Injectable GLP 1 therapy: weight loss effects seen in obesity with and without diabetes

Size: px
Start display at page:

Download "Injectable GLP 1 therapy: weight loss effects seen in obesity with and without diabetes"

Transcription

1 Injectable GLP 1 therapy: weight loss effects seen in obesity with and without diabetes Dr Masud Haq Consultant Lead in Diabetes & Endocrinology Maidstone & Tunbridge Wells NHS Trust & The London Preventative Medicine Center (LPMC) Sat 22 nd Sep 2012

2 Outline Burden of obesity Role of gut hormones in appetite regulation Injectable GLP 1 therapy Weight loss effects in diabetes and obesity Future & Conclusions

3 The global obesity problem Obesity has become a worldwide health issue with a rapidly increasing prevalence

4

5 Global obesity forecast The World Health Organization In billion overweight adults 400 million were obese Prediction by billion overweight adults 700 million will be obese Source: World Health Organisation 2005

6 Obesity health risks Heart disease Strokes Type 2 diabetes Hypertension Raised lipids Premature death Chronic lower back pain Osteoarthritis Cancer Obstructive sleep apnoea Worsening asthma DVTs & venous disease Gall bladder disease Fatty liver Risks to expectant mothers and baby

7 Obesity Due to a state in which energy intake exceeds energy expenditure over a prolonged period of time Current pharmacological treatments result in initial weight loss but effects are often transient In contrast, gastric bypass surgery is an established and effective treatment for obesity, leading to sustained weight loss Mechanism not yet fully understood but several gut hormones have been implicated

8 Following gastric bypass surgery Ghrelin Peptide YY (PYY) Glucagon like peptide 1 (GLP 1) Ability to mimic gut hormone changes following gastric bypass surgery using pharmacological agents offers a novel way of treating obesity

9 Appetite and energy balance regulation between central nervous system (CNS), gastrointestinal tract (GIT), pancreas and adipose tissue (AT). Large box represents hypothalamic nuclei (PVN, paraventricular nucleus; HL, lateral hypothalamus; ARC, arcuate nucleus) with orexigenic neurons (NPY/AgRP, MCH and ORX), anorexigenic neurons (POMC/CART and CRH/TRH) and their connections. Vagus nerve, VG NPY, neuropeptide Y; AgRP, agouti related peptide; POMC, proopiomelanocortin; CART, cocaine and amphetamine regulated transcript; α MSH, melanocyte stimulating hormone (melanocortin); CRH, corticotropin releasing hormone; TRH, thyrotropin releasing hormone; MCH, melanin concentrating hormone; ORX, orexins CCK, cholecystokinin; GLP 1, glucagon like peptide; OXM, oxyntomodulin; PYY, peptide YY. Open circles locations of CB1 receptors of the endocannabinoid system. Adapted from Boguszewski et al, Pol J Endocrinol Vol , 61(2), 2010

10 Gastrointestinal and pancreatic peptides involved in appetite regulation Adapted from Boguszewski et al, Pol J Endocrinol Vol , 61(2), 2010

11 Glucagon like peptide 1 Food Glucagon like peptide 1 (GLP 1) is an incretin hormone GLP 1 is released from intestinal L cells in response to eating Native GLP 1 is rapidly degraded by dipeptidyl peptidase 4 (DPP 4) GLP-1 Drucker DJ, Nauck M. Lancet 2006;368:

12 GLP 1: Multiple physiological effects Increased glucose dependent insulin secretion* Increased insulin synthesis Decreased glucagon secretion Reduced hepatic glucose output *GLP 1 only stimulates insulin secretion when glucose is raised, thereby reducing the risk of hypoglycaemia Promotes satiety and reduces appetite Decreased gastric emptying Increased beta cell proliferation Decreased beta cell apoptosis In in vitro studies Drucker DJ, Nauck M. Lancet 2006;368: Baggio LL, Drucker DJ. Gastroenterol 2007;132:

13 The Incretin Effect is Reduced in Subjects with Type 2 Diabetes The Incretin Effect accounts for ~ 60% of total Insulin release following a meal Control subjects Subjects with type 2 diabetes Insulin (mu/l) * * * * * * * Insulin (mu/l) * * * Time (min) Oral Glucose Time (min) Intravenous Glucose Nauck MA, et al. Diabetologia 1986;29: *P.05 compared with respective value after oral load.

14 Plasma GLP-1 after ingestion of glucose in overnight fasted lean (n = 12) and obese (n = 13) healthy male volunteers Carr et al, JCEM 2010;95:

15 GLP 1 therapy in Type 2 Diabetes

16 Native GLP 1 Native GLP 1 is of little clinical value in the treatment of type 2 diabetes It is rapidly degraded by the enzyme DPP 4, giving it a very short half life ( min) 1 T ½ = min! It would therefore have to be continuously infused to have any clinical effect Vilsbøll T et al. J Clin Endocrinol Metab 2003;88:220 4

17 Incretin-based therapies used in Type 2 Diabetes Oral DPP-4 inhibitors Protect native GLP-1 from inactivation by DPP-4 Injectable GLP-1 receptor agonists Mimic native GLP-1 Sitagliptin Vildagliptin Saxagliptin Linagliptin Exenatide (Exendin 4- based therapy) Exenatide LAR Liraglutide (Human GLP-1 analogue)

18 1. Vilsbøll T et al. Int Diabetes Monit 2009;21: Wajcberg E, Tavaria A. Expert Opin Pharmacother 2009;10: Drucker DJ, Nauck M. Lancet 2006;368: Structure of native GLP 1, liraglutide and exenatide 97% amino acid homology to human GLP % amino acid homology to human GLP 1 2

