Oral Hypoglycemics and Risk of Adverse Cardiac Events: A Summary of the Controversy
|
|
- Elwin Webb
- 6 years ago
- Views:
Transcription
1 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
2 Outline Glycemic targets and cardiovascular outcomes- recent trials Diabetes agents and cardiovascular outcomes Putting it in practice- ADA/EASD Guidelines VanderbiltHeart.com
3 ACCORD ADVANCE VADT # subjects Mean age (Yr) Baseline A1C (%) History of CVD (%) 10, , , A1C Goal (%) (Intensive vs. Standard) <6 vs vs. local guideline <6.0 vs. separation of 1.5 with standard Achieved A1C (%) 6.4 vs vs vs outcome Nonfatal MI /stroke, CVD death HR 1 outcome (95% CI) HR mortality (95% CI) 0.90 ( ) 1.22 ( ) Microvascular plus macrovascular (nonfatal MI/stroke, CVD death) 0.9 ( ) 0.93 ( ) Nonfatal MI/stroke, CVD death, CHF hospitalization, revascularization 0.88 ( ) 1.07 ( ) Skyler, JS et al Diabetes Care 2009; 32:
4 CV benefit of intensive glycemic control: it depends on how you look at it Subset analyses of ACCORD, ADVANCE, VADT suggested significant benefit of intensive control in patients with shorter duration of DM, lower A1C at entry, and/or absence of known CVD Meta-analysis of ACCORD, ADVANCE, VADT, and PROACTIVE (Lancet 2009;373: ) showed intensive glycemic control resulted in: 17% reduction in nonfatal MI 15% reduction in CV events (nonfatal MI+ CV death) No effect on stroke or all-cause mortality
5 Baseline Coronary Artery Calcium (CAC) and CV Outcomes in VADT (Diabetes 2009; 58: )
6 Association Between Symptomatic Hypoglycemia and Mortality in ACCORD (Bonds, DE et al BMJ 2010; 340:b4909) Retrospective epidemiological analysis of ACCORD trial data Defined hypoglycemia as one or more episodes of glucose <50 mg/dl, or symptoms requiring assistance of another that resolved with treatment Annual mortality for intensive control arm was 2.8% for patients with hypoglycemia, vs. 1.2% without (adjusted HR 1.41) Annual mortality for standard control arm was 3.7% for patients with hypoglycemia, vs. 1.0% without (adjusted HR 2.30) However, for patients with at least one hypoglycemia episode requiring ANY assistance, a non-significantly lower risk of death was seen in the intensive arm compared to the standard arm (HR 0.74, 95% CI ) A significantly lower risk was observed in the intensive arm compared to the standard arm for those with hypoglycemia requiring MEDICAL assistance (HR 0.55, 95% CI ) Conclusion: symptomatic severe hypoglycemia was associated with higher mortality risk in both arms. However, among patients with hypoglycemia the risk of death was LOWER in patients in the intensive arm compared to the standard arm
7 PROactive Trial Design and Baseline Characteristics Prospective randomized double blind placebo controlled study Patients with type 2 DM age with A1C>6.5% AND CVD CAD CVA PAD Excluding: class II-IV CHF, ESRD, liver dz 5238 subjects randomized to pioglitazone (titrated to 45 mg/d) or placebo + existing Tx Male - 66% Caucasian 98% Mean age 62 Mean weight 88 kg/bmi 31 Mean A1C 7.8% ACE/ARB 61% B-blocker 55% Antiplatelet 85% Statin 43% Fibrate 10% Mean LDL 112 mg/dl Mean HDL 43 mg/dl Mean Triglyceride 159 mg/dl Lancet. 2005;366(9493):
8 Key Results 0.6% net reduction in A1c in Pio group (6.9% vs. 7.5% final A1C) Modest improvement in lipids in Pio group (11% reduction trigs, 9% increase HDL) 3 mm Hg improvement in BP in Pio group 50% reduction for Pio group in progression to permanent insulin use for patients not on insulin at baseline Increased risk of hypoglycemia in Pio group 3.6 kg weight gain in Pio group NNH to cause CHF with Pio (requiring or not requiring hospitalization) = 30 (ARI 3.3%) Lancet. 2005;366(9493):
9 Death, nonfatal MI, stroke, amputation, ACS, coronary or leg revascularization
10 NNT to prevent first major cardiac event in 3 years= 48 (ARR 2.1%)
11 Rates of Myocardial Infarction and Death from Cardiovascular Causes with Rosiglitazone Nissen SE, Wolski K. N Engl J Med 2007;356:
