Type 2 Diabetes and Prediabetes: A New Understanding of Cause and Treatment. Bruce Latham, M.D. Endocrine Specialists Greenville Health System

Size: px
Start display at page:

Download "Type 2 Diabetes and Prediabetes: A New Understanding of Cause and Treatment. Bruce Latham, M.D. Endocrine Specialists Greenville Health System"

Transcription

1 Type 2 Diabetes and Prediabetes: A New Understanding of Cause and Treatment Bruce Latham, M.D. Endocrine Specialists Greenville Health System

2 Objectives for this presentation - Understand the thrifty genotype and thrifty phenotype hypothesis as to the origin of insulin receptor signaling pathway mutations in patients with type 2 diabetes - Review the new hypothesis as to the cause of pre-diabetes and type 2 diabetes - Understand why bariatric surgery and extreme diets can reverse type 2 diabetes - Briefly review current research for diagnosis and treatment of type 2 diabetes

3 Types of Diabetes Type 1 diabetes autoimmune destruction of beta cells in the islets of Langerhans in the pancreas Type 2 diabetes chronic hyperglycemia resulting from insulin receptor signaling pathway gene mutations LADA (latent autoimmune diabetes of adulthood) Diabetes due to pancreatic destruction (pancreatitis, pancreatic resection) Other genetic causes (Leprechaunism, MODY, etc)

4 Definition of pre-diabetes and diabetes Pre-diabetes: Two finger stick glucoses of HbA1c Post glucola (2hr) glucose Diabetes: Two finger stick fasting glucoses of 126 or higher HbA1c 6.5 or higher Post glucola (2hr) glucose >200

5 What causes pre-diabetes and diabetes? Is it obesity? Is it genetics? Is it bad life-style?

6

7 One size does not fit all

8 The Paradox - 85 percent of diabetics are overweight - but only 30 percent of overweight people have type 2 diabetes and 15 percent of type 2 diabetics have a normal BMI

9 Obesity is not the cause of diabetes

10 To understand the cause, we need to review insulin action

11 Only two organs need insulin to internalize glucose: Skeletal muscle Fat The key: both are involved in energy utilization: Skeletal muscle transforms chemical energy (glucose) to mechanical work on a as needed basis. Fat provides free fatty acids (FFA) for conversion to ATP in mitochondria during prolonged periods of energy need or during periods of fasting.

12

13 There are over 150 known mutations in the insulin receptor or receptor signaling pathway that lead to insulin resistance. Most mutations are detrimental to the survival of the organism. If this is the case, why are there so many mutations in this signaling pathway?

14 Hypothesis: These mutations may have once been beneficial to Homo sapiens The thrifty phenotype hypothesis The thrifty genotype hypothesis

15 Possible etiology of pre-diabetes and type 2 diabetes Thrifty genotype hypothesis

16 Possible etiology of type 2 diabetes Thrifty phenotype hypothesis Babies with low birth weight (less than 4.3 kg, especially those less than 2.5 kg) have a 7x higher incidence of impaired glucose or Type II diabetes as adults than those who were heaviest at birth. This is thought due to poor fetal nutrition leading to in utero genetic reprogramming for insulin resistance to increase the chance of surviving poor postnatal nutrition.

17 These adaptations are beneficial if the individual experiences poor nutrition postnatally Example: very low incidence of diabetes in sub- Saharan Africa: poor fetal nutrition + poor postnatal nutrition =no diabetes. These adaptations are most detrimental if the individual has poor fetal nutrition + good postnatal nutrition = high incidence of diabetes, especially if obese as an adolescent or adult

18 Examples: Pima Indians

19 Nauru Islanders: coca-colonization

20 Europeans: Until recently incidence was decreasing until glowing pixels of light and extreme life spans.

21 Patients with type 2 diabetes also have a greatly increased risk for NASH (non-alcoholic steatosis and hepatitis; i. e. severe fatty liver and liver failure) In one autopsy series, obesity and/or diabetes was found in 20 of 22 patients who died with NASH.

