Diabetes It s not just sugar
|
|
- Alvin Sullivan
- 6 years ago
- Views:
Transcription
1 HeartWise 2014 April 11, 2014 Matthew A. Sauder, MD LG Health Physicians Diabetes and Endocrinology Diabetes It s not just sugar Objectives Review the link between diabetes and cardiovascular disease Discuss diabetic dyslipidemia Explore the pharmacologic strategies to obtain glycemic control. 1
2 Diabetes and Risk of Heart Disease Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies Emerging Risk Factors Collaboration, Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, Ingelsson E, Lawlor DA, Selvin E, Stampfer M, Stehouwer CD, Lewington S, Pennells L, Thompson A, Sattar N, White IR, Ray KK, Danesh J. Lancet. 2010;375(9733):2215 Women > Men Women: HR 2.59 (95% CI ) Men: HR 1.89 (95% CI ) Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies Emerging Risk Factors Collaboration, Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, Ingelsson E, Lawlor DA, Selvin E, Stampfer M, Stehouwer CD, Lewington S, Pennells L, Thompson A, Sattar N, White IR, Ray KK, Danesh J. Lancet. 2010;375(9733):2215 Effects of Various Interventions Sattar. Revisiting the links between glycemia, diabetes, and cardiovascular risks. Diabetologia. (2013) 56:
3 Glycemic Control and CV disease Several recent trials (ACCORD, ADVANCE, VADT) did not show a cardiovascular benefit for intensive control No single diabetic drug has definitively been shown to reduced CV events Legacy effect Metformin?? Cycloset?? Steno-2 8 year study 160 diabetic patients with microalbuminuria Intensive vs. Conventional treatment Treated intensely with A1c targets, lipid targets, BP targets, and Aspirin vs standard of care Gaede, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. NEJM Jan 30;348(5): Gaede, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. NEJM Jan 30;348(5):
4 Steno - 2 Primary endpoint: Cardiovascular events Gaede, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. NEJM Jan 30;348(5): Steno - 2 Gaede, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. NEJM Jan 30;348(5): Interventions to Reduce CAD Diet Exercise ASA (when indicated) Blood pressure control Lipid management Smoking cessation 4
5 Microalbuminuria It is not just nephropathy It is strongly associated with coronary artery disease (even if there is no diabetes) Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, HalléJP, Young J, Rashkow A, Joyce C, Nawaz S, Yusuf S, HOPE Study Investigators. JAMA. 2001;286(4):421 Diabetic Dyslipidemia Hypoglycemia begets hypoglycemia Hyperglycemia begets hyperglycemia Hyperglycemia begets dyslipidemia Case 1 52 yo with a history of obesity, diabetes, hypertension, fatty liver disease PE: BMI 43. BP 138/88 Meds: Metformin, Lisinopril, HCTZ, Glyburide, Labs: AST 47, ALT 42, A1c 9.3. Cholesterol: Total cholesterol 210, HDL 34, Triglycerides are 390, Calculated LDL 98 5
6 What is the best medication for his dyslipidemia? A.) Niacin B.) Fenofibrate C.) Statin D.) Fix the glucose first E.) Fish oil Tenenbaum and Fisman Cardiovascular Diabetology 2012, 11:125 Supremacy of Statins 20% risk reduction for every 40 points of LDL lowering in diabetics, no matter what the baseline lipid levels NNT to avoid a vascular event 25 Cholesterol Treatment Trailist Collaborators. Efficacy of Cholesterol lowering in people with diabetes in 14 randomised trials of statins: a meta-analysis Lancet 2008: 371:
7 But don t statins cause diabetes? Statins and Diabetes Sattar et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomized statin trials. Lancet 2010: 375: Statins and Diabetes Incident diabetes: 1:255 New vascular events: 5.4 events per 255 patients 7
