Innovate. Discover. Cure. Type 2 Diabetes what you and your family need to know
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1 1 Innovate. Discover. Cure. Type 2 Diabetes what you and your family need to know
2 Opening comments Steven R. Smith, MD Founding Scientific Director - TRI Professor, metabolic diseases program, Sanford-Burnham 2 Innovate. Discover. Cure.
3 3 Formed in 2009 as a joint venture of Florida Hospital (FH) and the Sanford-Burnham Medical Research Institute. A pioneering initiative for clinical translational research that serves as the bridge between basic discovery research at Lake Nona and patientoriented research at Florida Hospital.
4 Figure 3 BMI from Height and Weight Weight (lbs) '0" 5'2" 5'4" Height 5'6" 5'8" 5'10" 6'0" 6'2" 6'4"
5 Obesity* Trends Among U.S. Adults BRFSS 1985 No Data <10% 10% 14% *BMI 30 Behavioral Risk Factor Surveillance System
6 Obesity* Trends Among U.S. Adults BRFSS 1986 No Data <10% 10% 14% *BMI 30 Behavioral Risk Factor Surveillance System
7 Obesity* Trends Among U.S. Adults BRFSS 1987 No Data <10% 10% 14% *BMI 30 Behavioral Risk Factor Surveillance System
8 Obesity* Trends Among U.S. Adults BRFSS 1988 No Data <10% 10% 14% *BMI 30 Behavioral Risk Factor Surveillance System
9 Obesity* Trends Among U.S. Adults BRFSS 1989 No Data <10% 10% 14% *BMI 30 Behavioral Risk Factor Surveillance System
10 Obesity* Trends Among U.S. Adults BRFSS 1990 No Data <10% 10% 14% *BMI 30 Behavioral Risk Factor Surveillance System
11 Obesity* Trends Among U.S. Adults BRFSS 1991 No Data <10% 10% 14% 15% 19% *BMI 30 Behavioral Risk Factor Surveillance System
12 Obesity* Trends Among U.S. Adults BRFSS 1992 No Data <10% 10% 14% 15% 19% *BMI 30 Behavioral Risk Factor Surveillance System
13 Obesity* Trends Among U.S. Adults BRFSS 1993 No Data <10% 10% 14% 15% 19% *BMI 30 Behavioral Risk Factor Surveillance System
14 Obesity* Trends Among U.S. Adults BRFSS 1994 No Data <10% 10% 14% 15% 19% *BMI 30 Behavioral Risk Factor Surveillance System
15 Obesity* Trends Among U.S. Adults BRFSS 1995 No Data <10% 10% 14% 15% 19% *BMI 30 Behavioral Risk Factor Surveillance System
16 Obesity* Trends Among U.S. Adults BRFSS 1996 No Data <10% 10% 14% 15% 19% *BMI 30 Behavioral Risk Factor Surveillance System
17 Obesity* Trends Among U.S. Adults BRFSS 1997 No Data <10% 10% 14% 15% 19% 20% 24% *BMI 30 Behavioral Risk Factor Surveillance System
18 Obesity* Trends Among U.S. Adults BRFSS 1998 No Data <10% 10% 14% 15% 19% 20% 24% *BMI 30 Behavioral Risk Factor Surveillance System
19 Obesity* Trends Among U.S. Adults BRFSS 1999 No Data <10% 10% 14% 15% 19% 20% 24% *BMI 30 Behavioral Risk Factor Surveillance System
20 Obesity* Trends Among U.S. Adults BRFSS 2000 No Data <10% 10% 14% 15% 19% 20% 24% *BMI 30 Behavioral Risk Factor Surveillance System
21 Obesity* Trends Among U.S. Adults BRFSS 2001 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% *BMI 30 Behavioral Risk Factor Surveillance System
22 Obesity* Trends Among U.S. Adults BRFSS 2002 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% *BMI 30 Behavioral Risk Factor Surveillance System
23 Obesity* Trends Among U.S. Adults BRFSS 2003 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% *BMI 30 Behavioral Risk Factor Surveillance System
24 Obesity* Trends Among U.S. Adults BRFSS 2004 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% *BMI 30 Behavioral Risk Factor Surveillance System
25 Obesity* Trends Among U.S. Adults BRFSS 2005 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% *BMI 30 Behavioral Risk Factor Surveillance System
26 Obesity* Trends Among U.S. Adults BRFSS 2006 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% *BMI 30 Behavioral Risk Factor Surveillance System
27 Obesity* Trends Among U.S. Adults BRFSS 2007 No Data <10% 10% 14% 15% 19% 20% 24% 25% 29% 30% *BMI 30 Behavioral Risk Factor Surveillance System
28 Patterns Of Overweight & Obesity Globally For Nationally Representative Samples (Percentage overweight + Obese) <10% 10-20% 21-30% 31-40% 41-50% >51% Arctic Ocean Arctic Ocean North Pacific Ocean Indian Ocean South Pacific Ocean South Atlantic Ocean Source: Barry Popkin, UNC Chapel Hill
29 BMI and Mortality Body-Mass Index and Mortality among 1.46 Million White Adults NEJM (2011) 363;23,
30 Cardiac Events and Regional Adiposity Odds Ratio (95% CI) Waist quintile Hip quintile Yusuf et al., Lancet, 2005 Innovate. Discover. Cure.
31 BMI and Lifespan Body-mass index and cause-specific mortality in 900,000 adults: collaborative analyses of 57 prospective studies Lancet 2009; 373:
32 40 Obesity and Diabetes in the US 35 NHANES Prevalence of Obesity (%) Year of Survey Prevalence of Diabetes (%)
33 County level prevalence of obesity and diabetes obesity diabetes Behavioral Risk Factor Surveillance System MMWR November 20, 2009 / 58(45); Innovate. Discover. Cure.