12 Intensive Glycemic Control and CV Prevention: Joint Statement by ADA and AHA The general recommendation for a target A1C <7% in adults remains the same For selected individual patients, providers may recommend a goal even lower than the target of <7%, if it can be achieved without significant hypoglycemia or other adverse treatment effects Consider in patients with long life expectancy, no baseline CAD, shorter duration of diabetes Conversely, less stringent A1C goals may be appropriate for patients with history of severe hypoglycemia, limited life expectancy, advanced macrovascular or microvascular complications, or extensive comorbidities with longstanding diabetes where the goal is difficult to obtain despite intensive management Circulation 2009;119;
13 Comparative Effectiveness of Sulfonylurea and Metformin Monotherapy on Cardiovascular Events in Type 2 Diabetes Mellitus: A Cohort Study Retrospective cohort study of US Veterans who initiated metformin (n=155,025) or sulfonylurea (n=98665 therapy for DM Excluded subjects with CKD (Cr 1.5), cancer, HIV, organ transplant, end stage liver disease, respiratory failure Outcome: Composite outcome of hospitalization for acute MI or stroke; or death, adjusted for: baseline demographic characteristics; medications; cholesterol, hemoglobin A1c, and serum creatinine levels; blood pressure; body mass index; health care utilization; and comorbid conditions Adjusted Hazard Ratio (ahr) for propensity score-matched cohort for CV event or death: ahr = 1.20 ( ) for sulfonylurea compared to metformin users Results were similar for glyburide ahr 1.21 ( ) compared to glipizide ahr 1.15 ( ) VanderbiltHeart.com
14 Comparative Effectiveness of Sulfonylurea and Metformin Monotherapy on Cardiovascular Events in Type 2 Diabetes Mellitus: A Cohort Study Ann Intern Med. 2012;157(9): VanderbiltHeart.com
15 ORIGIN (Outcome Reduction with Initial Glargine Intervention) N=12,537 subjects with dysglycemia (DM2, IFG or IGT) on none or one glucose lowering drug + additional CV RF Randomized to: Insulin glargine daily to target FPG 95 mg/dl Standard care per local guidelines Secondary outcomes: 28% reduction in development of new DM in IFG/IGT in glargine group 0.7% higher risk of severe hypoglycemia (1 vs. 0.3%) in glargine group N Engl J Med 2012; 367: VanderbiltHeart.com
16 Reported pleiotropic effects of GLP-1 or GLP-1 receptor agonists on various tissues and organs under experimental conditions Meier, J. J. (2012) Nat. Rev. Endocrinol. doi: /nrendo
17 Exenatide reduces reperfusion injury in STEMI: Infarct size plotted against area at risk potential cardioprotective signalling pathways Lønborg J et al. Eur Heart J 2012;33: Hausenloy D J, Yellon D M Eur Heart J 2012;33:
18 Main Pathophysiological Defects in T2DM incretin effect gut carbohydrate delivery & absorption - pancreatic glucagon secretion pancreatic insulin secretion HYPERGLYCEMIA? - + hepatic glucose production peripheral glucose uptake Adapted from: Inzucchi SE, Sherwin RS in: Cecil Medicine 2011
19 Tier 1 Therapies Tx ΔA1C (%) Advantages Disadvantages Lifestyle 1-2 -Broad benefits -No risk Metformin 1-2 -Weight neutral Sulfonylurea (glipizide, glimepiride, glyburide) Insulin or > -Cheap 1-2 -Cheap -Good tolerance -Rapidly effective -Good tolerance -Rapidly effective -Broad utility -Durability -Poor adherence -Insufficient over time -GI side effects -Contraindicated renal failure -Hypoglycemia -Weight gain -Insufficient over time -Hypoglycemia -Weight gain -Monitoring/complexity Diabetes Care 2009; 32:
20 Tier 2 Therapies Tx ΔA1C (%) Advantages Disadvantages TZD (rosiglitazone, pioglitazone) GLP1 agonist (exenatide, liraglutide) Glinide (repaglinide, nateglinide) DPP4 inhibitor (sitagliptin, linagliptin, saxagliptin) Low hypoglycemia risk as monotherapy -Better durability Weight loss -Can use with SU, metformin, or TZD Rapidly effective -Good tolerance Weight neutral -Can use with SU, metformin, or TZD -Edema/ CHF, Osteoporosis, Bladder CA risk, weight gain -Expensive -GI side effects -Expensive -Injections -Hypoglycemia, wt. gain -Expensive -3x/day dosing -Expensive -Limited data Diabetes Care 2009; 32:
