnancy in Women

More information

Scottish Medicines Consortium

Scottish Medicines Consortium Scottish Medicines Consortium saxagliptin, 5mg film-coated tablet (Onglyza ) No. (603/10) Bristol-Myers Squibb Pharmaceuticals Ltd 05 February 2010 The Scottish Medicines Consortium (SMC) has completed

More information

Prevalence of Polycystic Ovarian Syndrome among urban adolescent girls and young women in Mumbai

Prevalence of Polycystic Ovarian Syndrome among urban adolescent girls and young women in Mumbai Prevalence of Polycystic Ovarian Syndrome among urban adolescent girls and young women in Mumbai Principal Investigator Co- Investigators Consultant Collaborating Hospital Dr. Beena Joshi Dr. Srabani Mukherji

More information

Efficacy and Safety of Sitagliptin in Various Clinical Settings of T2DM

Efficacy and Safety of Sitagliptin in Various Clinical Settings of T2DM Efficacy and Safety of Sitagliptin in arious Clinical Settings of T2DM Young Min Cho, MD, PhD Division of Endocrinology and Metabolism Department of Internal Medicine Seoul National University College

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

Diabetic bone disease and Charcot joints: A review

Diabetic bone disease and Charcot joints: A review Article Diabetic bone disease and Charcot joints: A review Lesley D Hordon Citation: Hordon LD (2017) Diabetic bone disease and Charcot joints: A review. Journal of Diabetes Nursing 21: 50 5 Article points

More information

Key words: Polycystic ovary syndrome, insulin resistance, insulin sensitivity, exercise

Key words: Polycystic ovary syndrome, insulin resistance, insulin sensitivity, exercise 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 The impact of intensified exercise training on insulin resistance and fitness in overweight and obese women with

More information

Bad to the bones: treatments for breast and prostate cancer

Bad to the bones: treatments for breast and prostate cancer 12 th Annual Osteoporosis: New Insights in Research, Diagnosis, and Clinical Care 23 rd July 2015 Bad to the bones: treatments for breast and prostate cancer Richard Eastell, MD FRCP (Lond, Edin, Ireland)

More information

Vipul Lakhani, MD Oregon Medical Group Endocrinology

Vipul Lakhani, MD Oregon Medical Group Endocrinology Vipul Lakhani, MD Oregon Medical Group Endocrinology Disclosures None Objectives Be able to diagnose diabetes and assess control Be able to identify appropriate classes of medications for diabetes treatment

More information

Role of inositol in Reproductive Function

Role of inositol in Reproductive Function Role of inositol in Reproductive Function Dr. Mirudhubashini Govindarajan, FRCSC Clinical Director Womens Center Coimbatore HYPE OR HOPE???? Inositol an Introduction Inositol has 10 types of isomers Myo

More information

KEY COMPONENTS. Metabolic Risk Cardiovascular Risk Vascular Inflammation Markers

KEY COMPONENTS. Metabolic Risk Cardiovascular Risk Vascular Inflammation Markers CardioMetabolic Risk Poor blood sugar regulation and unhealthy triglyceride and lipoprotein levels often present long before the diagnosis of type 2 Diabetes. SpectraCell s CardioMetabolic and Pre-Diabetes

More information

My Journey in Endocrinology. Samuel Cataland M.D

My Journey in Endocrinology. Samuel Cataland M.D My Journey in Endocrinology Samuel Cataland M.D. 1968-2015 Drs Berson M.D. Yalow phd Insulin Radioimmunoassay Nobel Prize Physiology or Medicine 1977 Rosalyn Yalow: Radioimmunoassay Technology Andrew Schally

More information

Macrovascular Disease in Diabetes

Macrovascular Disease in Diabetes Macrovascular Disease in Diabetes William R. Hiatt, MD Professor of Medicine/Cardiology University of Colorado School of Medicine President, CPC Clinical Research Conflicts CPC Clinical Research (University-based

More information

Alternative management of hypogonadism Tamoxifen. Emmanuele A. Jannini, MD Tor Vergata University of Rome ITALY

Alternative management of hypogonadism Tamoxifen. Emmanuele A. Jannini, MD Tor Vergata University of Rome ITALY Alternative management of hypogonadism Tamoxifen Emmanuele A. Jannini, MD Tor Vergata University of Rome ITALY eajannini@gmail.com What hypogonadism is? What hypogonadism is? It is an empty glass The two

More information

Media Contacts: Amy Rose Investor Contact: Graeme Bell (908) (908)