19 Exenatide (Byetta) R Derived from exendin 4, a peptide isolated from the saliva of the Gila monster lizard native to S. America Exenatide is a synthetic form of exendin 4, approved in the EU in 2006 for type 2 diabetes treatment

20 Exenatide reduces HbA 1c in Type 2 Diabetes Change in HbA 1c (%) With MET With SU With MET + SU With MET + TZD With MET and/or SU MET, metformin SU, sulphonylurea TZD, thiazolidinedione week studies HbA 1c reduced by % with exenatide 2.0 Exenatide (up to 10 μg twice daily) Insulin glargine Placebo Adapted from: Drucker DJ, Nauck M. Lancet 2006;368:

21 Weight loss effects seen in Type 2 Diabetes patients treated with Exenatide Change in body weight (kg) With MET With SU With MET + SU With MET + TZD With MET and/or SU Exenatide (up to 10 μg twice daily) Insulin glargine Placebo MET, metformin SU, sulphonylurea TZD, thiazolidinedione week studies Weight reduced by kg with exenatide Adapted from: Drucker DJ, Nauck M. Lancet 2006;368:

22 Liraglutide (Victoza ) First human GLP 1 analogue Was approved for use in 2009 for treatment of adults with type 2 diabetes 97% homology to human native GLP 1

23 Liraglutide reduces HbA 1c in Type 2 Diabetes Change in HbA 1c (%) With MET 1 With glim 2 With MET + rosi With MET + glim 3 Phase 3 study results from the LEAD programme involving 3978 patients with type 2 diabetes MET, metformin glim, glimepiride rosi, rosiglitazone 26 week studies HbA 1c reduced by % with liraglutide Active comparators: Glimepiride 1 Rosiglitazone 2 Insulin glargine 3

24 Liraglutide often reduces weight With MET 1 With glim 2 With MET + rosi With MET + glim 3 Weight reduction of kg when used with: Metformin Change in weight (kg) Metformin + rosiglitazone Metformin + glimepiride Active comparators: Glimepiride 1 Rosiglitazone 2 Insulin glargine 3 Phase 3 study results from the LEAD programme involving 3978 patients with type 2 diabetes

25 Exenatide and Liraglutide: side effects Very common (10% of patients or more) Nausea Vomiting Diarrhoea Hypoglycaemia (in combination with sulphonylurea) Common (1 9% of patients) Abdominal pain Gastro oesophageal reflux disease Constipation Headache Dizziness

26 GLP 1 therapy in Obesity

27 Effects of Exenatide on Weight and Glucose tolerance in Obesity Subjects with and without Pre diabetes Primary end point results N= ± 0.5 kg N= ±0.5 kg p < N=152 randomised to receive Exenatide or Placebo Baseline weight ± 23, BMI 39.6 ±7, IGT or IFG 25% Rosenstock J Diabetes Care 2010;33(6):

28 Effects of Exenatide on Weight and Glucose tolerance in Obesity Subjects with and without Pre diabetes Secondary end points: Similar changes in blood pressure and lipids in both study groups Most subjects with pre diabetes (IFG or IGT) normalised glucose tolerance at 24 weeks (77% of Exenatide, 56% Placebo) Exenatide Placebo Nausea 25% 4% Diarrhoea 14% 3% Rosenstock J Diabetes Care 2010;33(6):

29 Effects of Liraglutide in the Treatment of Obesity: a randomised, double blind, placebo controlled study Astrup et al Lancet 2009; 374:

30 Changes in mean body weight from screening over 2 years Astrup et al Lancet 2009; 374:

31 Mean changes in body weight and waist circumference Astrup et al Lancet 2009; 374:

32 Percentage of individuals who lost more than 5% and 10% of baseline weight at 2yrs Astrup et al Lancet 2009; 374:

33 Safety and tolerability Most frequent side effects nausea and occasional vomiting Typically transient and at start of treatment > 90% mild to moderate Over 2 years, withdrawal rate from adverse events was 4% in liraglutide treated individuals Astrup et al Lancet 2009; 374:

34 Prevalence of pre diabetes and metabolic syndrome Astrup et al Lancet 2009; 374:

35 Changes in lipids Astrup et al Lancet 2009; 374:

36 Blood pressure and effects on pulse rate from randomisation to 2 yrs Astrup et al Lancet 2009; 374:

37 Future developments: GLP 1 receptor agonists Name (Brand) Developer Status Albiglutide (Syncria) GSK Phase 3; once weekly Lixisenatide (Lyxumia) Sanofi Phase 3; once daily Dulaglutide Eli Lilly Phase 3; once weekly LY Eli Lilly Phase 2; once weekly ITCA 650 Eli Lilly Phase 2; once yearly Exenatide QM Amylin Phase 2; once monthly

38 Conclusions Prevalence of obesity and its associated risks is rising rapidly Convincing evidence that GLP 1 agonists are beneficial in diabetes and leads to sustained weight loss in obese individuals over 2 years Well tolerated with commonest side effects of nausea and occasional vomiting typically being transient Additional benefits on lipids and blood pressure

39

40 Thank you Thank you

41

42 Audit of Exenatide Therapy in Tunbridge Wells DR RAHILA BHATTI, DR CYNTHIA MOHANDAS, DR LUQMAN SARDAR, DR DENNIS BARNES, DR MASUD HAQ SOUTH EAST THAMES PHYSICIANS DIABETES MEETING 11 TH MAY 2012

43 Methods Retrospective analysis. All T2DM patients who were started on Exe from were included in the audit. Demographic data, duration of known diabetes, diabetes medication list, HbA1c and weight (t= 0, 3, 6 and 12 months), side effects of Exe and reasons for discontinuation