21 Figure 1 Diabetes Care 2012;35: Diabetologia 2012;55: (Adapted with permission from: Ismail-Beigi et al. Ann Intern Med 2011;154:554)
22 Diabetes Care 2012;35: Diabetologia 2012;55:
23 ADA-EASD Position Statement: Management of Hyperglycemia in T2DM 4. OTHER CONSIDERATIONS Comorbidities - Coronary Disease - Heart Failure Metformin: CVD benefit (UKPDS) Avoid hypoglycemia? SUs & ischemic preconditioning? Pioglitazone & CVD events? Effects of incretin-based therapies Diabetes Care 2012;35: Diabetologia 2012;55:
24 ADA-EASD Position Statement: Management of Hyperglycemia in T2DM 4. OTHER CONSIDERATIONS Comorbidities - Coronary Disease - Heart Failure Metformin: May use unless condition is unstable or severe Avoid TZDs? Effects of incretin-based therapies Diabetes Care 2012;35: Diabetologia 2012;55:
Diabetes Mellitus: Implications of New Clinical Trials and New Medications
Diabetes Mellitus: Implications of New Clinical Trials and New Medications Estimates of Diagnosed Diabetes in Adults, 2005 Alka M. Kanaya, MD Asst. Professor of Medicine UCSF, Primary Care CME October
More 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 informationDiabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable?
Diabetes Guidelines in View of Recent Clinical Trials Are They Still Applicable? Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of
More informationCURRENT CONTROVERSIES IN DIABETES CARE
CURRENT CONTROVERSIES IN DIABETES CARE Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest Diabetes Mellitus: U.S. Impact
More informationCurrent Diabetes Care for Internists:2011
Current Diabetes Care for Internists:2011 Petch Rawdaree, DM, MSc, DLSHTM Faculty of Medicine Vajira Hospital University of Bangkok Metropolis 19 th January 2011 ก ก 1. ก ก ก ก 2. ก ก ก ก ก 3. ก ก ก ก
More informationTREATMENT OF DIABETES AFTER METFORMIN GREGG GERETY, MD ALBANY MEDICAL COLLEGE, DIVISION OF COMMUNITY ENDOCRINOLOGY JULY 14, 2017
TREATMENT OF DIABETES AFTER METFORMIN GREGG GERETY, MD ALBANY MEDICAL COLLEGE, DIVISION OF COMMUNITY ENDOCRINOLOGY JULY 14, 2017 Outline Review treatment algorithms from ADA/ EASD & ACE/AACE. Review positive
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 informationGlycemic control a matter of life and death
Glycemic control a matter of life and death Linda Garcia Mellbin MD PhD Specialist in Cardiology & Internal medicine Dep of Cardiology Karolinska University Hospital /Karolinska Institutet Mortality (%)
More informationDiabetes and the Heart
Diabetes and the Heart Jeffrey Boord, MD, MPH Advances in Cardiovascular Medicine Kingston, Jamaica December 6, 2012 Outline Screening for diabetes in patients with CAD Screening for CAD in patients with
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 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 informationMultiple Small Feedings of the Mind: Diabetes. Sonja K Fredrickson, MD, BC-ADM March 7, 2014
Multiple Small Feedings of the Mind: Diabetes Sonja K Fredrickson, MD, BC-ADM March 7, 2014 Question 1: Setting A1c Goals Describe the evidence based approach to determining the target HgbA1c in different
More informationAbbreviations DPP-IV dipeptidyl peptidase IV DREAM Diabetes REduction Assessment with ramipril and rosiglitazone
Index Abbreviations DPP-IV dipeptidyl peptidase IV DREAM Diabetes REduction Assessment with ramipril and rosiglitazone Medication GAD glutamic acid decarboxylase GLP-1 glucagon-like peptide 1 NPH neutral
More informationType 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 informationThe Many Faces of T2DM in Long-term Care Facilities