8 Case 2 60 yo male with uncontrolled DM2, dyslipidemia, and hypertension Meds: Lisinopril, Atorvastatin, Glyburide A1c 10.1 Total cholesterol: 200 HDL: 48 LDL: 70 Triglycerides: 410 What is the next step in management? 1.) Fenofibrate 2.) Niacin 3.) Lower glucose 4.) Colesevalem Hypertriglyceridemia Marker of ectopic fat Glycemic control can have a huge effect Diet: (depends on the level) Less data to suggest specific therapy aimed at lowering triglycerides (caveat: low HDL group) 8
9 Benefits of Glycemic Control Improved lipid control Prevention of Nephropathy Prevention of Retinopathy Prevention of Neuropathy Slows the rate of complications Diet is the heart and soul of this thing Bariatric surgery The intervention that is most likely to put diabetes in remission 9
10 9:22 Metformin Sulfonylureas Meglitinides Alpha-glucosidase inhibitors Thiazolidinediones GLP-1 agonists SGLT-2 inhibitors Cabergoline Bile acid sequestrants Symlin Insulin Holy Grail of Diabetes Meds Helps to preserve beta cells Prevents heart disease Robustly lowers glucose and A1c No hypoglycemia Promotes weight loss No side effects Cheap Antihyperglycemic therapy in type 2 diabetes: general recommendations. Inzucchi S E et al. Dia Care 2012;35: Copyright 2011 American Diabetes Association, Inc. 10
11 Drugs and Hypoglycemia 100,000 Emergency Room visits secondary to drug adverse effects every year for people over 65 ½ of these are in persons over 80 4 medications composed 67% of these admissions Warfarin 33% Insulin 14% Anti-platelet 13% Oral hypoglycemics 11% Budnitz et al. Emergency Hospitalizations for Adverse Drug Events in Older Americans. New England Journal of Medicine 2011; 365: Metformin 11
12 Case 3 47 yo male presents for diabetes. He is frustrated by his weight and inability to control glucoses. He tries to limit carbs but says his appetite is voracious. Current meds: Metformin BMI 43 A1c 8.6, Cr 1.0, ALT 14 What s the best med? 1.) Insulin 2.) Sulfonylurea 3.) DPP-IV 4.) GLP-1 agonist 5.) TZD How to decide? Efficacy Weight Side effects Hypoglycemia Cheap Insulin High Gain Hypo High risk +/- Sulfonylurea High Gain Hypo Interm risk Very cheap DPP-IV Intermed Neutral Rare Minimal Expensive GLP-1 Agonist High Loss GI Minimal Expensive TZD s High Gain Edema, CHF, osteoporosis Minimal Now generic 12
13 Insulin Efficacy: Highest Hypoglycemia: The most Weight: Weight gain is common Adverse effects: Hypoglycemia. No risk of cancer. Cost: Variable/expensive Avoid clinical inertia. Sulfonylureas Glipizide, Glimiperide, and Glyburide Efficacy: About 1% Hypoglycemia: Common Weight: Weight loss is common Adverse effects: Hypoglycemia. Increased cardiovascular events?? Cost: Inexpensive Do not use Glyburide with impaired renal function DPP-IV s Sitagliptin, Saxagliptin, Linagliptin, Alogliptin Efficacy: Intermediate ( %) Hypoglycemia: Very little Weight: Neutral Adverse effects: Pretty rare. Cost: Expensive Ideal situation: Elderly patient with an A1c of 8.3 and multiple comorbidities 13
14 TZD s Pioglitazone (Actos) and Rosiglitzone (Avandia) Efficacy: Very good (1 1.5%) Hypoglycemia: Very little Weight: Weight gain is common Adverse effects: Edema, HF, weight gain, fractures, cardiac???, bladder ca? Cost: $10 a month at Costco (generic) One of the only insulin sensitizers GLP-1 in DM2 Adapted from Nauck M, Stockmann F, Ebert R, Creutzfeldt W. Reduced incretin effect in type 2 (non-insulin-dependent) diabetes. Diabetologia Jan; 29(1): GLP-1 Agonists Once weekly exenatide (Bydureon) Once daily liraglutide (Victoza) Twice daily exenatide (Byetta) ~ 1% reduction in A1c ( %) Head to head: Greater A1c reduction than DPP-IV, TZD, sulfonylurea, and insulin Weight loss ( 2.8 kg, 3.4 to 2.3;18 trials) - - Shyangdan DS, Royle P, Clar C, Sharma P, Waugh N, Snaith A Glucagon- like pep>de analogues for type 2 diabetes mellitus. Cochrane Database Syst Rev Visboll et al. Effects of glucagon- like pep3de- 1 receptor agonists on weight loss: systema3c review and meta- analyses of randomised controlled trials. BMJ 2012;344:
15 Effects of GLP-1 Stimulates glucose-dependent insulin secretion Suppresses glucagon Slows gastric emptying Increases satiety (and/or nausea) Increases Beta-cell proliferation?? GLP-1 Agonists Adverse Effects GI side effects (8-40%): Less common for the longer acting preparations Hypoglycemia: rare but increased when combined with sulfonylureas or insulin Exenatide-once weekly and injection site reactions Long-acting formulations and C-cell tumor (species-specific) Renal disease Pancreatitis GLP-1 and Pancreatic Safety February 27, 2014 FDA and EMA (European Medicines Agency) Casual relationship with pancreatitis is not supported by the evidence Research will continue Egan, et al. Pancrea>c Safety of Incre>n Based Drugs- FDA and EMA assessment. N Engl J Med 2014; 370:
16 Case 4 48 yo white female presents with uncontrolled diabetes. A1c is 7.8. She is tolerating Metformin. She is very concerned about weight and absolutely refuses any medication that will cause weight gain. She has a history of recurrent pancreatitis. She has a family history of MEN 2A. What medication would you choose? A. Glimeperide (Amaryl) B. Pioglitazone (Actos) C. Canagliflozin (Invokana) D. Nateglinide (Starlix) E. Bromocriptine (Cycloset) 16
17 Meglitinides Repaglinide (Prandin) and Nateglinide (Starlix) Efficacy: 1% Hypoglycemia: Common Weight: Weight gain is common Adverse effects: Hypoglycemia. Cost: Now generic Can be used with other agents SGLT Inhibitors Canagliflozin (Invokana), Dapagliflozin (Forxiga) Efficacy: Intermediate Hypoglycemia: Very limited Weight: Weight loss is common Adverse effects: UTI s. Yeast infections. Cost: Expensive SGLT-2 Physiology 17
18 SGLT-2 Inhibitor A1c reduction of about 0.5% - 1.0% Weight loss of about 2-3 kg Blood pressure reduction of 2-5 mmhg Rosenwasser et al. SGLT-2 inhibitors and their potential in the treatment of diabetes. Diabetes Metabolic Syndrome Obesity 2013 Nov 27;6: Adverse Effects Do not use if GFR>45 Genital mycotic infections (7% in females, 2.5% in males) Slight increase in UTI s (2-13%) Very low rate of hypoglycemia (unless used with a sulfonylurea) Low rate of orthostatic hypotension Rosenwasser et al. SGLT-2 inhibitors and their potential in the treatment of diabetes. Diabetes Metabolic Syndrome Obesity 2013 Nov 27;6: Others Colesevelem (Welchol): A1c reduction of about 0.5% Bromocriptine (Cycloset): A1c reductin of about %. Some GI side effects 18
19 Case 5 43 yo white male presents with a 6 month history of weight loss, polyuria, and fatigue. Glucose in the office is 346. A1c = 11.4 What is the preferred treatment? 1.) Metformin 2.) Glipizide 3.) Liraglutide (Victoza) 4.) Insulin 5.) Canagliflozin (Invokana) Summary Good diabetes care involves targeting all cardiovascular risk factors Management of diabetic dyslipidemia is at the core of cardiac prevention There is an expanding array of options for diabetes and therapy should be individualized 19
Type 2 Diabetes: Where Do We Start with Treatment? DIABETES EDUCATION. Diabetes Mellitus: Complications and Co-Morbid Conditions
Diabetes Mellitus: Complications and Co-Morbid Conditions ADA Guidelines for Glycemic Control: 2016 Retinopathy Between 2005-2008, 28.5% of patients with diabetes 40 years and older diagnosed with diabetic
More 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 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 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 informationOral and Injectable Non-insulin Antihyperglycemic Agents
Appendix 5: Diabetes Education and Medical Management in Adults with Diabetes Oral and Injectable Non-insulin s This directive will be implemented by RPhs, RNs or RDs who have been deemed authorized implementers.