44 Baseline Characteristics Total number of patients 117 Male 68% Female 32% Caucasians 100% Mean age (yrs) 58 (39-86) HbA1c (mean mmol/mol) 80 (46-133) HbA1c (mean %) 9.5 ( ) Weight (mean kg) 109 (73-169) BMI (mean kg/m 2 ) 36.9 (30-62)

45 Change in mean HbA1c over one year p < 0.01

46 Change in mean weight over one year

GLP-1 agonists. Ian Gallen Consultant Community Diabetologist Royal Berkshire Hospital Reading UK

GLP-1 agonists. Ian Gallen Consultant Community Diabetologist Royal Berkshire Hospital Reading UK GLP-1 agonists Ian Gallen Consultant Community Diabetologist Royal Berkshire Hospital Reading UK What do GLP-1 agonists do? Physiology of postprandial glucose regulation Meal ❶ ❷ Insulin Rising plasma

More information

Practical 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. 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 information

GLP-1 Receptor Agonists and SGLT-2 Inhibitors. Debbie Hicks

GLP-1 Receptor Agonists and SGLT-2 Inhibitors. Debbie Hicks GLP-1 Receptor Agonists and SGLT-2 Inhibitors Debbie Hicks Prescribing and Adverse Event reporting information is available at this meeting from the AstraZeneca representative The views expressed by the

More information

Management of Type 2 Diabetes

Management of Type 2 Diabetes Management of Type 2 Diabetes Pathophysiology Insulin resistance and relative insulin deficiency/ defective secretion Not immune mediated No evidence of β cell destruction Increased risk with age, obesity

More information

Chief of Endocrinology East Orange General Hospital

Chief 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 information

New Treatments for Type 2 diabetes. Nandini Seevaratnam April 2016 Rushcliffe Patient Forum

New Treatments for Type 2 diabetes. Nandini Seevaratnam April 2016 Rushcliffe Patient Forum New Treatments for Type 2 diabetes Nandini Seevaratnam April 2016 Rushcliffe Patient Forum Overview Growing population of Type 2 diabetes Basic science on what goes wrong Current treatments Why there is

More information

INJECTABLE THERAPY FOR THE TREATMENT OF DIABETES

INJECTABLE THERAPY FOR THE TREATMENT OF DIABETES INJECTABLE THERAPY FOR THE TREATMENT OF DIABETES ARSHNA SANGHRAJKA DIABETES SPECIALIST PRESCRIBING PHARMACIST OBJECTIVES EXPLORE THE TYPES OF INSULIN AND INJECTABLE DIABETES TREATMENTS AND DEVICES AVAILABLE

More information

TREATMENTS FOR TYPE 2 DIABETES. Susan Henry Diabetes Specialist Nurse

TREATMENTS FOR TYPE 2 DIABETES. Susan Henry Diabetes Specialist Nurse TREATMENTS FOR TYPE 2 DIABETES Susan Henry Diabetes Specialist Nurse How can we improve outcomes in Type 2 diabetes? Earlier diagnosis Better patient education Stress central role of lifestyle management

More information

Early treatment for patients with Type 2 Diabetes

Early 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 information

Treatment Options for Diabetes: An Update

Treatment 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 information

Should Psychiatrists be diagnosing (and treating) metabolic syndrome

Should Psychiatrists be diagnosing (and treating) metabolic syndrome Should Psychiatrists be diagnosing (and treating) metabolic syndrome David Hopkins Clinical Director, Diabetes King s College Hospital, London Diabetes prevalence (thousands) Diabetes in the UK: 1995-2010

More information

Role of incretins in the treatment of type 2 diabetes

Role of incretins in the treatment of type 2 diabetes Role of incretins in the treatment of type 2 diabetes Jens Juul Holst Department of Medical Physiology Panum Institute University of Copenhagen Denmark Diabetes & Obesity Spanish Society of Internal Medicine

More information

GLP 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 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 information

GLUCAGON LIKE PEPTIDE (GLP) 1 AGONISTS FOR THE TREATMENT OF TYPE 2 DIABETES, WEIGHT CONTROL AND CARDIOVASCULAR PROTECTION.

GLUCAGON LIKE PEPTIDE (GLP) 1 AGONISTS FOR THE TREATMENT OF TYPE 2 DIABETES, WEIGHT CONTROL AND CARDIOVASCULAR PROTECTION. GLUCAGON LIKE PEPTIDE (GLP) 1 AGONISTS FOR THE TREATMENT OF TYPE 2 DIABETES, WEIGHT CONTROL AND CARDIOVASCULAR PROTECTION. Patricia Garnica MS, ANP-BC, CDE, CDTC Inpatient Diabetes Nurse Practitioner North

More information

Scottish Medicines Consortium

Scottish Medicines Consortium Scottish Medicines Consortium liraglutide 6mg/mL prefilled pen for injection (3mL) (Victoza ) Novo Nordisk Ltd. No. (585/09) 06 November 2009 The Scottish Medicines Consortium (SMC) has completed its assessment

More information

New and Emerging Therapies for Type 2 DM

New and Emerging Therapies for Type 2 DM Dale Clayton MHSc, MD, FRCPC Dalhousie University/Capital Health April 28, 2011 New and Emerging Therapies for Type 2 DM The science of today, is the technology of tomorrow. Edward Teller American Physicist

More information

CNS Control of Food Intake. Adena Zadourian & Andrea Shelton

CNS Control of Food Intake. Adena Zadourian & Andrea Shelton CNS Control of Food Intake Adena Zadourian & Andrea Shelton Controlling Food Intake Energy Homeostasis (Change in body adiposity + compensatory changes in food intake) Background Information/Review Insulin