The Many Faces of T2DM in Long-term Care Facilities Question #1 Which of the following is a risk factor for increased hypoglycemia in older patients that may suggest the need to relax hyperglycemia treatment
More informationType 2 Diabetes: Where Do We Start with Treatment? DIABETES EDUCATION. Diabetes Mellitus: Complications and Co-Morbid Conditions
Diabetes Mellitus: Complications and Co-Morbid Conditions ADA Guidelines for Glycemic Control: 2016 Retinopathy Between 2005-2008, 28.5% of patients with diabetes 40 years and older diagnosed with diabetic
More 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 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 information9/12/2014. Main Pathophysiological Defect in T1DM. Main Pathophysiological Defects in T2DM. Personalizing Diabetes Care: The Alphabet Soup of Options
9/12/2014 Baptist Health South Florida 13th Annual Primary Focus Symposium June 28, 2014 Silvio Inzucchi MD Section of Endocrinology Yale University School of Medicine Half-Century of HTN & T2DM Medications
More informationDiabetes Treatment Update
Diabetes Treatment Update Timothy C. Evans, MD PhD FACP University of Washington Department of Medicine Disclosure: Dr. Evans has no significant financial interest in any of the products or manufacturers
More informationObesity, Insulin Resistance, Metabolic Syndrome, and the Natural History of Type 2 Diabetes
Obesity, Insulin Resistance, Metabolic Syndrome, and the Natural History of Type 2 Diabetes Genetics, environment, and lifestyle (obesity, inactivity, poor diet) Impaired fasting glucose Decreased β-cell
More informationThe ABCs (A1C, BP and Cholesterol) of Diabetes
The ABCs (A1C, BP and Cholesterol) of Diabetes Gregg Simonson, PhD Director, Professional Training and Consulting International Diabetes Center; Adjunct Assistant Professor, University of Minnesota Department
More informationDiabetes 2013: Achieving Goals Through Comprehensive Treatment. Session 2: Individualizing Therapy
Diabetes 2013: Achieving Goals Through Comprehensive Treatment Session 2: Individualizing Therapy Joshua L. Cohen, M.D., F.A.C.P. Professor of Medicine Interim Director, Division of Endocrinology & Metabolism
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 informationVipul 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 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 informationCURRENT ISSUES IN DIABETES MANAGEMENT
CURRENT ISSUES IN DIABETES MANAGEMENT Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest Screening for Diabetes 2011 BMI
More informationManagement 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 informationOBJECTIVES 4/7/2014. Diabetes Update Overview of the Diabetes Epidemic in the United States. ISHP Annual Spring Meeting
Diabetes Update 2014 ISHP Annual Spring Meeting Hayley Miller MD April 13, 2014 OBJECTIVES Review diabetes guidelines. Understand diabetes management targets. Discuss current therapeutic strategies. Overview
More informationIDF 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 informationManagement of Diabetes Mellitus: A Primary Care Perspective. Screening for Diabetes Advantages of HbA1c as a Diagnostic Test
Management of Diabetes Mellitus: A Primary Care Perspective Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest Screening
More 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 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 informationCURRENT ISSUES IN DIABETES MANAGEMENT
CURRENT ISSUES IN DIABETES MANAGEMENT Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest Diabetes Mellitus: U.S. Impact DIABETES
More informationComprehensive Diabetes Treatment
Comprehensive Diabetes Treatment Joshua L. Cohen, M.D., F.A.C.P. Professor of Medicine Interim Director, Division of Endocrinology & Metabolism The George Washington University School of Medicine Diabetes
More informationEvidence-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 informationType 2 Diabetes Management: Case 1: Reducing Hypoglycemic Risk Case 2: Reducing Cardiovascular Risk