More informationDiabetes 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 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 informationOral 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 informationDIABETES. overview of pharmacologic agents used in the management of. Overview 4/3/2014 OBJECTIVES. Injectable Agents
overview of pharmacologic agents used in the management of DIABETES Kyle Roberts, Pharm.D. PGY-1 Pharmacy Resident Saint Alphonsus RMC 1. List the different classes of diabetes medications, including the
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 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 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 Oral Agents Pharmacology. University of Hawai i Hilo Pre-Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D
Diabetes Oral Agents Pharmacology University of Hawai i Hilo Pre-Nursing Program NURS 203 General Pharmacology Danita Narciso Pharm D 1 Learning Objectives Understand the role of the utilization of free
More informationDM Fundamentals Class 4 Meds for Type 2
DM Fundamentals Class 4 Meds for Type 2 Beverly Thomassian, RN, MPH, BC ADM, CDE President, Diabetes Education Services Copyright 1999 2015, Diabetes Education Services, All Rights Reserved. Diabetes Meds
More 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 informationDM Fundamentals Class 4 Meds for Type 2
DM Fundamentals Class 4 Meds for Type 2 Beverly Thomassian, RN, MPH, BC ADM, CDE President, Diabetes Education Services Copyright 1999 2015, Diabetes Education Services, All Rights Reserved. Diabetes Meds
More informationWhat 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 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 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 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 informationRPCC Pharmacy Forum. The Type 2 Diabetes Issue. Type 2 Diabetes: The Basics
Nov/Dec 2015 Issue 11 RPCC Pharmacy Forum Special Interest Articles: Diabetes Medication Chart Insulin Chart Afreeza Did you know? Exanatide, marketed as Byetta, is the synthetic form of exendin-4, which
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 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 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 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 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 informationObjectives. Recognize all available medical treatment options for diabetes. Individualize treatment and glycemic target based on patient factors
No disclosure Objectives Recognize all available medical treatment options for diabetes Individualize treatment and glycemic target based on patient factors Should be able to switch to more affordable
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 informationTable 1. Antihyperglycemic agents for use in type 2 diabetes
Table 1. Antihyperglycemic agents for use in type 2 diabetes DRUG IN ALPHA-GLUCOSIDASE INHIBITOR: inhibits pancreatic alpha-amyle and intestinal alpha-glucoside Acarbose (Glucobay) 0.6% Negligible Not
More informationDiabetes Mellitus in Older Adults. Presenter Disclosure Information
Diabetes Mellitus in Older Adults Medha Munshi, M.D. Joslin Diabetes Center Beth Israel Deaconess Medical Center Harvard Medical School Presenter Disclosure Information Medha Munshi Research grant from
More informationClinical Cases in Diabetes Management. Joseph Cook D.O.
Clinical Cases in Diabetes Management Joseph Cook D.O. Objectives State the prevalence of Diabetes Mellitus in Ohio State the percentage of diabetic patients in the U.S. treated by Primary Care Physicians
More informationDiabetes Management in CAD Patients. Stuart R. Chipkin, MD Research Professor School of Public Health and Health Sciences University of Massachusetts
Diabetes Management in CAD Patients Stuart R. Chipkin, MD Research Professor School of Public Health and Health Sciences University of Massachusetts Disclosure Stuart R. Chipkin, MD, FACE Nothing to disclose
More information6/1/2018. Lou Haenel, IV, DO, FACE, FACOI Endocrinology Roper St Francis Charleston, SC THE OMINOUS OCTET: HOW PATHOPHYSIOLOGY AND THERAPY MERGE
Lou Haenel, IV, DO, FACE, FACOI Endocrinology Roper St Francis Charleston, SC THE OMINOUS OCTET: HOW PATHOPHYSIOLOGY AND THERAPY MERGE 1 2 3 Sulfonylureas Glipizide Glyburide Glimeperide 4 Metformin Gold
More 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 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 informationLearning and Earning with Gateway Professional Education CME/CEU Webinar Series. Diabetes Update July 6, :00pm 1:00pm