Media Contacts: Amy Rose Investor Contact: Graeme Bell (908) (908) News Release FOR IMMEDIATE RELEASE Media Contacts: Amy Rose Investor Contact: Graeme Bell (908) 423-6537 (908) 423-5185 Tracy Ogden (267) 305-0960 FDA Approves Once-Daily JANUVIA, the First and Only DPP-4

More information

A Clinical Context Report

A Clinical Context Report Type 2 Diabetes in Practice An Expert Commentary with Silvio E. Inzucchi, MD A Clinical Context Report Clinical Context: Type 2 Diabetes in Practice Expert Commentary Jointly Sponsored by: and Clinical

More information

INSULIN 101: When, How and What

INSULIN 101: When, How and What INSULIN 101: When, How and What Alice YY Cheng @AliceYYCheng Copyright 2017 by Sea Courses Inc. All rights reserved. No part of this document may be reproduced, copied, stored, or transmitted in any form

More information

Lifestyle Medicine. This presentation will:

Lifestyle Medicine. This presentation will: Lifestyle Medicine This presentation will: Present the biological and environmental factors contributing to the obesity epidemic Discuss the lifestyle modification therapy for patients with obesity, prediabetes,

More information

Hot Topics: The Future of Diabetes Management Cutting Edge Medication and Technology-Based Care

Hot Topics: The Future of Diabetes Management Cutting Edge Medication and Technology-Based Care Hot Topics: The Future of Diabetes Management Cutting Edge Medication and Technology-Based Care Mary Jean Christian, MA, MBA, RD, CDE Diabetes Program Coordinator UC Irvine Health Hot Topics: Diabetes

More information

Kristen Cain, MD FACOG Reproductive Medicine Institute Sanford Health, Fargo ND

Kristen Cain, MD FACOG Reproductive Medicine Institute Sanford Health, Fargo ND Kristen Cain, MD FACOG Reproductive Medicine Institute Sanford Health, Fargo ND 7% of all women 18-45 Obesity 1/3 of all US women Incidence of PCOS is increasing with increase obesity Obesity Irregular

More information

12/27/2013. Kristen Cain, MD FACOG Reproductive Medicine Institute Sanford Health, Fargo ND

12/27/2013. Kristen Cain, MD FACOG Reproductive Medicine Institute Sanford Health, Fargo ND Kristen Cain, MD FACOG Reproductive Medicine Institute Sanford Health, Fargo ND 7% of all women 18-45 Obesity 1/3 of all US women Incidence of PCOS is increasing with increase obesity Obesity Irregular

More information

Inositols for PCOS : An Update. Mark H. Ratner, MD Shady Grove Reproductive Science Center Rockville, Maryland

Inositols for PCOS : An Update. Mark H. Ratner, MD Shady Grove Reproductive Science Center Rockville, Maryland Inositols for PCOS : An Update Mark H. Ratner, MD Shady Grove Reproductive Science Center Rockville, Maryland Overview Understanding the role of insulin in PCOS The relationship between inositols and insulin

More information

3/25/2010. Age-adjusted incidence rates for coronary heart disease according to body mass index and waist circumference tertiles

3/25/2010. Age-adjusted incidence rates for coronary heart disease according to body mass index and waist circumference tertiles Outline Relationships among Regional Adiposity, Physical Activity, and CVD Risk Factors: Preliminary Results from Two Epidemiologic Studies Molly Conroy, MD, MPH Obesity Journal Club February 18, 2010

More information

Case 3: Pancreatitis Risk with Incretin Therapies: Is It Real? Case: Pancreatitis Risk with Incretin Therapy

Case 3: Pancreatitis Risk with Incretin Therapies: Is It Real? Case: Pancreatitis Risk with Incretin Therapy Case 3: Pancreatitis Risk with Incretin Therapies: Is It Real? Case: Pancreatitis Risk with Incretin Therapy 43-year-old obese woman Long-standing type 2 diabetes Currently treated with metformin 1000

More information

Types of Diabetes that the Dipeptidyl Peptidase-4 Inhibitor May Act Effectively and Safely

Types of Diabetes that the Dipeptidyl Peptidase-4 Inhibitor May Act Effectively and Safely The Open Diabetes Journal, 2011, 4, 1-5 1 Open Access Types of Diabetes that the Dipeptidyl Peptidase-4 Inhibitor May Act Effectively and Safely Hidekatsu Yanai * and Hiroki Adachi Department of Internal

