Current Updates & Challenges In Managing Diabetes in CVD
|
|
- August Cox
- 5 years ago
- Views:
Transcription
1 Current Updates & Challenges In Managing Diabetes in CVD Preventive Cardiovascular Conference 2016 Instituit Jantung Negara 12 th November 2016 Nor Azmi Kamaruddin Diabetes Clinic Department of Medicine National University of Malaysia (UKM) Kuala Lumpur
2 National University of Malaysia Disclosure of Financial Relationships with Pharmaceutical Companies (Conflict of Interest Declaration) Nor Azmi Kamaruddin MBBS, MMed, DIS, AM, FACE Advisory Board Member: Astra-Zeneca (Hyperlipidemia) Astra-Zeneca (Diabetes) Bohringer-Ingelheim (Asian SGLT2 ) Bohringer-Ingelheim (M sian DPPIV & SGLT2 ) Eli Lily (Insulin) GSK (Insulin Resistance) Novartis (Renin Inhibition) Novo Nordisk (Insulin Therapy) Sanofi Aventis (Cardio-Metabolic Risks) Sanofi Aventis (Intercontinental Diseases Registry) Research Contracts & Grants (Principal Investigator): Abbott, Astra-Zeneca, Bohringer-Ingelheim, GSK, Johnson & Johnson, Merck, MSD, Novo Nordisk, Pfizer, Quintiles, Sanofi-Aventis Deliver Lectures For The Following: Abbott, Astra Zeneca, GSK, Novartis, Novo Nordisk, Pharmalink, Roche, Sanofi-Aventis
3 Controversies in DM & CVD 1. DM is a CVD Equivalent Disease? 2. Diagnosis of DM based on glycaemic levels that lead to microvascular complication (retinopathy) instead of CVD? 3. SU leads to significant risk of CVD? 4. Hyperinsulin state & risk of CVD? 5. Glycaemic control doesn t improve risk of CVD 6. Anti-Diabetic Agents have to be tested for CVD safety 7. Newer agents are more effective than old agents? Same goes with insulin? 8. Women with DM have poorer prognosis than men?
4 Outline of Presentation 1. Eleven pathologies involved in hyperglycaemia of T2DM 2. DM a CVD Equivalent Or CVD Defining Disease? 3. Latest CVD Outcome Trials A. GLIP1-RA (Elixa, Leader, Sustain-6) B. SGLT2i (Empa-Reg) 4. Treatment Recommendation for DM with CVD
5
6 Egregious Eleven
7 Type 2 Diabetes and CHD 7-Year Incidence of Fatal/Nonfatal MI (East West Study) 7-Year Incidence Rate of MI P<0.001 P< % 20.2% 18.8% 3.5% No DM, No MI No DM, MI DM, No MI DM, MI No Diabetes Diabetes CHD=coronary heart disease; MI=myocardial infarction; DM=diabetes mellitus Haffner SM et al. N Engl J Med. 1998;339:
8 Kaiser Permanente Northern California Healthcare Delivery System J Gen Intern Med 31(4):387 93
9 CHD Free Survival Among Those With No Previous History, History of CHD, History of DM or Both from J Gen Intern Med 31(4):387 93
10 CHD Event Rates Among Those With No Previous History, History of CHD, History of DM or Both from J Gen Intern Med 31(4):387 93
11 Risk of CHD by duration of diabetes versus prior CHD J Gen Intern Med 31(4):387 93
12 Diabetes Mellitus Is A Cardiovascular Disease (CVD) Risk Equivalent For Peripheral Arterial Disease And Carotid Artery Stenosis (Peripheral Arterial Disease) J Am Coll Cardiol. 2016;67(13_S): (Carotid Art Dis)
13 DM & AMI Status and Hazard Ratios for CVD Events British Regional Heart Study > 60 yrs old < 60 yrs old
14 Newly Diagnosed And Known Type 2 Diabetes As Coronary Heart Disease Equivalent 5198 subjects 7.6 year follow-up From Hadaegh et al. Cardiovascular Diabetology 2010, 9:84
15 Newly Diagnosed And Known Type 2 Diabetes As Coronary Heart Disease Equivalent 5198 subjects 7.6 year follow-up From Hadaegh et al. Cardiovascular Diabetology 2010, 9:84