Learning and Earning with Gateway Professional Education CME/CEU Webinar Series Diabetes Update July 6, 2017 12:00pm 1:00pm Jennifer Pennock Holst, MD Endocrinology, Diabetes & Metabolism AHN Center for
More informationDiabetes Medication Updates Erica Bukovich, PharmD, BC-ADM, CDE September 20, 2018
Diabetes Medication Updates Erica Bukovich, PharmD, BC-ADM, CDE September 20, 2018 Learning Objectives Identify medication classes available for treatment of individuals with diabetes. Demonstrate understanding
More informationOral Medication for the Management of Diabetes Mechanism of. Duration of Daily Dosing Action
Glyburide (Micronase, Diabeta, Glynase) Glipizide (Glucotrol) Glipizide XL (Glucotrol XL) Glimepiride (Amaryl) Prandin (Repaglinide) Starlix (Nateglinide) 1.25, 2.5, 5mg tabs, Dosing: 2.5-20 mg 12- (Glynase:
More informationNew Therapies for Diabetes
Type 2 diabetes is increasingly prevalent New Therapies for Diabetes Lynn Mack, M.D. Associate Professor Diabetes, Endocrinology, & Metabolism The Nebraska Medical Center lmack@unmc.edu No Conflicts of
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 informationDr A Pokrajac MD MSc MRCP Consultant
Dr A Pokrajac MD MSc MRCP Consultant Onset at 5-15 years of T1DM Can be present at diagnosis of T2DM Detect in regular MA/Cr screening (2X first urine sample, no UTI, no other causes) Contributing Factors
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 informationJonathan Stoehr, MD PhD Endocrinology, Diabetes, Metabolism and Nutrition Virginia Mason Medical Center Seattle, WA 2012 Virginia Mason Medical
Jonathan Stoehr, MD PhD Endocrinology, Diabetes, Metabolism and Nutrition Virginia Mason Medical Center Seattle, WA There is no conflict of interest that could be perceived as prejudicing the impartiality
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 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 informationRebecca Newberry APRN MS CDE
Current Diabetes Medications Nursing Implications and Applications Rebecca Newberry APRN MS CDE Methodist Center for Diabetes and Nutritional Health Disclosures Objectives Speakers Bureaus/Consulting Board
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 informationSociety for Ambulatory Anesthesia Consensus Statement on Perioperative Blood Glucose Management in Diabetic Patients Undergoing Ambulatory Surgery
Society for Ambulatory Anesthesia Consensus Statement on Perioperative Blood Glucose Management in Diabetic Patients Undergoing Ambulatory Surgery Girish P. Joshi, MB BS, MD, FFARCSI Anesthesia & Analgesia
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 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 informationTYP 2 DIABETES. Marc Donath
TYP 2 DIABETES Marc Donath Treatment of Typ 2 Diabetes GLP-1 Anti-IL-1β Insulin sulfonylureas Metformin UCP-1 IL-1β Sport SGLT2i Bariatric surgery Cardiomyocytes Control Glucose Dyntar et al. Diabetes
More informationDiabetes 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 informationOverview T2DM medications. Winnie Ho
Overview T2DM medications Winnie Ho Diabetes in Australia 1.7 million Australians with diabetes, of these 85% have T2DM 2-fold excess risk CV death in patients with diabetes Risk factor for progression
More informationNon-Insulin Diabetes Medications Summary
Non-Insulin Diabetes Medications Summary Medications marked with an asterisk (*) can cause hypoglycemia INSULIN SECRETAGOGUES Sulfonylureas* GLYBURIDE* (Diabeta) (Micronase) production. Side effects: Potential
More informationDisclosure. Learning Objectives. Case. Diabetes Update: Incretin Agents in Diabetes-When to Use Them? I have no disclosures to declare
Disclosure Diabetes Update: Incretin Agents in Diabetes-When to Use Them? I have no disclosures to declare Spring Therapeutics Update 2011 CSHP BC Branch Anar Dossa BScPharm Pharm D CDE April 20, 2011
More informationDiabesity. Metabolic dysfunction that ranges from mild blood glucose imbalance to full fledged Type 2 DM Signs
Diabesity Metabolic dysfunction that ranges from mild blood glucose imbalance to full fledged Type 2 DM Signs Abdominal obesity Low HDL, high LDL, and high triglycerides HTN High blood glucose (F>100l,
More informationWhat the Pill Looks Like. How it Works. Slows carbohydrate absorption. Reduces amount of sugar made by the liver. Increases release of insulin
Diabetes s Oral s - Pills These are some of the pills that are currently available in Canada to treat diabetes. Each medication has benefits and side effects you should be aware of. Your diabetes team