More information

OCP OF NEW GENERATION - FOCUS ON DROSPIRENONE

OCP OF NEW GENERATION - FOCUS ON DROSPIRENONE OCP OF NEW GENERATION - FOCUS ON DROSPIRENONE (Drospirenone 3 mg +Ethinyl estradiol 30mcg) Way Past Just Contraception Rasmin - Composition An OC formulation based on drospirenone Each calender pack contains

More information

Case Questions. Polycystic Ovarian Syndrome: Treatment Goals and Options. Differential Diagnosis of Hyperandrogenic Anovulation

Case Questions. Polycystic Ovarian Syndrome: Treatment Goals and Options. Differential Diagnosis of Hyperandrogenic Anovulation Polycystic Ovarian Syndrome: Treatment Goals and Options Marc Cornier, MD Division of Endocrinology, Metabolism and Diabetes Colorado Center for Health and Wellness University of Colorado School of Medicine

More information

Advanced Practice Education Associates. Endocrine

Advanced Practice Education Associates. Endocrine Advanced Practice Education Associates Endocrine Overview Diabetes Thyroid Disease 162 Copyright 2016 Advanced Practice Education Associates DIABETES MELLITUS What is the BMI cut point for screening adults

More information

13 th Annual Women s Health Day PCOS. Saturday 02/09/2017 Dr Mathias Epee-Bekima O&G Consultant KEMH

13 th Annual Women s Health Day PCOS. Saturday 02/09/2017 Dr Mathias Epee-Bekima O&G Consultant KEMH 13 th Annual Women s Health Day PCOS Saturday 02/09/2017 Dr Mathias Epee-Bekima O&G Consultant KEMH Learning objectives Perform the appropriate investigations in women where there is a clinical suspicion

More information

This program applies to Commercial, GenPlus and Health Insurance Marketplace formularies.

This program applies to Commercial, GenPlus and Health Insurance Marketplace formularies. OBJECTIVE The intent of the GLP-1 (glucagon-like peptide-1) Agonists [Adlyxin (lixisenatide), Byetta (exenatide), Bydureon (exenatide extended-release), Tanzeum (albiglutide), Trulicity (dulaglutide),

More information

Ipoglicemia: trattamento e strategie di prevenzione

Ipoglicemia: trattamento e strategie di prevenzione Ipoglicemia: trattamento e strategie di prevenzione Antonio Ceriello Insititut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) Barcelona Spain Frequency of Hypoglycemia Increases as HbA1c Declines

More information

S. Del Prato. Dept. of Endocrinology & Metabolism Section of Metabolic Diseases & Diabetes, University of Pisa, Italy

S. Del Prato. Dept. of Endocrinology & Metabolism Section of Metabolic Diseases & Diabetes, University of Pisa, Italy S. Del Prato Dept. of Endocrinology & Metabolism Section of Metabolic Diseases & Diabetes, University of Pisa, Italy S. Del Prato Dept. of Endocrinology & Metabolism Section of Metabolic Diseases & Diabetes,

More information

Metabolic Syndrome: What s so big about BIG?

Metabolic Syndrome: What s so big about BIG? Tuesday, 10:00 11:30, A2 Objectives: Notes: Metabolic Syndrome: What s so big about BIG? Patrice Conrad pbconrad1@att.net 1. Identify advances in clinical assessment and management of selected healthcare

More information

Clinical Overview of Combination Therapy with Sitagliptin and Metformin

Clinical Overview of Combination Therapy with Sitagliptin and Metformin Clinical Overview of Combination Therapy with Sitagliptin and Metformin 1 Contents Pathophysiology of type 2 diabetes and mechanism of action of sitagliptin Clinical data overview of sitagliptin: Monotherapy

More information

sitagliptin, 25mg, 50mg and 100mg film-coated tablets (Januvia ) SMC No. (1083/15) Merck Sharp and Dohme UK Ltd

sitagliptin, 25mg, 50mg and 100mg film-coated tablets (Januvia ) SMC No. (1083/15) Merck Sharp and Dohme UK Ltd sitagliptin, 25mg, 50mg and 100mg film-coated tablets (Januvia ) SMC No. (1083/15) Merck Sharp and Dohme UK Ltd 07 August 2015 The Scottish Medicines Consortium (SMC) has completed its assessment of the

More information

What s New in Diabetes Medications. Jena Torpin, PharmD

What s New in Diabetes Medications. Jena Torpin, PharmD What s New in Diabetes Medications Jena Torpin, PharmD 1 Objectives Discuss new medications in the management of diabetes Understand the mechanism of the medications discussed Understand the side effects