16 Newly Diagnosed And Known Type 2 Diabetes As Coronary Heart Disease Equivalent 5198 subjects 7.6 year follow-up From Hadaegh et al. Cardiovascular Diabetology 2010, 9:84
17
18 Glycated Hemoglobin Measurement and Prediction of Cardiovascular Disease Hazard ratios for incident CVD by baseline levels of glycemia measures 73 prospective studies involving 294,998 participants without a known history of diabetes mellitus or CVD at the baseline adjusted for several conventional cardiovascular risk factors, there was an approximately J-shaped association between HbA1c and CVD risk Di Angelantonio E et al, The Emerging Risk Factors Collaboration, JAMA 311: , 2014
19 Diabetes Prevention Program (DPP) & 10-Year Follow UP Diabetes Care 2015 Jan; 38(1):
20
21
22
23
24 ELIXA Trial design: Patients with type 2 diabetes and prior acute coronary syndrome were randomized to daily injection of lixisenatide vs. placebo. % (p for noninferiority < 0.05) Results CV death, MI, stroke, or hospitalization for unstable angina: 13.4% of the lixisenatide group vs. 13.2% of the placebo group (p for non-inferiority < 0.05; p for superiority = NS) Lixisenatide Placebo Conclusions Among patients with type 2 diabetes and prior acute coronary syndrome, lixisenatide was noninferior to placebo While this agent failed to demonstrate superiority compared with placebo, cardiovascular safety for this agent was established
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40 Issues with Leader Trial 1. The incidence of pancreatic cancers in liraglutide (13 in lira vs 5(+4) in placebo, p=0.06) % (28 of 170) in the placebo arm who did not received any ADA at all ended up with CVD events % (361 of 2244) in the placebo with A1c > 8.3% had CVD event. 4. With the overall CVD event rate in the placebo being 14.9% (694/4672) the above 2 issues could very well had driven the CVD event rate in the placebo arm.
41 Issues with Sustain-6 Trial 1. A1c difference of 0.7% for 0.5 mg & 1.0% for 1.0 mg semaglutide cf to placebo. 2. Drop out rate of semaglutide bet % 3. Diabetic retinopathy complications occurred in 50 patients (3.0%) in the semaglutide group and 29 (1.8%) in the placebo group (hazard ratio, 1.76; 95% CI, 1.11 to 2.78; P=0.02) The treatment difference between groups was first seen very early in the trial. The numbers of patients who required retinal photocoagulation were 38 (2.3%) in the semaglutide group versus 20 (1.2%) in the placebo group, the numbers of those who had a vitreous hemorrhage were 16 (1.0%) versus 7 (0.4%), and the numbers of those who had an onset of diabetes-related blindness were 5 (0.3%) versus 1 (0.1%).
42
43
44
45
46
47
48
49
50
51 Issues with Empa-Reg 1. No satisfactory explanation for early benefit in CV mortality 2. Individual empagliflozin arms did not reach statistical significance in outcomes compared to placebo 3. Planned as a non-inferiority study 4. Exclusion of silent AMI from the composite endpoints. Trend of increased silent AMI with Empa. 5. Trend in increasing strokes with increased haematocrit 6. Heterogeneity in sub-groups analysis. Statistically significant reductions in the primary outcome were found only in certain subgroups, e.g., Age 65, A1C <8.5%, Asian race, BMI < Less than 30% and 10% of subjects remained in the study after 3 years and 4 years respectively.