Type 2 Diabetes Management M. Susan Burke, MD, FACP Clinical Associate Professor of Medicine Sidney Kimmel Medical College at Thomas Jefferson University Senior Advisor, Lankenau Medical Associates Lankenau
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 informationCase Studies in Type 2 Diabetes Mellitus: Focus on Cardiovascular Outcomes Trials
Case Studies in Type 2 Diabetes Mellitus: Focus on Cardiovascular Outcomes Trials Louis Kuritzky MD Clinical Assistant Professor Emeritus Department of Community Health and Family Medicine College of Medicine
More informationCardiovascular Management of a Patient with Diabetes
Cardiovascular Management of a Patient with Diabetes Dr Jeremy Krebs Clinical Leader Endocrinology and Diabetes Wellington Hospital Summary People with diabetes take a lot of medication Compliance and
More informationMae Sheikh-Ali, M.D. Assistant Professor of Medicine Division of Endocrinology University of Florida College of Medicine- Jacksonville
Mae Sheikh-Ali, M.D. Assistant Professor of Medicine Division of Endocrinology University of Florida College of Medicine- Jacksonville Pathogenesis of Diabetes Mellitus (DM) Criteria for the diagnosis
More informationA Practical Approach to the Use of Diabetes Medications
A Practical Approach to the Use of Diabetes Medications Juan Pablo Frias, M.D., FACE President, National Research Institute, Los Angles, CA Clinical Faculty, University of California, San Diego, CA OUTLINE
More informationDiabetes Update: Diabetes Management In Primary Care. Jonathon M. Firnhaber, MD, FAAFP
Diabetes Update: Diabetes Management In Primary Care Jonathon M. Firnhaber, MD, FAAFP Learning objectives 1. Critically evaluate the evidence emerging within diabetes research as it applies to recommendations
More informationNEW DIABETES CARE MEDICATIONS
NEW DIABETES CARE MEDICATIONS James Bonucchi DO, ECNU, FACE Adult Medicine and Endocrinology Specialists Disclosures Speakers bureau Sanofi AZ BI Diabetes Diabetes cost ADA 2017 data Ever increasing disorder.
More informationCURRENT ISSUES IN DIABETES MANAGEMENT. Screening for Diabetes Advantages of HbA1c as a Diagnostic Test. Diagnosis of Diabetes 2013
CURRENT ISSUES IN DIABETES MANAGEMENT Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest Screening for Diabetes 2013 BMI
More informationMedical therapy advances London/Manchester RCP February/June 2016
Medical therapy advances London/Manchester RCP February/June 2016 Advances in medical therapies for diabetes mellitus Duality of interest: The speaker or institutions with which he is associated has received
More informationJoslin Diabetes Center Joslin Diabetes Forum 2013: The Impact of Comorbidities on Glucose Control Scenario 2: Reduced Renal Function
Scenario 2: Reduced Renal Function 62 y.o. white man with type 2 diabetes for 18 years Hypertension and hypercholesterolemia Known proliferative retinopathy Current medications: Metformin 1000 mg bid Glyburide
More informationNewer and Expensive treatment of diabetes. Endocrinology Visiting Associate Professor Institute of Medicine TUTH
Newer and Expensive treatment of diabetes Jyoti Bhattarai MD Endocrinology Visiting Associate Professor Institute of Medicine TUTH Four out of every five people with diabetes now live in developing countries.
More informationChief of Endocrinology East Orange General Hospital
Targeting the Incretins System: Can it Improve Our Ability to Treat Type 2 Diabetes? Darshi Sunderam, MD Darshi Sunderam, MD Chief of Endocrinology East Orange General Hospital Age-adjusted Percentage
More informationAdult Diabetes Clinician Guide NOVEMBER 2017
Kaiser Permanente National CLINICAL PRACTICE GUIDELINES Adult Diabetes Clinician Guide Introduction NOVEMBER 2017 This evidence-based guideline summary is based on the 2017 KP National Diabetes Guideline.