More informationEarly treatment for patients with Type 2 Diabetes
Israel Society of Internal Medicine Kibutz Hagoshrim, June 22, 2012 Early treatment for patients with Type 2 Diabetes Eduard Montanya Hospital Universitari Bellvitge-IDIBELL CIBERDEM University of Barcelona
More informationType 2 Diabetes Mellitus hypoglycaemic agents
Type 2 Diabetes Mellitus hypoglycaemic agents Name Metformin Drug Name (eg brand name) Metformin (Diaformin Diabex) Cost / PBS per 28d mth $10.24 (1.5g dly) 1000mg+500mg / $4.44+$5.80 Concerns? Lactic
More informationDrug Class Review Newer Diabetes Medications and Combinations
Drug Class Review Newer Diabetes Medications and Combinations Final Update 2 Report July 2016 The purpose reports is to make available information regarding the comparative clinical effectiveness and harms
More 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 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 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 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 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 informationTreatment Options for Diabetes: An Update
Treatment Options for Diabetes: An Update A/Prof. Marg McGill Manager, Diabetes Centre Dr. Ted Wu Staff Specialist Endocrinologist Diabetes Centre Centre of Health Professional Education Education Provider
More 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 informationGlucose Control drug treatments
Glucose Control drug treatments It should be noted that glitazones are under suspicion of precipitating acute cardiac events and current recommendations contraindicate the use of glitazones in patients
More information9/29/ Disclosure. Learning Objectives. Diabetes Update: Guidelines, Treatment Options & Trends
+ Diabetes Update: Guidelines, Treatment Options & Trends Melissa Max, PharmD, BC-ADM, CDE Assistant Professor of Pharmacy Practice Harding University College of Pharmacy + Disclosure Conflicts Of Interest
More informationDipeptidyl-Peptidase 4 (DPP-4) Inhibitors Drug Class Prior Authorization Protocol
Dipeptidyl-Peptidase 4 (DPP-4) Inhibitors Drug Class Prior Authorization Protocol Line of Business: Medicaid P&T Approval Date: February 21, 2018 Effective Date: April 1, 2018 This policy has been developed
More informationDIABETES. Mary Bruskewitz APNP, MS, BC-ADM Clinical Nurse Specialist Diabetes. November 2013
DIABETES Mary Bruskewitz APNP, MS, BC-ADM Clinical Nurse Specialist Diabetes November 2013 mbruskewitz@outlook.com Objectives Part 1 Overview of Endocrine Physiology Pathophysiology of Diabetes Diabetes
More informationChoosing a Diabetes Strategy Where to Start and Where to Go
Choosing a Diabetes Strategy Where to Start and Where to Go Erin Keely, MD, FRCPC; and Sharon Brez, RN, BScN, MA(Ed), CDE As presented at the University of Ottawa's 52nd Annual Refresher Course for Family
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 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 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 informationDiabetes Medications: Oral Anti-Hyperglycemic Medications
Diabetes Medications: Oral Anti-Hyperglycemic Medications Medication Types 1. Biguanides 2. Sulfonylureas 3. Thiazolidinediones (TZDs) 4. Alpha-Glucosidase Inhibitors 5. D-Phenylalanine Meglitinides 6.
More informationIndividualizing Care for Patients with Type 2 Diabetes
Individualizing Care for Patients with Type 2 Diabetes Disclosures Speaker: AstraZeneca, Novo Nordisk, BI/Lilly, Valeritas, Takeda Advisor: Tandem Diabetes, Sanofi Objectives Develop individualized approaches
More informationIntensification of Diabetic Therapy. Case studies
Intensification of Diabetic Therapy Case studies Patient #1 1 st visit: 64 year old male, H/O prediabetes, lost weight 280 lbs. to 240 lbs. ER for dental abscess, glucose >300 A1C 11.4%, no diabetic medication,
More information4/9/2018 HOW TO REGULATE DIABETES MEDICATIONS. By Sarah Froemsdorf MSN, RNC, CDE, FNP DISCLOSURES NONE. Diagnosis
HOW TO REGULATE DIABETES MEDICATIONS By Sarah Froemsdorf MSN, RNC, CDE, FNP DISCLOSURES NONE Diagnosis 1 NORMAL BODY The normal pancreas releases one unit of insulin every hour all day. The normal pancreas
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, Drugs and Dangerous Discrepancies. Sally Bodenhamer, OD, OT/L, CDE
Diabetes, Drugs and Dangerous Discrepancies Sally Bodenhamer, OD, OT/L, CDE I have no disclosures Disclosures $245 BILLION American DM ASSOC 2012 cost of Diabetes Economic Costs of Diabetes in the U.S.