52 Issues with Empa-Reg 8. Many deaths (n=124) were categorized as nonassessable and adjudicated as presumed CV deaths (71 versus 53 for empagliflozin versus placebo). Deaths that were non-assessable but presumed to be CV-deaths comprised 40% of CV deaths, and 27% of overall deaths in the trial. In a sensitivity analysis that removes all nonassessable deaths from the primary endpoint, empagliflozin was no longer demonstrated to be superior to placebo (HR 0.90, 95% CI 0.77, 1.06).
53 Answers the question: What would you give yourself if you were a patient? Recommendations based on 5 priorities; 1. Safety 2. Convenience to aid compliance 3. CVD Global Risk Reduction (eg obesity) 4. Glycaemic Efficacy 5. Cost
54
55 Treatment Recommendation DM + CVD No AMI No CCF Low Risk* High Risk* Age > 65 years AMI CCF Modify dose of diuretic if on SGLT2i Obese CKD Stage 4 & 5 BMI > 27.5kg/m 2 GFR < 45 ml/min/1.73m 3 Normal Kidney Function CCF GFR units Metformin SGLT2i (Empaglifozin) SGLT2i (Empaglifozin) SGLT2i (Empaglifozin) DPPIVi SGLT2i (Empaglifozin) GLIP1-RA (Liraglutide, Semaglutide) GLIP1-RA GLIP1-RA Gliclazide GLIP1-RA (Liraglutide, Semaglutide) Metformin Metformin Metformin Bolus Insulin DPPIVi / Gliclazide DPPIVi / Gliclazide Gliclazide / DPPIVi DPPIVi / Gliclazide Basal Bolus Insulin Basal Insulin Basal Insulin Basal Insulin Basal Insulin Basal Bolus Basal Bolus Basal Bolus Basal Bolus Insulin Insulin Insulin Insulin * Having any of the following combination of risk factors Patient assessed as unlikely to comply to insulin
56 Remember what can happen
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 informationCardiovascular Outcomes With Newer Diabetes Drugs: Results From The EMPA-REG and LEADER Trials
Cardiovascular Outcomes With Newer Diabetes Drugs: Results From The EMPA-REG and LEADER Trials Rajiv Roy, MD Endocrinology Sharp Rees-Stealy Medical Group Background Between 1990 and 2010: Incidence of
More informationLATE 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 informationUpdate 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 informationCANVAS Program Independent commentary
CANVAS Program Independent commentary Cliff Bailey Aston University, Birmingham, UK 2017 Disclosures and disclaimers Clifford J Bailey CJB has attended advisory boards, undertaken ad hoc consultancy, received
More informationManagement 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 informationEndocrinologist Sweetgrass Endocrinology
Endocrinologist Sweetgrass Endocrinology Sanders, Cummings Ask Justice Department to Investigate Insulin Prices The Department of Justice and the FTC are asked to investigate whether Lilly, Novo Nordisk,
More informationPROTEZIONE DAL DANNO RENALE NEL DIABETE TIPO 2: RUOLO DEI NUOVI FARMACI. Massimo Boemi UOC Malattie Metaboliche e Diabetologia IRCCS INRCA Ancona
PROTEZIONE DAL DANNO RENALE NEL DIABETE TIPO 2: RUOLO DEI NUOVI FARMACI Massimo Boemi UOC Malattie Metaboliche e Diabetologia IRCCS INRCA Ancona Disclosure Dr Massimo Boemi has been granted as speaker
More informationCardiologists 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 informationUpdates in Diabetes and Cardiovascular Disease Management: Are You Making the Link?