22 Prerequisites for development of pre-diabetes and type 2 diabetes - Insulin receptor signaling pathway gene defect - High organ (visceral) fat (liver and pancreas) concentrations. Subcutaneous fat not important.

23 High organ fat pancreas and liver High liver fat leads to impaired down-regulation of gluconeogenesis and and glycogenolysis and later, NASH High pancreas fat (later) decreased insulin production

24 Interventional Therapies Weight Reduction in patients without diabetes Finnish Diabetes Prevention Study (522 subjects) Diabetes Prevention Study (U.S.) (3243 subjects) Patients treated with: Regular moderate exercise (2.5-3 hrs/wk) Optimal diet (low simple carbs, more dietary fiber, less saturated fat) 7% weight loss over 3 years 58% fewer people developed type II diabetes than in the control groups.

25 Interventional Therapies Weight reduction in patients without diabetes Da Qing trial (577 subjects) Three treatment groups: diet, exercise, or both After 6 years, risk reduction of developing T2DM 31%, 46%, and 42%, respectively (Pan XR, et.al. Diabetes Care 1997, )

26 Interventional Therapies Weight reduction in patients with diabetes 11 patients with type 2 DM (age 49+/-2.5; BMI 36; 9 male 2 female). 8 non-diabetic control pts 600 kcal diet for 8 weeks Pancreatic and hepatic fat measured by MRI after 1, 4 and 8 weeks. Insulin suppression of hepatic glucose production, 1 st phase insulin response measured Lim KG et. al. Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol. Diabetologia (2011) 54:

27 Interventional Therapies Weight reduction in patients with diabetes Results After 1 week, fasting plasma glucose normalized Insulin suppression of hepatic glucose improved from 43% to 74%. Hepatic triacylglycerol fell from 12% to 2.9% 1 st phase pancreatic insulin response improved from.19 nmol/min/m to.46 nmol/min/m. Maximal insulin response became supranormal at 8 weeks (1.36 vs nmol/min/m controls) Pancreatic triacylglycerol decreased from 8 to 6.2 nmol/min/m

28 Interventional Therapies Weight reduction in patients with diabetes Bariatric surgery 136 studies; patients. 18% men, 72% women -Mean age 39 years; mean BMI 46.9 (range ) -Gastric banding, gastric bypass, gastroplasty, biliopancreatic diversion or duodenal switch Operative mortality.1% for restrictive procedures,.5% for gastric bypass, 1.1% for biliopancreatic diversion or duodenal switch (Buchwald, et. al. JAMA 292, Oct. 13, 2004)

29 Interventional Therapies Weight Reduction Bariatric surgery Diabetes completely resolved in 76.8%; resolved or improved in 86%. Hyperlipidemia improved in 70%. Hypertension resolved in 62% or resolved or improved in 78.5% Sleep apnea resolved in 86% and resolved or improved in 83%.

30 Interventional Therapies Current Research 2, 4, dinitrophenol Blocks oxidative phosphorylation in mitochondria Causes runaway consumption of hepatic fat conversion to heat rather than to ATP Once used for weight loss; banned in the 1930 s due to deaths from severe hyperthermia Still abused by some athletes today to promote rapid weight loss

31 In the Zucker diabetic rat, can treatment with small amounts of 2,4 dinitrophenol reverse diabetes? When given in very small amounts to these rats, it caused a 40% reduction in fasting glucose 50% reduction in plasma insulin concentration 90% reduction in hepatic diacylglycerol (fatty acids) Perry RJ, et.al. Science Mar 13;347(6227):

32 What is the concentration of pancreatic and hepatic fat that is associated with the onset of type 2 diabetes?

33 So, how does this new information influence day to day treatment algorithms of type 2 diabetes?

34 Diabetes treatment algorithms are rapidly changing First, metformin (inhibits hepatic gluconeogenesis; weight neutral) Then what?