More information

Glucose Control drug treatments

Glucose 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 information

Type 2 DM in Adolescents: Use of GLP-1 RA. Objectives. Scope of Problem: Obesity. Background. Pathophysiology of T2DM

Type 2 DM in Adolescents: Use of GLP-1 RA. Objectives. Scope of Problem: Obesity. Background. Pathophysiology of T2DM Type 2 DM in Adolescents: Use of GLP-1 RA Objectives Identify patients in the pediatric population with T2DM that would potentially benefit from the use of GLP-1 RA Discuss changes in glycemic outcomes

More information

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Single Technology Appraisal. Canagliflozin in combination therapy for treating type 2 diabetes

NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE. Single Technology Appraisal. Canagliflozin in combination therapy for treating type 2 diabetes NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE Single Technology Appraisal Canagliflozin in combination therapy for Final scope Remit/appraisal objective To appraise the clinical and cost effectiveness

More information

Sitagliptin: first DPP-4 inhibitor to treat type 2 diabetes Steve Chaplin MSc, MRPharmS and Andrew Krentz MD, FRCP

Sitagliptin: first DPP-4 inhibitor to treat type 2 diabetes Steve Chaplin MSc, MRPharmS and Andrew Krentz MD, FRCP Sitagliptin: first DPP-4 inhibitor to treat type 2 diabetes Steve Chaplin MSc, MRPharmS and Andrew Krentz MD, FRCP KEY POINTS sitagliptin (Januvia) is a DPP-4 inhibitor that blocks the breakdown of the

More information

Incretin-based Therapies for Type 2 Diabetes Comparisons Between Glucagon-like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors

Incretin-based Therapies for Type 2 Diabetes Comparisons Between Glucagon-like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors Incretin-based Therapies for Type 2 Diabetes Comparisons Between Glucagon-like Peptide-1 Receptor Agonists and Dipeptidyl Peptidase-4 Inhibitors Timothy Bailey, MD, FACE, CPI Director, AMCR Institute,

More information

What s New in Diabetes Treatment. Disclosures

What 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 information

How can we improve outcomes in Type 2 diabetes?

How can we improve outcomes in Type 2 diabetes? How can we improve outcomes in Type 2 diabetes? Earlier diagnosis Better patient education Stress central role of lifestyle management Identify and treat all risk factors Use rational pharmacological therapy

More information

Effect of macronutrients and mixed meals on incretin hormone secretion and islet cell function

Effect of macronutrients and mixed meals on incretin hormone secretion and islet cell function Effect of macronutrients and mixed meals on incretin hormone secretion and islet cell function Background. Following meal ingestion, several hormones are released from the gastrointestinal tract. Some

More information

Ingestive Behaviors 33. Introduction. Page 1. control and story lines. (a review of general endocrinology) Integration (or the basic reflex arc model)

Ingestive Behaviors 33. Introduction. Page 1. control and story lines. (a review of general endocrinology) Integration (or the basic reflex arc model) Ingestive Behaviors 33 (a review of general endocrinology) A neuroendocrine system: components, a reflex arc, the endocrine system, the AN, endocrine / nervous systems as afferents and efferents, the theoretical

More information

The Many Faces of T2DM in Long-term Care Facilities

The 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 information

Current Status of Incretin Based Therapies in Type 2 Diabetes

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

More information

GLP-1. GLP-1 is produced by the L-cells of the gut after food intake in two biologically active forms It is rapidly degraded by DPP-4.

GLP-1. GLP-1 is produced by the L-cells of the gut after food intake in two biologically active forms It is rapidly degraded by DPP-4. GLP-1 GLP-1 is produced by the L-cells of the gut after food intake in two biologically active forms It is rapidly degraded by DPP-4 Food intake éinsulin Gut églucose uptake Pancreas Beta cells Alpha cells

More information

Novel anti-diabetic therapies

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

More information

Newer and Expensive treatment of diabetes. Endocrinology Visiting Associate Professor Institute of Medicine TUTH

Newer 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 information

YOU 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 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 information

EXENATIDE (BYETTA ) PROTOCOL, 5mcg and 10mcg SC injection pre-filled pens

EXENATIDE (BYETTA ) PROTOCOL, 5mcg and 10mcg SC injection pre-filled pens EXENATIDE (BYETTA ) PROTOCOL, 5mcg and 10mcg SC injection pre-filled pens This document should be read in conjunction with the current Summary of Product Characteristics http://www.medicines.org.uk 1.

More information

Dr Karen McNeil Consultant Endocrinologist

Dr Karen McNeil Consultant Endocrinologist Dr Karen McNeil Consultant Endocrinologist Aged 53 Type 2 Diabetes 2010 HbA1c 7.9% ACR 5.3 mg/mmol What treatment? MF 500 mg bd (misses midday dose) Control Symptoms, BGL Complications DR, DN, PN Associations

More information

Dept of Diabetes Main Desk

Dept of Diabetes Main Desk Dept of Diabetes Main Desk 01202 448060 Glucose management in Type 2 Diabetes in Adults The natural history of type 2 diabetes is for HbA1c to deteriorate with time. A stepwise approach to treatment is

More information

Diabetes in the UK: Update on Diabetes Treatment and Care. Why is diabetes increasing? Obesity Increased waist circumference.