Updates in Diabetes and Cardiovascular Disease Management: Are You Making the Link? Denise Kolanczyk, PharmD, BCPS AQ Cardiology 1 Erika Hellenbart, PharmD, BCPS 2 Jennifer D Souza, PharmD, CDE, BC ADM
More informationCurrent 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 informationDu 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 informationGlucose 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 informationUpdate 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 informationEffect of SGLT-2 Inhibitors on the Heart. Robert Zimmerman MD Vice Chairman Endocrinology Director Diabetes Center Cleveland Clinic
Effect of SGLT-2 Inhibitors on the Heart Robert Zimmerman MD Vice Chairman Endocrinology Director Diabetes Center Cleveland Clinic Disclosures Speaker - Johnson and Johnson - Merck Research - Merck - Novo
More informationEmpagliflozin (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 informationNavigating 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 informationGli endpoint micro-vascolari nei trial di outcome cardiovascolare
Gli endpoint micro-vascolari nei trial di outcome cardiovascolare Giorgio Sesti University Magna Graecia of Catanzaro ITALY Potenziali conflitti di interesse Il Prof Giorgio Sesti dichiara di aver ricevuto
More informationIn 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 informationPreventing 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 informationTerapia 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 informationDiabete: 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 informationLa 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 informationDiabetes and Heart Failure: The Role of SGLT2 Inhibitors
22 nd Annual Heart Failure 2018 Symposium Diabetes and Heart Failure: The Role of SGLT2 Inhibitors Gregg C. Fonarow, MD, FACC, FAHA, FHFSA Elliot Corday Professor of Cardiovascular Medicine UCLA Division
More informationWhy 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 informationCan Treating Diabetes with SGLT2 inhibitors Prevent Heart Failure?
UCSD Hawaii 2017 Symposium Can Treating Diabetes with SGLT2 inhibitors Prevent Heart Failure? Gregg C. Fonarow, MD, FACC, FAHA Elliot Corday Professor of Cardiovascular Medicine UCLA Division of Cardiology
More information01/09/2017. Outline. SGLT 2 inhibitor? Diabetes Patients: Complex and Heterogeneous. Association between diabetes and cardiovascular events
MICROVASCULAR COMPLICATIONS Incidence of outcome g 1 Cardioprotective Effects of SGLT2s Relevant for Which T2 Diabetes Patient? SGLT 2 inhibitor? 58 year old, waist circumference 5 cm, PMH: IHD On statin,
More informationThe EMPA-REG OUTCOME trial: Design and results. David Fitchett, MD University of Toronto, Canada
The EMPA-REG OUTCOME trial: Design and results David Fitchett, MD University of Toronto, Canada Asian Cardio Diabetes Forum April 23 24, 2016 Kuala Lumpur, Malaysia Life Expectancy Is Reduced by ~12 Years
More informationLEADER Liraglutide and cardiovascular outcomes in type 2 diabetes
LEADER Liraglutide and cardiovascular outcomes in type 2 diabetes Presented at DSBS seminar on mediation analysis August 18 th Søren Rasmussen, Novo Nordisk. LEADER CV outcome study To determine the effect
More informationCardiovascular 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 informationACCORD, 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 informationCauses of death in Diabetes
Rates of CV events in Diabetes patients Respiratory4.2 Cancer 7.6 Diabetes 1.3 CV disease 17.3 Causes of death in Diabetes 250 200 150 100 50 0 per 10,000 person-years 97 151 243 Framingham 5 X increase
More informationNew Strategies for Cardiovascular Risk reduction in Diabetes