34 County level prevalence of obesity and diabetes Behavioral Risk Factor Surveillance System MMWR November 20, 2009 / 58(45); Innovate. Discover. Cure.
35 One in 3 Projected Prevalence of Diabetes in the U.S. One in 4 One in 5 These projected increases are largely attributable to the aging of the US population, increasing numbers of members of higher-risk minority groups in the population, and people with diabetes living longer. Boyle, Population Health Metrics 2010, 8:29 Innovate. Discover. Cure.
36 Cawley, J. & Meyerhoefer, C The Medical Care Costs of Obesity: An Instrumental Variables Approach, NBER Working Paper No , October 2010 Economic Costs of Obesity The estimated annual cost of treating obesity in the U.S. adult noninstitutionalized population is $168.4 billion or 16.5% of national spending on medical care.
37 Are you at risk for diabetes? Major risk factors for diabetes are: 1. Positive family history 2. Obesity 3. Inactivity 4. Age Innovate. Discover. Cure.
38 6.5 diabetes 126 mg/dl HbA1C 110 mg/dl Fasting blood sugar mg/dl normal
39 Pre-diabetes 1. Increased fasting glucose (>100mg/dL) or 2. Increased hemoglobin A1C (glycohemoglobin) Pre-diabetes A1C 5.7% - 6.4%* Diabetes A1C 6.5% or higher * In this range, the higher the percentage, the higher your risk for diabetes and cardiovascular disease. Those over 6.0% (very high risk) need intensive interventions and vigilant follow-up. Innovate. Discover. Cure.
40 Pre-diabetes at the stage of IGT, individuals have lost over 80% of their beta-cell function,
41 Diabetes occurs when insulin secretion is insufficient HI secretion LOW Insulin resistance insulin sensitivity
42 DPP Primary Goal To prevent or delay the development of type 2 diabetes in persons with impaired glucose tolerance (IGT)
43 Study Interventions Eligible participants Randomized Standard lifestyle recommendations Intensive Metformin Placebo Lifestyle (n = 1079) (n = 1073) (n = 1082)
44 Diabetes Prevention Program Clinics
45 Lifestyle Intervention An intensive program with the following specific goals: > 7% loss of body weight and maintenance of weight loss Dietary fat goal -- <25% of calories from fat Calorie intake goal kcal/day > 150 minutes per week of physical activity
46 Lifestyle Intervention Structure 16 session core curriculum (over 24 weeks) Long-term maintenance program Supervised by a case manager Access to lifestyle support staff Dietitian Behavior counselor Exercise specialist
47 Body Weight in the DPP Trial 1 Troglitazone Change in weight (kg) Placebo Metformin Lifestyle -7 DPP Overlap DPPOS Month Venditti et al. Obesity 2008
48 Cumulative incidence (%) Incidence of Diabetes Percent developing diabetes Placebo n=1082 Metformin n=1073 p<0.001 vs. Placebo (n=1079, p<0.001 vs. Met, p<0.001 vs. Plac ) Lifestyle n=1079 p<0.001 vs. Metformin Metformin (n=1073, p<0.001 Plac) vs. p<0.001 vs. Placebo (n=1082) Placebo Risk reduction 31% by metformin 58% by lifestyle All participants The DPP Research Group, NEJM 346: , 2002 Years from randomization
49 Redrawn from Hamman, et al Diabetes Care 29: , 2006
50 Weight loss prevents type 2 diabetes the DPP Incidence rate per 100 person-years Change in weight from baseline (kg) Redrawn from: Hamman, et al Diabetes Care 29: , 2006
51 Body Weight in the DPP Trial 1 Troglitazone Change in weight (kg) Placebo Metformin Lifestyle -7 DPP Overlap DPPOS Month Venditti et al. Obesity 2008
52 Environmental factors Memory, Cognition and Emotion
53 Amylin GLP-1 oxyntomodulin PYY 3-36 Courtesy Hans-Rudolf Berthoud Leptin
54 Amylin GLP-1 hypothalamus oxyntomodulin area postrema NTS PYY 3-36 Leptin vagal afferents Peptides Fuels and metabolites
55 Leptin - a fat cell hormone - regulates appetite and fat burning Children and adults with deficiency of the fat cell hormone leptin develop obesity They have an increased appetite and cannot burn fat. Leptin is now available as an injectable medication and cures these children. We are now learning that other genes can cause obesity (e.g. MCR4, PC1, FTO and many others) Many of these genes are being explored as drug candidates. Farooqi IS, O'Rahilly S. Am J Clin Nutr Mar;89(3):980S-984S. Leptin: a pivotal regulator of human energy homeostasis.
56 Important Things To Know If You Have Been Diagnosed With Diabetes 1. Don t blame yourself. 2. You are not alone. 3. There is hope. 4. Learn. 5. Lead. Innovate. Discover. Cure.
57 57 ORIGINS Metabolic fitness athletes FH- FH+ obese T2DM The primary aim of this research protocol is to identify subtypes of diabetes in order to develop personalized approaches to diabetes therapy. In depth study of metabolism at the biochemical and genetic level. Detailed studies of diabetes risk using advanced testing.
58 Take home messages Major risk How factors prevent for diabetes diabetes? are: 1. Positive family 1. Weight history loss 2. Obesity 2. Exercise 3. Inactivity 3. Metformin 4. Age Innovate. Discover. Cure.
59 How to learn more 1. If you have diabetes FHDI 2. Participate in a clinical research project Innovate. Discover. Cure.
60 60 Innovate. Discover. Cure.
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