Diabetes in the UK: Update on Diabetes Treatment and Care. Why is diabetes increasing? Obesity Increased waist circumference. Update on Diabetes Treatment and Care Tahseen A Chowdhury Consultant Diabetologist Royal London and Mile End Hospitals Diabetes prevalence (thousands) Diabetes in the UK: 1995-21 3 25 2 15 1 5 Type 1 Type

More information

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

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

More information

Oral Agents. Ian Gallen Consultant Community Diabetologist Royal Berkshire Hospital Reading UK

Oral Agents. Ian Gallen Consultant Community Diabetologist Royal Berkshire Hospital Reading UK Oral Agents Ian Gallen Consultant Community Diabetologist Royal Berkshire Hospital Reading UK What would your ideal diabetes drug do? Effective in lowering HbA1c No hypoglycaemia No effect on weight/ weight

More information

Francesca Porcellati

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

More information

The first stop for professional medicines advice

The first stop for professional medicines advice London Medicines Evaluation Network Overview: Glucagon-Like Peptide-1 receptor analogues The first stop for professional medicines advice 1 London Medicines Evaluation Network Overview: Glucagon-Like Peptide-1

More information

exenatide 2mg powder and solvent for prolonged-release suspension for injection (Bydureon ) SMC No. (748/11) Eli Lilly and Company Limited

exenatide 2mg powder and solvent for prolonged-release suspension for injection (Bydureon ) SMC No. (748/11) Eli Lilly and Company Limited exenatide 2mg powder and solvent for prolonged-release suspension for injection (Bydureon ) SMC No. (748/11) Eli Lilly and Company Limited 09 December 2011 The Scottish Medicines Consortium (SMC) has completed

More information

Disclosure. Learning Objectives. Case. Diabetes Update: Incretin Agents in Diabetes-When to Use Them? I have no disclosures to declare

Disclosure. 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 information

There have been important changes in diabetes care which may not be covered in undergraduate textbooks.

There have been important changes in diabetes care which may not be covered in undergraduate textbooks. Diabetes Clinical update There have been important changes in diabetes care which may not be covered in undergraduate textbooks. Changes in the diagnosis of diabetes a) HbA1C Since 2011, World Health Organisation

More information

How they work and when to take them. Diabetes Medications

How they work and when to take them. Diabetes Medications How they work and when to take them Diabetes Medications BIGUANIDES Metformin Actions Slows down the release of glucose from the liver. Helps the bodies cells become more sensitive to insulin. Pros Weight

More information

Pharmacotherapy IV: Liraglutide for Chronic Weight Management SARAH CAWSEY MD, FRCPC 2 ND ANNUAL OBESITY UPDATE SEPTEMBER 22, 2018

Pharmacotherapy IV: Liraglutide for Chronic Weight Management SARAH CAWSEY MD, FRCPC 2 ND ANNUAL OBESITY UPDATE SEPTEMBER 22, 2018 Pharmacotherapy IV: Liraglutide for Chronic Weight Management SARAH CAWSEY MD, FRCPC 2 ND ANNUAL OBESITY UPDATE SEPTEMBER 22, 2018 Disclosures Faculty Assistant Clinical Professor, Department of Medicine,

More information

Management of Type 2 Diabetes. Why Do We Bother to Achieve Good Control in DM2. Insulin Secretion. The Importance of BP and Glucose Control

Management of Type 2 Diabetes. Why Do We Bother to Achieve Good Control in DM2. Insulin Secretion. The Importance of BP and Glucose Control Insulin Secretion Management of Type 2 Diabetes DG van Zyl Why Do We Bother to Achieve Good Control in DM2 % reduction 0-5 -10-15 -20-25 -30-35 -40 The Importance of BP and Glucose Control Effects of tight

More information

Treating Type 2 Diabetes with Bariatric Surgery. Goal of Treating T2DM. Remission of T2DM with Bariatric

Treating Type 2 Diabetes with Bariatric Surgery. Goal of Treating T2DM. Remission of T2DM with Bariatric Treating Type 2 Diabetes with Bariatric Surgery Number (in Millions) of Persons with Diagnosed Diabetes, United States, 198 25 The number of Americans with diabetes increased from 5.6 to 15.8 million Guilherme

More information

Selecting GLP-1 RA Treatment

Selecting GLP-1 RA Treatment Selecting GLP-1 RA Treatment Dr Felicity Kaplan March 2017 Objectives Review the progressive nature of type 2 diabetes Understand the need for timely treatment intensification Examine the place of GLP-1

More information

Gut hormones KHATTAB

Gut hormones KHATTAB Gut hormones PROF:ABD ALHAFIZ HASSAN KHATTAB Gut as an endocrine gland The talk will cover the following : Historical background. Why this subject is chosen. Gastro-intestinal hormones and their function.

More information

Neurophysiology of the Regulation of Food Intake and the Common Reward Pathways of Obesity and Addiction. Laura Gunter

Neurophysiology of the Regulation of Food Intake and the Common Reward Pathways of Obesity and Addiction. Laura Gunter Neurophysiology of the Regulation of Food Intake and the Common Reward Pathways of Obesity and Addiction Laura Gunter The Brain as the Regulatory Center for Appetite The brain is the integration center

More information

FARXIGA (dapagliflozin) Jardiance (empagliflozin) tablets. Synjardy (empagliflozin and metformin hydrochloride) tablets. GLUCOPHAGE* (metformin)

FARXIGA (dapagliflozin) Jardiance (empagliflozin) tablets. Synjardy (empagliflozin and metformin hydrochloride) tablets. GLUCOPHAGE* (metformin) Type 2 Medications Drug Class How It Works Brand and Generic Names Manufacturers Usual Starting Dose The kidneys filter sugar and either absorb it back into your body for energy or remove it through your

More information

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 2 December 2009

The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION. 2 December 2009 The legally binding text is the original French version TRANSPARENCY COMMITTEE OPINION 2 December 2009 VICTOZA 6 mg/ml solution for injection in pre-filled pen Pack size of two 3 ml pens (CIP: 396 323-6)