New Strategies for Cardiovascular Risk reduction in Diabetes Dr. Godwin LEUNG Tat Chi MB ChB(HK), MRCP (UK), FHKCP, FHKAM (Medicine) FRCP (Glasg), FACC Specialist in Cardiology % event as first CV event
More informationDiabetes 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 informationDiabetes new challenges, new agents, new order
Diabetes new challenges, new agents, new order Ken Earle St Georges University Hospitals NHS Foundation Trust Overview Cardiovascular disease unmet needs Treating evident and residual risk Integrating
More informationThe 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 informationNo Increased Cardiovascular Risk for Lixisenatide in ELIXA
ON ISSUES IN THE MANAGEMENT OF TYPE 2 DIABETES JUNE 2015 Coverage of data from ADA 2015, June 5 9 in Boston, Massachusetts No Increased Cardiovascular Risk for Lixisenatide in ELIXA First Cardiovascular
More informationWhen Statins Aren t Enough: Appropriate Therapies for High-Risk Patients with Diabetes
When Statins Aren t Enough: Appropriate Therapies for High-Risk Patients with Diabetes Kim K. Birtcher, MS, PharmD, AACC, FNLA, CLS, BCPS (AQ-Cardiology), CDE Clinical Professor University of Houston College
More informationT2 Diabetes in Sep-16. Stephen Leow Disclosures. Why do we treat diabetes? Agenda. Targets
Stephen Leow Disclosures I have received honoraria, sat on the advisory boards or received grants from Novo Nordisk, Sanofi Aventis, Eli Lilly, Boehringer Ingleheim, Jansenn Cilag, Mundipharma, BioCSL,
More informationUpdate 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 informationHeart Failure Management in T2 DM A Practical Approach. David Fitchett MD St Michael s Hospital Toronto
Heart Failure Management in T2 DM A Practical Approach David Fitchett MD St Michael s Hospital Toronto Faculty: Faculty Disclosure David Fitchett MD,, FRCP(C) Associate Professor of Medicine, University
More informationDisclosures. Diabetes and Cardiovascular Risk Management. Learning Objectives. Atherosclerotic Cardiovascular Disease
Disclosures Diabetes and Cardiovascular Risk Management Tony Hampton, MD, MBA Medical Director Advocate Aurora Operating System Advocate Aurora Healthcare Downers Grove, IL No conflicts or disclosures
More informationTop HF Trials to Impact Your Practice
Top HF Trials to Impact Your Practice Biykem Bozkurt, MD, FACC The Mary and Gordon Cain Chair & Professor of Medicine Medical Care Line Executive, DeBakey VA Medical Center, Director, Winters Center for
More informationNewer Diabetes Treatments Drug Class Update with New Drug Evaluation: Semaglutide and Ertugliflozin
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationHelp the Heart. An Update on GLP-1 Agonists and SGLT2 Inhibitors. Tara Hawley, PharmD PGY1 Pharmacy Resident Mayo Clinic Health System Eau Claire
Help the Heart An Update on GLP-1 Agonists and SGLT2 Inhibitors Tara Hawley, PharmD PGY1 Pharmacy Resident Mayo Clinic Health System Eau Claire Mayo Clinic Grand Rounds May 16, 2017 2017 MFMER slide-1
More informationDisclosures. Objectives. Bryan Cardiology Conference DM2 & Cardiovascular Outcome Trials 8/28/2017
Bryan Cardiology Conference DM2 & Cardiovascular Outcome Trials Shannon Wakeley MD Complete Endocrinology 9/2/2017 Disclosures Speakers Bureau: Astra Zeneca, Sanofi, Abbvie, Boehringer-Ingelheim, Medtronic,
More informationCardiovascular 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 informationGLP 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 informationDiabetes and Heart Disease. Sarah Alexander, MD, FACC Assistant Professor of Medicine Rush University Medical Center
Diabetes and Heart Disease Sarah Alexander, MD, FACC Assistant Professor of Medicine Rush University Medical Center No conflicts of interest or financial relationships to disclose. 2 What s the problem??