35 Older therapies: Insulin injections Sulfonylurea oral agents often cause weight gain leading to increased insulin resistance

36 Interventional Therapies Newer diabetic medications which cause weight loss: GLP-1 agonists: exenatide (Byetta), liraglutide (Victoza), dulaglutide (Trulicity), etc. SGLT 2 inhibitors: dapagliflozin (Farxiga), canagliflozin (Invokana), empagliflozin (Jardiance)

37 Take Home Points Obesity itself does not cause type 2 diabetes. Type 2 diabetes is the result of an insulin receptor or receptor pathway mutation in some individuals, present from birth. It is the combination of the mutation along with visceral fat that may lead to type 2 diabetes. The visceral fat content needed to cause type 2 diabetes is not yet known. Weight loss and exercise can prevent and may reverse diabetes in some if not most individuals.

38 Take Home Points Prediabetes and type 2 diabetes are diseases of our times. The rapid change in human culture from hunter-gatherers to the agricultural age, and now the industrial age has made a once apparently beneficial mutation in our genetic code a detriment. Because of the rapid nature of our cultural change, we as a species have not had time to adapt to our new environment. Since those of us in western societies no longer eat or exercise as our distant ancestors did, this mutation has left many at risk for cardiovascular disease and type II diabetes.

39

Reversing type 2 diabetes: pancreas composition and function during return to normal glucose tolerance

Reversing type 2 diabetes: pancreas composition and function during return to normal glucose tolerance Reversing type 2 diabetes: pancreas composition and function during return to normal glucose tolerance Dr Sarah Steven Clinical Research Fellow to Professor Roy Taylor Observations from bariatric surgery

More information

Diagnosis, classification and prevention of diabetes

Diagnosis, classification and prevention of diabetes Diagnosis, classification and prevention of diabetes Section 1 1 of 4 Curriculum Module II 1 Diagnosis, classification and presentation of diabetes Slide 2 of 48 Polyurea Definition of diabetes Slide 3

More information

PowerPoint Lecture Outlines prepared by Dr. Lana Zinger, QCC CUNY. 12a. FOCUS ON Your Risk for Diabetes. Copyright 2011 Pearson Education, Inc.

PowerPoint Lecture Outlines prepared by Dr. Lana Zinger, QCC CUNY. 12a. FOCUS ON Your Risk for Diabetes. Copyright 2011 Pearson Education, Inc. PowerPoint Lecture Outlines prepared by Dr. Lana Zinger, QCC CUNY 12a FOCUS ON Your Risk for Diabetes Your Risk for Diabetes! Since 1980,Diabetes has increased by 50 %. Diabetes has increased by 70 percent

More information

Diabetes and Obesity in Children. Janie Berquist, RN, BSN, MPH, CDE Children s Mercy Hospitals and Clinics Kansas City, MO

Diabetes and Obesity in Children. Janie Berquist, RN, BSN, MPH, CDE Children s Mercy Hospitals and Clinics Kansas City, MO Diabetes and Obesity in Children Janie Berquist, RN, BSN, MPH, CDE Children s Mercy Hospitals and Clinics Kansas City, MO Diabetes and Obesity in Children What is Diabetes? How are Diabetes and Obesity

More information

Diabetes and Obesity. The diabesity epidemic

Diabetes and Obesity. The diabesity epidemic Diabetes and Obesity Frank B. Diamond, Jr. M.D. Professor of Pediatrics University of South Florida College of Medicine The diabesity epidemic Prevalence of diabetes worldwide was over 135 million people

More information

Diabetes mellitus. Lecture Outline

Diabetes mellitus. Lecture Outline Diabetes mellitus Lecture Outline I. Diagnosis II. Epidemiology III. Causes of diabetes IV. Health Problems and Diabetes V. Treating Diabetes VI. Physical activity and diabetes 1 Diabetes Disorder characterized