More information

GLP-1-based therapies in the management of type 2 diabetes

GLP-1-based therapies in the management of type 2 diabetes GLP-1-based therapies in the management of type 2 diabetes Makbul Aman Mansyur Division Endocrine & Metabolism Department of Internal Medicine Faculty of Medicine Hasanuddin University/ RSUP Dr. Wahidin

More information

Chapter 12. Ingestive Behavior

Chapter 12. Ingestive Behavior Chapter 12 Ingestive Behavior Drinking a. fluid compartments b. osmometric thirst c. volumetric thirst Eating a. energy sources b. starting a meal c. stopping a meal d. eating disordersd Drinking a. fluid

More information

Internal Regulation II Energy

Internal Regulation II Energy Internal Regulation II Energy Reading: BCP Chapter 16 lookfordiagnosis.com Homeostasis Biologically, what is necessary for life is a coordinated set of chemical reactions. These reactions take place in

More information

Scope. History. History. Incretins. Incretin-based Therapy and DPP-4 Inhibitors

Scope. History. History. Incretins. Incretin-based Therapy and DPP-4 Inhibitors Plasma Glucose (mg/dl) Plasma Insulin (pmol/l) Incretin-based Therapy and Inhibitors Scope Mechanism of action ผศ.ดร.นพ.ว ระเดช พ ศประเสร ฐ สาขาว ชาโภชนว ทยาคล น ก ภาคว ชาอาย รศาสตร คณะแพทยศาสตร มหาว ทยาล

More information

For Personal Use Only. Any commercial use is strictly prohibited. Role of glucagon-like peptide 1 receptor agonists in management of obesity

For Personal Use Only. Any commercial use is strictly prohibited. Role of glucagon-like peptide 1 receptor agonists in management of obesity Role of glucagon-like peptide 1 receptor agonists in management of obesity Diana Isaacs, Pharm.D., BCPS, BC-ADM, CDE, Chicago State University, Chicago, IL, and Oak Lawn VA Clinic of Edward Hines Jr. VA

More information

Diabesity. 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 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 information

Newer Drugs in the Management of Type 2 Diabetes Mellitus

Newer 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 information

Drugs used in Diabetes. Dr Andrew Smith

Drugs used in Diabetes. Dr Andrew Smith Drugs used in Diabetes Dr Andrew Smith Plan Introduction Insulin Sensitising Drugs: Metformin Glitazones Insulin Secretagogues: Sulphonylureas Meglitinides Others: Acarbose Incretins Amylin Analogues Damaglifozin

More information

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Proposed Health Technology Appraisal

NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE. Proposed Health Technology Appraisal NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE Proposed Health Technology Appraisal Dapagliflozin in combination therapy for the Final scope Remit/appraisal objective To appraise the clinical and

More information

LESSON 3.3 WORKBOOK. How do we decide when and how much to eat?

LESSON 3.3 WORKBOOK. How do we decide when and how much to eat? Appetite The psychological desire to eat, driven by feelings of pleasure from the brain. Hunger The biological or physiological need to eat, caused by a release of hormones from the digestive tract. LESSON

More information

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

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

More information

the person is intolerant of either metformin or a sulphonylurea, or treatment with metformin or a sulphonylurea is contraindicated, and

the person is intolerant of either metformin or a sulphonylurea, or treatment with metformin or a sulphonylurea is contraindicated, and Exenatide (Byetta) and Liraglutide (Victoza) prescribing guidance: Notes for initiation in primary care These incretin mimetics are given by subcutaneous injection once or twice daily. They have similar

More information

Horizon Scanning Technology Summary. Liraglutide for type 2 diabetes. National Horizon Scanning Centre. April 2007

Horizon Scanning Technology Summary. Liraglutide for type 2 diabetes. National Horizon Scanning Centre. April 2007 Horizon Scanning Technology Summary National Horizon Scanning Centre Liraglutide for type 2 diabetes April 2007 This technology summary is based on information available at the time of research and a limited

More information

Liraglutide: First Once-Daily Human GLP-1 Analogue

Liraglutide: First Once-Daily Human GLP-1 Analogue DRUG PROFILE KERALA MEDICAL JOURNAL Liraglutide: First Once-Daily Human GLP-1 Analogue Sreejith N Kumar Research Cell, IMA Kerala State, K-5, Kochar Road, Sasthamangalam Thiruvananthapuram* ABSTRACT Published

More information

Insulin Initiation and Intensification. Disclosure. Objectives

Insulin Initiation and Intensification. Disclosure. Objectives Insulin Initiation and Intensification Neil Skolnik, M.D. Associate Director Family Medicine Residency Program Abington Memorial Hospital Professor of Family and Community Medicine Temple University School

More information

Liraglutide (Victoza) in combination with basal insulin for type 2 diabetes

Liraglutide (Victoza) in combination with basal insulin for type 2 diabetes Liraglutide (Victoza) in combination with basal insulin for type 2 diabetes May 2011 This technology summary is based on information available at the time of research and a limited literature search. It

More information

Data from an epidemiologic analysis of

Data from an epidemiologic analysis of CLINICAL TRIAL RESULTS OF GLP-1 RELATED AGENTS: THE EARLY EVIDENCE Lawrence Blonde, MD, FACP, FACE ABSTRACT Although it is well known that lowering A 1c (also known as glycated hemoglobin) is associated

More information

Non-insulin treatment in Type 1 DM Sang Yong Kim

Non-insulin treatment in Type 1 DM Sang Yong Kim Non-insulin treatment in Type 1 DM Sang Yong Kim Chosun University Hospital Conflict of interest disclosure None Committee of Scientific Affairs Committee of Scientific Affairs Insulin therapy is the mainstay