More informationLEADER and EMPA-REG. John Buse, MD, PhD. University of North Carolina School of Medicine Chapel Hill, NC, USA. Duality of Interest Declaration
1 LEADER and EMPA-REG John Buse, MD, PhD University of Nth Carolina School of Medicine Chapel Hill, NC, USA Duality of Interest Declaration I rept the following potential duality/dualities of interest
More informationSoo 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 informationCardiologists and HbA1c: Novel Diabetes Drugs and the Cardiologist as Diabetician
Biomarkers 2019 Cardiologists and HbA1c: Novel Diabetes Drugs and the Cardiologist as Diabetician Gregg C. Fonarow, MD, FACC, FAHA, FHFSA Elliot Corday Professor of Cardiovascular Medicine UCLA Division
More informationThe Clinical Unmet need in the patient with Diabetes and ACS
The Clinical Unmet need in the patient with Diabetes and ACS Professor Kausik Ray (UK) BSc(hons), MBChB, MD, MPhil, FRCP (lon), FRCP (ed), FACC, FESC, FAHA Diabetes is a global public health challenge
More informationVery 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 informationNew Drug Evaluation: lixisenatide injection, subcutaneous
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More informationManaging Perioperative Diabetes What s new? Kathryn A. Myers MD FRCPC Chair Chief Division of GIM Professor of Medicine Western University
Managing Perioperative Diabetes What s new? Kathryn A. Myers MD FRCPC Chair Chief Division of GIM Professor of Medicine Western University Objectives: By the end of this session, you will be able to: Identify
More informationIndustry Relationships and Institutional Affiliations
Efficacy and safety of alirocumab in high cardiovascular risk patients with inadequately controlled hypercholesterolaemia on maximally tolerated daily statin: results from the ODYSSEY COMBO II study Christopher
More informationBeyond 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 informationHanyang University Guri Hospital Chang Beom Lee
Hanyang University Guri Hospital Chang Beom Lee Meal prayer, Van Brekelenkam 17 th C Introduction 2012 ADA/EASD Position Statement Proper Patients for Pioglitazone β-cell Preservation by Pioglitazone Benefit
More informationDisclosures of Interest. Publications Diabetologia Key points to emphasize
Disclosures of Interest No conflicts or disclosures How to Use the American Diabetes Association s Type 2 Diabetes Treatment Algorithm Rashida Downing, MD, FAAFP Primary Care Physician JenCare Medical
More informationCVD risk assessment using risk scores in primary and secondary prevention
CVD risk assessment using risk scores in primary and secondary prevention Raul D. Santos MD, PhD Heart Institute-InCor University of Sao Paulo Brazil Disclosure Honoraria for consulting and speaker activities
More informationSGLT2 inhibition in diabetes: extending from glycaemic control to renal and cardiovascular protection
SGLT2 inhibition in diabetes: extending from glycaemic control to renal and cardiovascular protection Hiddo Lambers Heerspink Department of Clinical Pharmacy and Pharmacology University Medical Center
More informationCedars Sinai Diabetes. Michael A. Weber
Cedars Sinai Diabetes Michael A. Weber Speaker Disclosures I disclose that I am a Consultant for: Ablative Solutions, Boston Scientific, Boehringer Ingelheim, Eli Lilly, Forest, Medtronics, Novartis, ReCor
More informationPrevention of complications: are we winning or losing the battle. Naveed Sattar Professor of Metabolic Medicine
Prevention of complications: are we winning or losing the battle Naveed Sattar Professor of Metabolic Medicine Duality of Interest Declaration Consultant or speaker for: Amgen, AstraZeneca, Boehringer
More informationDiabetes and Hypertension
Diabetes and Hypertension William C. Cushman, MD, FAHA, FACP, FASH Chief, Preventive Medicine, Veterans Affairs Medical Center Professor, Preventive Medicine, Medicine, and Physiology University of Tennessee
More informationDiabetic Management of the Cardiac Patient
Diabetic Management of the Cardiac Patient Dr Peter A Senior BMedSci MBBS PhD FRCP(E) Associate Professor, Director Division of Endocrinology, University of Alberta Disclosures Grants/Research Support:
More information2019 Update on Recent Guideline Releases for Diabetes, Hypertension, and Dyslipidemia: Can We, Please, All Just Get on the Same Page?!
2019 Update on Recent Guideline Releases for Diabetes, Hypertension, and Dyslipidemia: Can We, Please, All Just Get on the Same Page?! Jeremy L. Johnson, PharmD, BCACP, CDE, BC-ADM Assistant Professor,
More information7 th Munich Vascular Conference
7 th Munich Vascular Conference Secondary prevention of major cardiovascular events in patients with CHD or PAD - What can we learn from EUCLID and COMPASS, evaluating Clopidogrel, Ticagrelor and Univ.-Prof.