More informationJennifer Loh, MD, FACE Chief of Endocrinology KP Hawaii AAMD of Medical Education, KP Hawaii
Individualized Diabetes Treatment for the Elderly Jennifer Loh, MD, FACE Chief of Endocrinology KP Hawaii AAMD of Medical Education, KP Hawaii Extremely Relevant Baby Boomers are aging! ¼ of people age
More informationAntihyperglycemic Agents in Diabetes. Jamie Messenger, PharmD, CPP Department of Family Medicine East Carolina University August 18, 2014
Antihyperglycemic Agents in Diabetes Jamie Messenger, PharmD, CPP Department of Family Medicine East Carolina University August 18, 2014 Objectives Review 2014 ADA Standards of Medical Care in DM as they
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 informationMetformin. Sulfonylurea. Thiazolidinedione. Insulin
동아의대내분비내과박미경 Metformin Sulfonylurea Thiazolidinedione Insulin 요약 markers of inflammation (hs-crp, TNF-a) markers of impaired endothelial function (VFW, scams, tpa, PAI-1) LDL-C, fasting and postprandial
More informationOlder Adults & Optimal Outcome. Individualizing Diabetes Management. Mary Moyer Janci BC-FNP BC-ADM CDE Teaching Associate Diabetes Care Center UWMC
Older Adults & Optimal Outcome Individualizing Diabetes Management Mary Moyer Janci BC-FNP BC-ADM CDE Teaching Associate Diabetes Care Center UWMC What is Diabetes? METABOLIC DISEASE Food breakdown (carbohydrates,
More informationStephen Clement M.D. CDE Medical Director, Endocrine Services Inova Fairfax Hospital
Stephen Clement M.D. CDE Medical Director, Endocrine Services Inova Fairfax Hospital Financial Disclosures Consulting Panel for GSK on Hepatitis Vaccines Case Study BH is a 67 y/o female with T2 DM for
More informationWhat s New in Type 2? Peter Hammond Consultant Physician Harrogate District Hospital
What s New in Type 2? Peter Hammond Consultant Physician Harrogate District Hospital Therapy considerations in T2DM Thiazoledinediones DPP IV inhibitors GLP 1 agonists Insulin Type Delivery Horizon scanning
More informationThe Burden of the Diabetic Heart
The Burden of the Diabetic Heart Dr. Ghaida Kaddaha (MBBS, MRCP-UK, FRCP-london) Diabetes Unit Rashid Hospital Dubai U.A.E Risk of CVD in Diabetes Morbidity and mortality from CVD is 2-4 fold higher than
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 informationPre-diabetes. Pharmacological Approaches to Delay Progression to Diabetes
Pre-diabetes Pharmacological Approaches to Delay Progression to Diabetes Overview Definition of Pre-diabetes Risk Factors for Pre-diabetes Clinical practice guidelines for diabetes Management, including
More informationManagement of Diabetes
Management of Diabetes Mellitus: Which Drugs for Which Patients? Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine baron@medicine.ucsf.edu Disclosure No relevant financial relationships
More informationCONTROLLO GLICEMICO E RISCHIO CARDIOVASCOLARE. AGOSTINO CONSOLI DMSI - Università d Annunzio CHIETI ITALY. sul Paziente ad alto rischio CV*
CONTROLLO GLICEMICO E RISCHIO CARDIOVASCOLARE AGOSTINO CONSOLI DMSI - Università d Annunzio CHIETI ITALY sul Paziente ad alto rischio CV* Does reducing hyperglycemia protect against cardiovascular risk?
More informationDIABETES DEBATE - IS NEW BETTER?
DIABETES DEBATE - IS NEW BETTER? WHAT MEDICATION CLASS AFTER METFORMIN TO CONTROL BLOOD SUGAR Dr. Lydia Hatcher, MD, CCFP, FCFP, CHE, D-CAPM Associate Clinical Professor of Family Medicine, McMaster Chief
More informationEffective Health Care
Number 8 Effective Health Care Comparative Effectiveness and Safety of Oral Diabetes Medications for Adults With Type 2 Diabetes Executive Summary Background Type 2 diabetes is characterized by insulin
More informationPharmacology 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 informationModulating the Incretin System: A New Therapeutic Strategy for Type 2 Diabetes
Modulating the Incretin System: A New Therapeutic Strategy for Type 2 Diabetes Geneva Clark Briggs, PharmD, BCPS Adjunct Professor at University of Appalachia College of Pharmacy Clinical Associate, Medical
More informationFinding the sweet spot: Individualized targets for older adults with Type 2 DM
Finding the sweet spot: Individualized targets for older adults with Type 2 DM Samuel C. Durso, M.D., M.B.A. Mason F. Lord Professor of Medicine Director, Division of Geriatric Medicine and Gerontology
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 informationDr Tahseen A. Chowdhury Royal London Hospital. New Guidelines in Diabetes: NICE or Nasty?