More information

CASE B1. Newly Diagnosed T2DM in Patient with Prior MI

CASE B1. Newly Diagnosed T2DM in Patient with Prior MI Newly Diagnosed T2DM in Patient with Prior MI 1 Our case involves a gentleman with acute myocardial infarction who is newly discovered to have type 2 diabetes. 2 One question is whether anti-hyperglycemic

More information

Diabetes in Primary Care course MCQ Answers 2016

Diabetes in Primary Care course MCQ Answers 2016 Diabetes in Primary Care course MCQ Answers 2016 Diagnosis of Diabetes HbA1C should not be used as a diagnostic tool in the following situations: (answer each TRUE or FALSE) 1. Gestational Diabetes TRUE

More information

trends in the treatment of Diabetes type 2 - New classes of antidiabetic drugs. IAIM, 2015; 2(4): 223-

trends in the treatment of Diabetes type 2 - New classes of antidiabetic drugs. IAIM, 2015; 2(4): 223- Review Article Pharmacological trends in the treatment of Diabetes type 2 - New classes of antidiabetic Silvia Mihailova 1*, Antoaneta Tsvetkova 1, Anna Todorova 2 1 Assistant Pharmacist, Education and

More information

Family History and Diabetes. Practical Genomics for the Public Health Professional

Family History and Diabetes. Practical Genomics for the Public Health Professional Family History and Diabetes Practical Genomics for the Public Health Professional Outline Overview of Type 2 Diabetes/Gestational Diabetes Familial/Genetic Nature of Diabetes Interaction of Genes and Environment

More information

The weight of the world.

The weight of the world. The weight of the world. SONY ANTHONY Obesity Derived from the Latin word obesus to devour Definition: having a very high amount of body fat in relation to lean body mass Classifications using Body Mass

More information

Body Composition & Longevity. Ohan Karatoprak, MD, AAFP Clinical Assistant Professor, UMDNJ

Body Composition & Longevity. Ohan Karatoprak, MD, AAFP Clinical Assistant Professor, UMDNJ Body Composition & Longevity Ohan Karatoprak, MD, AAFP Clinical Assistant Professor, UMDNJ LONGEVITY Genetic 25% Environmental Lifestyle Stress 75% BMI >30 OBESE 25-30 OVERWEIGHT 18-25 NORMAL WEIGHT 18

More information

BARIATRIC SURGERY MAY CURE TYPE 2 DIABETES IN SOME PATIENTS

BARIATRIC SURGERY MAY CURE TYPE 2 DIABETES IN SOME PATIENTS BARIATRIC SURGERY MAY CURE TYPE 2 DIABETES IN SOME PATIENTS Thomas Rogula MD, Stacy Brethauer MD, Bipand Chand MD, and Philip Schauer, MD. "Gastric bypass surgery has become a popular option for obese

More information

CME Test for AMDA Clinical Practice Guideline. Diabetes Mellitus

CME Test for AMDA Clinical Practice Guideline. Diabetes Mellitus CME Test for AMDA Clinical Practice Guideline Diabetes Mellitus Part I: 1. Which one of the following statements about type 2 diabetes is not accurate? a. Diabetics are at increased risk of experiencing

More information

Metabolic Diseases: Obesity, Hyperlipidemia, and Diabetes

Metabolic Diseases: Obesity, Hyperlipidemia, and Diabetes Metabolic Diseases: Obesity, Hyperlipidemia, and Diabetes Obesity Approximately 1 in 3 adults are overweight in the U.S. Arizona According to CDC, Arizona has highest reported percentage of adults who

More information

DIABETES AND INSULIN RESISTANCE DIABETES PREVALANCE

DIABETES AND INSULIN RESISTANCE DIABETES PREVALANCE DIABETES AND INSULIN RESISTANCE KARI KOHRS RD LDN CDE UICMC NUTRITION & WELLNESS CENTER DIABETES PREVALANCE Third leading cause of death-- United States 18 million diagnosed Growing at the rate of 3 new

More information

Department Of Biochemistry. Subject: Diabetes Mellitus. Supervisor: Dr.Hazim Allawi & Dr.Omar Akram Prepared by : Shahad Ismael. 2 nd stage.