More informationIncredible Incretins Abby Frye, PharmD, BCACP
Incredible Incretins Abby Frye, PharmD, BCACP Objectives & Disclosures Review the pathophysiology of T2DM and the impact of the incretin system Describe the defining characteristics of the available glucagonlike
More informationSafety profile of Liraglutide: Recent Updates. Mohammadreza Rostamzadeh,M.D.
Safety profile of Liraglutide: Recent Updates Mohammadreza Rostamzadeh,M.D. Pancreatitis: Victoza post-marketing experience: spontaneous reports of pancreatitis For the majority of the cases, there is
More informationDrug Class Update with New Drug Evaluation: Non-insulin Diabetes Treatments (SGLT-2 Inhibitors and GLP-1 Receptor Agonists)
Copyright 2012 Oregon State University. All Rights Reserved Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35 Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119
More information3. Cardiovascular Disease?
Swiss recommendations 2016 Swiss Society of Endocrinology and Diabetology 1. Deficiency? Basal Premixed- Basal + GLP-1 RA (Xultophy ) or Basal Bolus 2. egfr < 30 ml/min? 3. Cardiovascular Disease? 4. Heart
More informationEvaluating the Cardiovascular Benefits of Antidiabetic Medications
Evaluating the Cardiovascular Benefits of Antidiabetic Medications Target Audience: Pharmacists ACPE#: 0202-0000-18-054-L01-P Activity Type: Application-based Disclosures Stuart T. Haines has no relevant
More informationUpdate Diabetes Therapie. Marc Y Donath
Update Diabetes Therapie Marc Y Donath Recent CV outcome studies in Diabetes N Engl J Med. 2015 373:2117-28 (Empa-Reg outcome study) N Engl J Med. 2016 June 13 (LEADER trial) N Engl J Med. 2017 June 12
More informationMOA: Long acting glucagon-like peptide 1 receptor agonist
Alexandria Rydz MOA: Long acting glucagon-like peptide 1 receptor agonist Increases glucose dependent insulin secretion Decreases inappropriate glucagon secretion Increases β- cell growth and replication
More informationA Guidance Statement from the American College of Physicians
Hemoglobin A1c Targets for Glycemic Control with Pharmacologic Therapy in Non-Pregnant Adults with Type 2 Diabetes Mellitus: A Guidance Statement from the American College of Physicians Timothy J. Wilt,
More informationADA Analyst Presentation Saturday 9 th June
ADA Analyst Presentation Saturday 9 th June Carlo Russo Senior Vice-President & Albiglutide Team Leader, GSK Property of GlaxoSmithKline Agenda Welcome & introduction to the Harmony Clinical Programme
More informationManagement 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 informationADVANCE post trial ObservatioNal Study
Hot Topics in Diabetes 50 th EASD, Vienna 2014 ADVANCE post trial ObservatioNal Study Sophia Zoungas The George Institute The University of Sydney Rationale and Study Design Sophia Zoungas The George Institute
More informationHEART FAILURE AND DIABETES MELLITUS: DANGEROUS LIASONS MICHEL KOMAJDA, MD
HEART FAILURE AND DIABETES MELLITUS: DANGEROUS LIASONS MICHEL KOMAJDA, MD Author affiliations: Department of Cardiology, Hôpital Saint Joseph, Paris, France Address for correspondence: Michel Komajda,
More informationThe 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 informationDiabetes and Heart Failure: Challenges and Opportunities
AHA Get With The Guidelines-Heart Failure Webinar Diabetes and Heart Failure: Challenges and Opportunities Gregg C. Fonarow, MD, FACC, FAHA, FHFSA Elliot Corday Professor of Cardiovascular Medicine UCLA
More informationGlucose Lowering Medications and CV Risk Reduction: A New Era Jane EB Reusch MD ADA President for Medicine and Science
Glucose Lowering Medications and CV Risk Reduction: A New Era Jane EB Reusch MD ADA President for Medicine and Science Professor of Medicine, Division of Endocrinology, Metabolism and Diabetes and Associate