Dr Tahseen A. Chowdhury Royal London Hospital New Guidelines in Diabetes: NICE or Nasty? I have no conflicts of interest I do not undertake talks / advisory bodies / research for any pharma company Consultant
More informationMANAGING DIABETES IN 2016 WHAT TO ADD, WHEN AND WHY?
MANAGING DIABETES IN 2016 WHAT TO ADD, WHEN AND WHY? Faculty: Maria Wolfs MD, MHSc, FRCPC Assistant Professor, University of Toronto Staff Endocrinologist, St. Michael's Hospital Relationships with commercial
More informationDISCLOSURES. Learning objectives NAVIGATING THE TREATMENT OF TYPE 2 DIABETES: WHAT S NEW? Investigator Initiated Trial Support:
NAVIGATING THE TREATMENT OF TYPE 2 DIABETES: WHAT S NEW? Jane E-B Reusch MD Professor of Medicine, Biochemistry and Bioengineering Associate Director Center for Women s Health Research University of Colorado
More informationPathogenesis of Type 2 Diabetes
9/23/215 Multiple, Complex Pathophysiological Abnmalities in T2DM incretin effect gut carbohydrate delivery & absption pancreatic insulin secretion pancreatic glucagon secretion HYPERGLYCEMIA? Pathogenesis
More informationOld oral antidiabetic agents in the armamentarium of diabetes mellitus treatment: Safety and efficacy
Old oral antidiabetic agents in the armamentarium of diabetes mellitus treatment: Safety and efficacy Melpomeni Peppa Assistant Professor of Endocrinology 2 nd Dept of Internal Medicine-Propaedeutic, Athens
More informationAn Update on Guidelines and Evidence of the Treatment of Type 2 Diabetes Mellitus
Nevada Academy of Family Physicians 29 th Annual Summer CME Meeting August 3 5, 2018 An Update on Guidelines and Evidence of the Treatment of Type 2 Diabetes Mellitus Presented by: James D. Honeycutt,
More informationWhat s New in Diabetes Treatment. Disclosures
What s New in Diabetes Treatment Shiri Levy M.D. Henry Ford Hospital Senior Staff Physician Service Chief, West Bloomfield Hospital Endocrinology, Metabolism, Bone and Mineral Disorders Disclosures None
More informationUpdate on CVD and Microvascular Complications in T2D
Update on CVD and Microvascular Complications in T2D Jay S. Skyler, MD, MACP Division of Endocrinology, Diabetes, and Metabolism and Diabetes Research Institute University of Miami Miller School of Medicine
More informationAge-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes
Age-adjusted Percentage of U.S. Adults Who Were Obese or Who Had Diagnosed Diabetes Obesity (BMI 30 kg/m 2 ) 1994 2000 2009 No Data 26.0% Diabetes 1994 2000 2009
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 informationWayne Gravois, MD August 6, 2017
Wayne Gravois, MD August 6, 2017 Americans with Diabetes (Millions) 40 30 Source: National Diabetes Statistics Report, 2011, 2017 Millions 20 10 0 1980 2009 2015 2007 - $174 Billion 2015 - $245 Billion
More 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 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 informationJoslin Diabetes Center Advances in Diabetes and Thyroid Disease 2013 Noninsulin Treatment of Diabetes: What the PCP Needs to Know
Non Insulin Treatment of Type 2 Diabetes: What the PCP Needs to Know Martin J. Abrahamson, MD Senior Vice President for Medical Affairs Joslin Diabetes Center Associate Professor of Medicine Harvard Medical
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 Mellitus: Overview and Guidelines
Diabetes Mellitus: Overview and Guidelines Rezvan Salehidoost, M.D., Endocrinologist Abidi Diabetes Master Class IMPORTANCE? Why is it interesting to do research in diabetes J. Olefsky, JAMA 2001:285:628-632
More informationEugene Barrett M.D., Ph.D. University of Virginia 6/18/2007. Diagnosis and what is it Glucose Tolerance Categories FPG
Diabetes Mellitus: Update 7 What is the unifying basis of this vascular disease? Eugene J. Barrett, MD, PhD Professor of Internal Medicine and Pediatrics Director, Diabetes Center and GCRC Health System
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 informationPharmacology Updates. Quang T Nguyen, FACP, FACE, FTOS 11/18/17
Pharmacology Updates Quang T Nguyen, FACP, FACE, FTOS 11/18/17 14 Classes of Drugs Available for the Treatment of Type 2 DM in the USA ### Class A1c Reduction Hypoglycemia Weight Change Dosing (times/day)
More 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 informationInitiation and Titration of Insulin in Diabetes Mellitus Type 2
Initiation and Titration of Insulin in Diabetes Mellitus Type 2 Greg Doelle MD, MS April 6, 2016 Disclosure I have no actual or potential conflicts of interest in relation to the content of this lecture.
