Welcome and Introduction This presentation will: Define obesity, prediabetes, and diabetes Discuss the diagnoses and management of obesity, prediabetes, and diabetes Explain the early risk factors for diabetes and the rationale for aggressive treatment to delay or prevent diabetes onset
Age-adjusted Prevalence of Obesity and Diagnosed Diabetes Among US Adults Obesity (BMI 30 kg/m 2 ) 1994 2000 2013 No Data <14.0% 14.0% 17.9% 18.0% 21.9% 22.0% 25.9% > 26.0% Diabetes 1994 2000 2013 No Data <4.5% 4.5% 5.9% 6.0% 7.4% 7.5% 8.9% >9.0% BMI = body mass index; CDC = U.S. Center for Disease Control and Prevention. CDC s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics
Obesity and Metabolic Syndrome: A Cluster of Coronary Heart Disease Risk Factors Diet, physical inactivity and stress All potentiate genetic susceptibility to obesity Prothrombotic State Atherogenic Dyslipidemia Genetic Susceptibility Obesity Insulin Resistance Raised Blood Pressure Autonomic Dysfunction Proinflammatory State Triglycerides High-Density Lipoprotein Cholesterol Small Low-Density Lipoprotein Particles Adapted from Grundy SM. J Clin Endocrinol Metab. 2005;89:2595-2600. Slide Source: Obesityonline.org
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 function Insulin resistance Impaired glucose tolerance Ominous octet T2DM Ongoing hyperglycemia DEATH Ongoing, worsening macrovascular and microvascular complications Hypertension Endothelial dysfunction Hyperinsulinemia HDL-C, Triglycerides Eye, nerve, and kidney damage Atherosclerosis Myocardial infarction Cardiovascular event Blindness Chronic renal failure Amputation Disability HDL-C = high density lipoprotein-cholesterol; T2DM = type 2 diabetes mellitus.
Treating the ABCs Reduces Diabetic Complications Strategy Blood glucose control (A1C) Blood pressure control Lipid control (Cardiovascular) Complication Reduction of Complication Heart attack 37% 1 Cardiovascular disease Heart failure Stroke Diabetes-related deaths Coronary heart disease mortality Major coronary heart disease event Any atherosclerotic event Cerebrovascular disease event 51% 2 56% 3 44% 3 32% 3 35% 4 55% 5 37% 5 53% 4 A1C = glycated hemoglobin. 1. UKPDS Study Group (UKPDS 33). Lancet. 1998;352:837-853. 2. Hansson L, et al. Lancet. 1998;351:1755-1762. 3. UKPDS Study Group (UKPDS 38). BMJ. 1998;317:703-713. 4. Grover SA, et al. Circulation. 2000;102:722-727. 5. Pyŏrälä K, et al. Diabetes Care. 1997;20:614-620.
A1C The ABCs of Diabetes Care: Recommended Goals ADA and IDF recommend < 7.0% in general, < 6.0% in selected individuals. AACE/ACE recommend 6.5% in patients without concurrent serious illness and at low hypoglycemia risk, and > 6.5% in patients with concurrent serious illness and at risk for hypoglycemia. Blood Pressure AACE/ACE and IDF recommend < 130/80 mm Hg ADA recommends <140/90 mm Hg Cholesterol AACE/ACE and ADA recommend LDL-C: < 100 mg/dl (< 70 mg/dl in very high risk patients) HDL-C: > 40 mg/dl in men and > 50 mg/dl in women Non HDL-C: < 130 mg/dl (< 100 mg/dl in high-risk patients) Triglycerides: < 150 mg/dl A1C = glycated hemoglobin; AACE = American Association of Clinical Endocrinologists; ACE = American College of Endocrinology; ADA = American Diabetes Association; HDL-C = high density lipoprotein-cholesterol; IDF = International Diabetes Federation; LDL-C = low density lipoprotein-cholesterol. American Diabetes Association. Diabetes Care. 2016;39 Suppl 1:S1-102; Handlesman Y et al. Endocr Pract. 2015; 21 Suppl 1:1-87; IDF Clinical Guidelines Task Force. Global Guideline for Type 2 Diabetes. Available at: http://www.idf.org/sites/default/files/idf- Guideline-for-Type-2-Diabetes.pdf
Diabetes Day for Primary Care Clinicians Advances in Diabetes Care Saturday, February 18, 2017, Marriott Condado Agenda 7:00AM 8:00AM Registration Exhibit Hall Open 8:00AM 8:10AM Introduction Moderator Dr. Myriam Allende 8:10AM 8:25AM AACE Comprehensive Diabetes Management Algorithm 2016 Dr. Jorge De Jesús Summarize the key objectives of each step of the algorithm and describe how each step helps improve disease management and outcomes for patients with T2D. 8:25AM 8:45AM Lifestyle Therapy Dr. Jorge De Jesús Identify barriers to lifestyle therapy and develop strategies to promote behavioral changes in patients with obesity and/or T2D. 8:45AM 8:55AM Q & A 8:55AM 9:15AM 9:15AM 9:40AM Update on Oral Agents Dr. Jorge De Jesús Update on Noninsulin Injectables for T2D Dr. Harry Jiménez Evaluate the efficacy, safety, and extraglycemic effects of noninsulin agents for T2D. Design appropriate treatment strategies to meet individual patient needs. 9:40AM 10:00AM Q & A 10:000AM 10:30AM Break Exhibit Hall Open 10:30AM 10:55AM Update on Insulin-based Agents for T2D Dr. Harry Jiménez Evaluate the efficacy and safety of different formulations of insulin, including insulin-incretin combination products. Develop strategies for appropriate initiation and intensification of insulin therapy for T2D. 10:55AM 11:05AM Q & A 11:05AM 11:35AM Cardiovascular Risk Management in Patients with T2DM Dr. Francis Baco Discuss results of cardiovascular outcomes trials of antihyperglycemic therapies in patients with T2D. Develop strategies to mitigate the risk of cardiovascular disease in patients with T2D. 11:35AM 12:05PM Q & A 12:05PM 12:35PM Advances in Diabetes Care Technologies Dr. Francis Baco Evaluate the benefits and limitations of glucose monitoring devices and insulin pumps for use in patients with T2D. 12:35PM 1:00PM Application of the Diabetes Algorithm to a Patient All Faculty Apply knowledge gained from this activity to improve the disease management and outcomes for patients with T2D. Case discussion Open forum for Q & A