More information

New Treatment Options for Type 2 Diabetes: Incretin-Based Therapy

New Treatment Options for Type 2 Diabetes: Incretin-Based Therapy New Treatment Options for Type 2 Diabetes: Incretin-Based Therapy New Treatment Options for Type 2 Diabetes: Incretin-Based Therapy is supported by an educational grant from Novo Nordisk Inc. This program

More information

Beyond 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 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 information

Modulating the Incretin System: A New Therapeutic Strategy for Type 2 Diabetes

Modulating 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 information

RPCC Pharmacy Forum. The Type 2 Diabetes Issue. Type 2 Diabetes: The Basics

RPCC 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 information

Professor Rudy Bilous James Cook University Hospital

Professor Rudy Bilous James Cook University Hospital Professor Rudy Bilous James Cook University Hospital Rate per 100 patient years Rate per 100 patient years 16 Risk of retinopathy progression 16 Risk of developing microalbuminuria 12 12 8 8 4 0 0 5 6

More information

Targeting Incretins in Type 2 Diabetes: Role of GLP-1 Receptor Agonists and DPP-4 Inhibitors. Richard E. Pratley and Matthew Gilbert

Targeting Incretins in Type 2 Diabetes: Role of GLP-1 Receptor Agonists and DPP-4 Inhibitors. Richard E. Pratley and Matthew Gilbert REVIEW Targeting Incretins in Type 2 Diabetes: Role of GLP-1 Receptor Agonists and DPP-4 Inhibitors Richard E. Pratley and Matthew Gilbert Diabetes and Metabolism Translational Medicine Unit, University

More information

STEP 3: Add or Substitute with one of

STEP 3: Add or Substitute with one of Prescribing of Hypoglycaemic Agents for Adult Patients with Type 2 Diabetes: Sunderland Refer to DESMOND Structured Education classes to promote Increased Physical Activity, Weight Loss and Calories Reduction

More information

Expanding Treatment Options for Diabetes: GLP-1 Receptor Agonists. Copyright

Expanding Treatment Options for Diabetes: GLP-1 Receptor Agonists. Copyright CLINICAL Viewpoint Expanding Treatment Options for Diabetes: GLP-1 Receptor Agonists Advancements in Diabetes Management: A Canadian Diabetes Steering Committee Report Copyright Not for Sale or Commercial

More information

GLP-1 receptor agonists for type 2 diabetes currently available in the U.S.

GLP-1 receptor agonists for type 2 diabetes currently available in the U.S. GLP-1 receptor agonists for type 2 diabetes currently available in the U.S. GLP-1 agonists are a class of antidiabetic agents that mimic the actions of the glucagon-like peptide. GLP-1 is one of several

More information

DIABETES IN 2007 What snew

DIABETES IN 2007 What snew DIABETES IN 2007 What snew 1 Objectives 1. Review recently published clinical trials in diabetes What does this mean to us? 1. Discuss novel concepts in the treatment of diabetes What should we expect?

More information

Update on GLP-1 Agonists in Type 2 Diabetes is supported by an educational grant from Novo Nordisk Inc. It has been accredited by the American

Update on GLP-1 Agonists in Type 2 Diabetes is supported by an educational grant from Novo Nordisk Inc. It has been accredited by the American Update on GLP-1 Agonists in Type 2 Diabetes is supported by an educational grant from Novo Nordisk Inc. It has been accredited by the American Association of Diabetes Educators (AADE) for nurses, dietitians,

More information

Management of Obesity. Objectives. Background Impact and scope of Obesity. Control of Energy Homeostasis Methods of treatment Medications.

Management of Obesity. Objectives. Background Impact and scope of Obesity. Control of Energy Homeostasis Methods of treatment Medications. Medical Management of Obesity Ben O Donnell, MD 1 Objectives Background Impact and scope of Obesity Control of Energy Homeostasis Methods of treatment Medications 2 O'Donnell 1 Impact of Obesity According

More information

Medical therapy advances London/Manchester RCP February/June 2016

Medical 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 information

MANAGEMENT OF TYPE 2 DIABETES

MANAGEMENT OF TYPE 2 DIABETES MANAGEMENT OF TYPE 2 DIABETES 3 Month trial of lifestyle changes. Refer to DESMOND structured education programme. Set glycaemic target HbA1c < 7.0% (53mmol/mol) or individualised If HbA1c > 53mmol/mol

More information

What 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 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 information

Neuroprotective properties of GLP-1 - a brief overview. Michael Gejl Jensen, MD Dept. Of Pharmacology, AU

Neuroprotective properties of GLP-1 - a brief overview. Michael Gejl Jensen, MD Dept. Of Pharmacology, AU Neuroprotective properties of GLP-1 - a brief overview Michael Gejl Jensen, MD Dept. Of Pharmacology, AU mg@farm.au.dk Agenda Glucagon-like peptide (GLP-1) GLP-1 and neuronal activity GLP-1 in disease-specific

More information

COMMISSIONING POLICY RECOMMENDATION TREATMENT ADVISORY GROUP Policy agreed by (Vale of York CCG/date)

COMMISSIONING POLICY RECOMMENDATION TREATMENT ADVISORY GROUP Policy agreed by (Vale of York CCG/date) Drug, Treatment, Device name ( Vipidia; Takeda) COMMISSIONING POLICY RECOMMENDATION TREATMENT ADVISORY GROUP Policy agreed by (Vale of York CCG/date) Licensed indication To improve glycaemic control in