More information

RCHC Clinical Guidelines Type 2 Diabetes; Adults

RCHC Clinical Guidelines Type 2 Diabetes; Adults RCHC Clinical Guidelines Type 2 Diabetes; Adults Screening for diabetes in asymptomatic adults 1 Population: Aged > 45 years; Aged < 45 years who are overweight (BMI> 25kg/m 2 ) and have an additional

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

Advances in Outpatient Diabetes Care: Algorithms for Care and the Role of Injectable Therapies. Module D

Advances in Outpatient Diabetes Care: Algorithms for Care and the Role of Injectable Therapies. Module D Advances in Outpatient Diabetes Care: Algorithms for Care and the Role of Injectable Therapies Module D 1 Learning Objectives Apply the principles of the comprehensive diabetes algorithms to patients with

More information

Polycystic Ovary Syndrome

Polycystic Ovary Syndrome Polycystic Ovary Syndrome Polycystic ovary syndrome (PCOS) is common. It can cause period problems, reduced fertility, excess hair growth, and acne. Many women with PCOS are also overweight. Treatment

More information

Why Do We Care About Prediabetes?

Why Do We Care About Prediabetes? Why Do We Care About Prediabetes? Complications of Diabetes Diabetic Retinopathy Leading cause of blindness in adults 1,2 Diabetic Nephropathy Leading cause of Kidney failure Stroke 2- to 4-fold increase

More information

Personalized therapeutics in diabetes

Personalized therapeutics in diabetes Personalized therapeutics in diabetes Leen M. t Hart Molecular Cell Biology & Molecular Epidemiology Leiden University Medical Center Epidemiology & Biostatistics VU University Medical Center Diabetes

More information

Barriers to Achieving A1C Targets: Clinical Inertia and Hypoglycemia. KM Pantalone Endocrinology

Barriers to Achieving A1C Targets: Clinical Inertia and Hypoglycemia. KM Pantalone Endocrinology Barriers to Achieving A1C Targets: Clinical Inertia and Hypoglycemia KM Pantalone Endocrinology Disclosures Speaker Bureau AstraZeneca, Merck, Novo Nordisk, Sanofi Consultant Novo Nordisk, Eli Lilly, Merck

More information

12/13/2017. Important references for PCOS. Polycystic Ovarian Syndrome (PCOS) for the Family Physician. 35 year old obese woman

12/13/2017. Important references for PCOS. Polycystic Ovarian Syndrome (PCOS) for the Family Physician. 35 year old obese woman Polycystic Ovarian Syndrome (PCOS) for the Family Physician Barbara S. Apgar MD, MS Professor or Family Medicine University of Michigan Ann Arbor, Michigan Important references for PCOS Endocrine Society

More information

Evidence-Based Glucose Management in Type 2 Diabetes

Evidence-Based Glucose Management in Type 2 Diabetes Evidence-Based Glucose Management in Type 2 Diabetes James R. Gavin III, MD, PhD CEO and Chief Medical Officer Healing Our Village, Inc. Clinical Professor of Medicine Emory University School of Medicine

More information

ACCORD, ADVANCE & VADT. Now what do I do in my practice?

ACCORD, ADVANCE & VADT. Now what do I do in my practice? ACCORD, ADVANCE & VADT Now what do I do in my practice? Richard M. Bergenstal, MD International Diabetes Center Park Nicollet Health Services University of Minnesota Minneapolis, MN richard.bergenstal@parknicollet.com

More information

NEW TREATMENTS FOR DIABETES

NEW TREATMENTS FOR DIABETES Jeffrey I. Mechanick, M.D. Professor of Medicine Medical Director, The Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart Director, Metabolic Support Divisions of Cardiology

More information

New Approaches for Treating Challenging Patients with Diabetes

New Approaches for Treating Challenging Patients with Diabetes New Approaches for Treating Challenging Patients with Diabetes Anne Peters, MD Professor, USC Keck School of Medicine Director, USC Clinical Diabetes Programs Disclosure of Potential Conflicts of Interest

More information

Diabetes and the Heart

Diabetes and the Heart Diabetes and the Heart By Samir Naim Assaad, MD, MRCP(UK), FRCP(Edin), FRCP(Lond) Professor of Medicine & Endocrinology University of Alexandria EGYPT Disclosure None, related to this presentation Road

More information