More informationProfessor 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 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 informationNewer Drugs in the Management of Type 2 Diabetes Mellitus
Newer Drugs in the Management of Type 2 Diabetes Mellitus Dr. C. Dinesh M. Naidu Professor of Pharmacology, Kamineni Institute of Medical Sciences, Narketpally. 1 Presentation Outline Introduction Pathogenesis
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 informationMultiple 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 informationDiabetes Management: A diagnostic perspective
Diabetes Management: A diagnostic perspective Images: http://www.engadget.com/2009/09/23/bayer-introduces-countour-usb-glucose-meter/ http://www.medtronicdiabetes.com/treatment-and-products/minimed-530g-diabetes-system-with-enlite
More informationDisclaimers 22/03/2018. Role of DPP-4 Inhibitors, GLP-1 Agonists, and SGLT-2 Inhibitors in the treatment of Diabetes Mellitus Type 2
Disclaimers Role of DPP-4 Inhibitors, GLP-1 Agonists, and SGLT-2 Inhibitors in the treatment of Diabetes Mellitus Type 2 I have not received money or gifts from medical device companies or from the pharmaceutical
More informationDiabetes Update Bryan Heart Conference September 5, 2015 Shannon Wakeley, MD. Disclosures. Objectives 9/1/2015
Diabetes Update Bryan Heart Conference September 5, 2015 Shannon Wakeley, MD Disclosures I speak on behalf of the following companies: Astra Zeneca, Boehringer Ingelheim, Johnson & Johnson, Sanofi and
More informationManagement of Type 2 Diabetes: Should We Change Our Algorithm?
Management of Type 2 Diabetes: Should We Change Our Algorithm? Estimated lifetime risk of developing diabetes for individuals born in the United States in 2000 60 50 Total Non-Hispanic Black Non-Hispanic
More informationPharmacologic Agents for Treatment of Type 2 Diabetes
Pharmacologic Agents for Treatment of Type 2 Diabetes SCAN Drugs Medication Biguanides 1 1 er uncoated tabs 500 mg & 750 mg Sulfonylureas 1 1 500 850 mg QD - TID 500 2000 mg glimepiride 1 1 1 8 mg glipizide
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 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 informationDiabetes Family Medicine Board Review
Diabetes Family Medicine Board Review Sarah Kim, MD Assistant Clinical Professor of Clinical Medicine, UCSF Division of Endocrinology, SFGH March 10, 2016 No disclosures Diabetes Test Topics Majority Type
More informationDiabetes Mellitus: A Cardiovascular Disease
Diabetes Mellitus: A Cardiovascular Disease Nestoras Mathioudakis, M.D. Assistant Professor of Medicine Division of Endocrinology, Diabetes, & Metabolism September 30, 2013 1 The ABCs of cardiovascular
More informationPractical Strategies for the Clinical Use of Incretin Mimetics CME/CE. CME/CE Released: 09/15/2009; Valid for credit through 09/15/2010
Practical Strategies for the Clinical Use of Incretin Mimetics CME/CE Robert R. Henry, MD Authors and Disclosures CME/CE Released: 09/15/2009; Valid for credit through 09/15/2010 Introduction Type 2 diabetes
More informationOBESITY IN TYPE 2 DIABETES
OBESITY IN TYPE 2 DIABETES Ashley Crowl, PharmD, BCACP Assistant Professor University of Kansas Objectives Review how to manage obesity in patients with type-2 diabetes mellitus Compare antiobesity agents
More informationYOU HAVE DIABETES. Angie O Connor Community Diabetes Nurse Specialist 25th September 2013
YOU HAVE DIABETES Angie O Connor Community Diabetes Nurse Specialist 25th September 2013 Predicated 2015 figures are already met 1 in 20 have diabetes:1in8 over 60years old Definite Diagnosis is key Early
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 Family Medicine Board Review
Diabetes Family Medicine Board Review Sarah Kim, MD Associate Clinical Professor of Clinical Medicine, UCSF Division of Endocrinology, SFGH March 21, 2018 No disclosures Diabetes Test Topics Majority Type
More information