More informationLet s not sugarcoat it! Update on Pharmacologic Management of Type II DM
Let s not sugarcoat it! Update on Pharmacologic Management of Type II DM Gregory Castelli, PharmD, BCPS, BC-ADM Clinical Pharmacist UPMC St. Margaret Objectives By the end of this presentation, participants
More informationKidney and heart: dangerous liaisons. Luis M. RUILOPE (Madrid, Spain)
Kidney and heart: dangerous liaisons Luis M. RUILOPE (Madrid, Spain) Type 2 diabetes and renal disease: impact on cardiovascular outcomes The "heavyweights" of modifiable CVD risk factors Hypertension
More informationAlia 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 informationWhat 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 informationCARDIOVASCULAR RISK FACTOR CONTROL IN TYPE 2 DIABETES MELLITUS AND NEW TRIAL EVIDENCE
CARDIOVASCULAR RISK FACTOR CONTROL IN TYPE 2 DIABETES MELLITUS AND NEW TRIAL EVIDENCE *Peter M. Nilsson Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden *Correspondence
More informationA.K. Gitt, F. Towae, C. Juenger, A. Papp, R. Zahn, U. Zeymer, J. Senges For the STAR-Study-Group Herzzentrum Ludwigshafen, Germany
Impact of Interventional Versus Conservative Approach on 5-Year-Mortality of Patients With Stable Angina and Documented Coronary Artery Disease in Clinical Practice: Results of the STAR-Registry A.K. Gitt,
More informationFaculty. Robert S. Busch, MD, FACE Director of Clinical Research Albany Medical Faculty: Community Endocrine Group Albany, NY
Faculty Robert S. Busch, MD, FACE Director of Clinical Research Albany Medical Faculty: Community Endocrine Group Albany, NY 2 Disclosures Robert S. Busch, MD, FACE serves as a speaker for Astra Zeneca,
More informationCardiovascular disease and diabetes Vascular harmony
Cardiovascular disease and diabetes 2018 Vascular harmony Robert Chilton Professor of Medicine University of Texas Health Science Center Director of Cardiac Catheterization labs Director of clinical proteomics
More informationThe Diabetes Link to Heart Disease
The Diabetes Link to Heart Disease Anthony Abe DeSantis, MD September 18, 2015 University of WA Division of Metabolism, Endocrinology and Nutrition Oswald Toosweet Case #1 68 yo M with T2DM Diagnosed DM
More informationDiabetes Mellitus Type 2 Evidence-Based Drivers
This module is supported by an unrestricted educational grant by Aventis Pharmaceuticals Education Center. Copyright 2003 1 Diabetes Mellitus Type 2 Evidence-Based Drivers Driver One: Reducing blood glucose
More informationCV 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 informationREGISTER OF INTERESTS SIGN guideline 154: Pharmacological management of glycaemic control in people with type 2 diabetes Published: 29 November 2017
CHAIR John Petrie, Professor of Diabetic Medicine Financial Non-financial Non-personal Last updated Specific Non-Specific Specific Non- Specific Professor of Diabetic Medicine, University of Glasgow Academic.
More informationCARDIO-RENAL SYNDROME
CARDIO-RENAL SYNDROME Luis M Ruilope Athens, October 216 DISCLOSURES: ADVISOR/SPEAKER for Astra-Zeneca, Bayer, BMS, Daiichi-Sankyo, Esteve, GSK Janssen, Lacer, Medtronic, MSD, Novartis, Pfizer, Relypsa,
More informationESC 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 informationNew Therapies for Type 2 Diabetes
New for Type 2 Diabetes Joshua J. Joseph, MD Assistant Professor of Medicine Division of Endocrinology, Diabetes and Metabolism The Ohio State University Wexner Medical Center Financial Disclosures: None
More informationNew Therapies for Type 2 Diabetes
New for Type 2 Diabetes Joshua J. Joseph, MD Assistant Professor of Medicine Division of Endocrinology, Diabetes and Metabolism The Ohio State University Wexner Medical Center Financial Disclosures: None
More information