More information

Pre-diabetes. Pharmacological Approaches to Delay Progression to Diabetes

Pre-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 information

REGULATION OF FOOD INTAKE AND NUTRITIONAL STATE

REGULATION OF FOOD INTAKE AND NUTRITIONAL STATE REGULATION OF FOOD INTAKE AND NUTRITIONAL STATE INTAKE OUTPUT CENTER OF SATIETY ncl. ventromedialis in hypothalamus - CENTER OF HUNGER (permanently active) lateral hypothalamus (nucleus under fasciculus

More information

DPP-4 inhibitor. The new class drug for Diabetes

DPP-4 inhibitor. The new class drug for Diabetes DPP-4 inhibitor The new class drug for Diabetes 1 Cause of Death in Korea 1 st ; Neoplasm 2 nd ; Cardiovascular Disease 3 rd ; Cerebrovascular Disease Diabetes 2 Incidence of Fatal or Nonfatal MI During

More information

GLP-1 RECEPTOR AGONIST SHOULD I TRY IT? VERONICA BRADY, PHD, BC-ADM, CDE PROJECT ECHO JUNE 21, 2018

GLP-1 RECEPTOR AGONIST SHOULD I TRY IT? VERONICA BRADY, PHD, BC-ADM, CDE PROJECT ECHO JUNE 21, 2018 GLP-1 RECEPTOR AGONIST SHOULD I TRY IT? VERONICA BRADY, PHD, BC-ADM, CDE PROJECT ECHO JUNE 21, 2018 SOMETHING TO CONSIDER IF YOU COULD PRESCRIBE A MEDICATION FOR YOUR PATIENT WITH DIABETES THAT: DECREASED

More information

DR HJ BODANSKY MD FRCP CONSULTANT PHYSICIAN LEEDS TEACHING HOSPITALS ASSOCIATE PROFESSOR, UNIVERSITY OF LEEDS

DR HJ BODANSKY MD FRCP CONSULTANT PHYSICIAN LEEDS TEACHING HOSPITALS ASSOCIATE PROFESSOR, UNIVERSITY OF LEEDS DR HJ BODANSKY MD FRCP CONSULTANT PHYSICIAN LEEDS TEACHING HOSPITALS ASSOCIATE PROFESSOR, UNIVERSITY OF LEEDS DIABETETES UPDATE 2015 AIMS OF THE SEMINAR Diagnosis Investigation Management When to refer

More information

Meccanismi fisiopatologici e trattamento dei disturbi metabolici in soggetti affetti da disturbo mentale grave

Meccanismi fisiopatologici e trattamento dei disturbi metabolici in soggetti affetti da disturbo mentale grave Meccanismi fisiopatologici e trattamento dei disturbi metabolici in soggetti affetti da disturbo mentale grave Francesco Bartoli, MD, PhD Università degli Studi di Milano Bicocca Ospedale San Gerardo di

More information

Dr Larry Distiller BSc MB BCh FCP(SA) FRCP FACE Specialist Physician / Endocrinologist Centre for Diabetes and Endocrinology, Houghton Hon Visiting

Dr Larry Distiller BSc MB BCh FCP(SA) FRCP FACE Specialist Physician / Endocrinologist Centre for Diabetes and Endocrinology, Houghton Hon Visiting Dr Larry Distiller BSc MB BCh FCP(SA) FRCP FACE Specialist Physician / Endocrinologist Centre for Diabetes and Endocrinology, Houghton Hon Visiting Professor, Cardiff University School of Medicine Obesity

More information

IDF Regions and global projections of the number of people with diabetes (20-79 years), 2013 and Diabetes Atlas -sixth Edition: IDF 2013

IDF Regions and global projections of the number of people with diabetes (20-79 years), 2013 and Diabetes Atlas -sixth Edition: IDF 2013 IDF Regions and global projections of the number of people with diabetes (20-79 years), 2013 and 2035 Diabetes Atlas -sixth Edition: IDF 2013 Diabetes Atlas -sixth Edition: IDF 2013 Chronic complications

More information

Achieving and maintaining good glycemic control is an

Achieving and maintaining good glycemic control is an Glycemic Efficacy, Weight Effects, and Safety of Once-Weekly Glucagon-Like Peptide-1 Receptor Agonists Yehuda Handelsman, MD, FACP, FNLA, FASPC, MACE; Kathleen Wyne, MD, PhD, FACE, FNLA; Anthony Cannon,

More information

T2DM is a global epidemic with

T2DM is a global epidemic with : a new option for the management of type 2 diabetes Marc Evans MRCP, MD, Consultant Diabetologist, Llandough Hospital, Cardiff Incretin-based therapies for the treatment of diabetes mellitus (T2DM) present

More information

Wayne Gravois, MD August 6, 2017

Wayne 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 information

INJECTABLE THERAPIES IN DIABETES. Barbara Ann McKee Diabetes Specialist Nurse

INJECTABLE THERAPIES IN DIABETES. Barbara Ann McKee Diabetes Specialist Nurse INJECTABLE THERAPIES IN DIABETES Barbara Ann McKee Diabetes Specialist Nurse 1 Aims of the session Describe the different injectable agents for diabetes and when they would be used. Describe some common

More information

Empower Preventive Medicine. Timothy J. McCormick, DO, MPH 4221 Baymeadows Suite 6 Jacksonville, FL

Empower Preventive Medicine. Timothy J. McCormick, DO, MPH 4221 Baymeadows Suite 6 Jacksonville, FL Empower Preventive Medicine Timothy J. McCormick, DO, MPH 4221 Baymeadows Suite 6 Jacksonville, FL 32217 904-367-4005 Drtim@emprevmed.com Obesity Medicine Old paradigm: Obesity was a matter of willpower,

More information