More informationWhat s the Goal? Individualizing Glycemic Targets. Matthew Freeby M.D. December 3 rd, 2016
What s the Goal? Individualizing Glycemic Targets Matthew Freeby M.D. December 3 rd, 2016 Diabetes Mellitus: Complications and Co-Morbid Conditions Retinopathy Between 2005-2008, 28.5% of patients with
More informationIMPROVED DIAGNOSIS OF TYPE 2 DIABETES AND TAILORING MEDICATIONS
IMPROVED DIAGNOSIS OF TYPE 2 DIABETES AND TAILORING MEDICATIONS Dr Bidhu Mohapatra, MBBS, MD, FRACP Consultant Physician Endocrinology and General Medicine Introduction 382 million people affected by diabetes
More informationReviewing Diabetes Guidelines. Newsletter compiled by Danny Jaek, Pharm.D. Candidate
Reviewing Diabetes Guidelines Newsletter compiled by Danny Jaek, Pharm.D. Candidate AL AS KA N AT IV E DI AB ET ES TE A M Volume 6, Issue 1 Spring 2011 Dia bet es Dis pat ch There are nearly 24 million
More informationSulfoniluree e glinidi: pro e contro
Sulfoniluree e glinidi: pro e contro Giorgio Sesti Università Magna Graecia di Catanzaro ITALY T2DM anti-hyperglycaemic therapy: general recommendations Diabetes Care 35:1364-1379, 2012; Diabetologia 55:1577-1596,
More informationHEALTH SERVICES POLICY & PROCEDURE MANUAL
PAGE 1 of 5 PURPOSE To assure that DOP inmates with Diabetes are receiving high quality Primary Care for their condition. POLICY All DOP Primary Care Providers are to follow these guidelines when treating
More informationWhat s New on the Horizon: Diabetes Medication Update
What s New on the Horizon: Diabetes Medication Update Outline of Talk Newly released and upcoming medications: the incretins, DPP-IV inhibitors, and what s coming Revised ADA/EASD and AACE guidelines:
More informationMANAGING DIABETES IN 2017 WHAT TO ADD, WHEN AND WHY? December 8, 2017 Maria Wolfs MD MHSc FRCPC
MANAGING DIABETES IN 2017 WHAT TO ADD, WHEN AND WHY? December 8, 2017 Maria Wolfs MD MHSc FRCPC Faculty Disclosure Faculty: Maria Wolfs MD, MHSc, FRCPC Assistant Professor, University of Toronto Endocrinologist,
More informationNo disclosures. Diabetes Test Topics. Case #1. Diabetes Family Medicine Board Review: Improving Clinical Care Across the Lifespan
Diabetes Family Medicine Board Review: Improving Clinical Care Across the Lifespan No disclosures Sarah Kim, MD Assistant Clinical Professor of Clinical Medicine, UCSF Division of Endocrinology, SFGH March
More informationManagement of Hyperglycemia in Type 2 Diabetes Celeste C. Thomas MD, MS
Management of Hyperglycemia in Type 2 Diabetes Celeste C. Thomas MD, MS Disclosures In compliance with the accrediting board policies, the American Diabetes Association requires the following disclosure
More informationComparative Effectiveness and Safety of Diabetes Medications for Adults with Type 2 Diabetes
Draft Comparative Effectiveness Review Comparative Effectiveness and Safety of Diabetes Medications for Adults with Type Diabetes Prepared for: Agency for Healthcare Research and Quality U.S. Department
More informationDiabetes Drugs and Cardiac Disease. Disclosures
Diabetes Drugs and Cardiac Disease Robert J. Rushakoff, MD Professor of Medicine University of California, San Francisco robert.rushakoff@ucsf.edu Disclosures None 1 Written Comments As I have said every
More information