Department Of Biochemistry. Subject: Diabetes Mellitus. Supervisor: Dr.Hazim Allawi & Dr.Omar Akram Prepared by : Shahad Ismael. 2 nd stage. Department Of Biochemistry Subject: Diabetes Mellitus Supervisor: Dr.Hazim Allawi & Dr.Omar Akram Prepared by : Shahad Ismael. 2 nd stage. Diabetes mellitus : Type 1 & Type 2 What is diabestes mellitus?

More information

Getting Off the Chronic Disease Merry-Go-Round: What s the Weight of the Research?

Getting Off the Chronic Disease Merry-Go-Round: What s the Weight of the Research? Getting Off the Chronic Disease Merry-Go-Round: What s the Weight of the Research? Jody Dushay, MD MMSc Beth Israel Deaconess Medical Center Boston, MA Session 445 No disclosures Disclosure Jody Dushay,

More information

Treating Patients with PRE-DIABETES David Doriguzzi, PA-C First Valley Medical Group. Learning Objectives. Background. CAPA 2015 Annual Conference

Treating Patients with PRE-DIABETES David Doriguzzi, PA-C First Valley Medical Group. Learning Objectives. Background. CAPA 2015 Annual Conference Treating Patients with PRE-DIABETES David Doriguzzi, PA-C First Valley Medical Group Learning Objectives To accurately make the diagnosis of pre-diabetes/metabolic syndrome To understand the prevalence

More information

TYPE 2 DIABETES MELLITUS: NEW HOPE FOR PREVENTION. Robert Dobbins, M.D. Ph.D.

TYPE 2 DIABETES MELLITUS: NEW HOPE FOR PREVENTION. Robert Dobbins, M.D. Ph.D. TYPE 2 DIABETES MELLITUS: NEW HOPE FOR PREVENTION Robert Dobbins, M.D. Ph.D. Learning Objectives Recognize current trends in the prevalence of type 2 diabetes. Learn differences between type 1 and type

More information

Clinical Assistant Professor. Clinical Pharmacy Specialist Wesley Family Medicine Residency Program. Objectives

Clinical Assistant Professor. Clinical Pharmacy Specialist Wesley Family Medicine Residency Program. Objectives What s New in Diabetes Medications? Matthew Kostoff, PharmD, BCPS, BCACP Clinical Assistant Professor Clinical Pharmacy Specialist Wesley Family Medicine Residency Program Objectives Discuss new literature

More information

1. PATHOPHYSIOLOGY OF METABOLIC SYNDROME

1. PATHOPHYSIOLOGY OF METABOLIC SYNDROME 1. PATHOPHYSIOLOGY OF METABOLIC SYNDROME Izet Aganović, Tina Dušek Department of Internal Medicine, Division of Endocrinology, University Hospital Center Zagreb, Croatia 1 Introduction The metabolic syndrome

More information

CLINICAL PRACTICE GUIDELINE

CLINICAL PRACTICE GUIDELINE CLINICAL PRACTICE GUIDELINE Procedure: Diabetes Guideline Review Cycle: Biennial Reviewed By: Amish Purohit, MD, MHA, CPE, FACHE Review Date: November 2014 Committee Approval Date: 11/12/2014 PURPOSE:

More information

Overview of Diabetes Management. By Cindy Daversa, M.S.,R.D.,C.D.E. UCI Health

Overview of Diabetes Management. By Cindy Daversa, M.S.,R.D.,C.D.E. UCI Health Overview of Diabetes Management By Cindy Daversa, M.S.,R.D.,C.D.E. UCI Health Objectives: Describe the pathophysiology of diabetes. From a multiorgan systems viewpoint. Identify the types of diabetes.

More information

Causes, incidence, and risk factors

Causes, incidence, and risk factors Causes, incidence, and risk factors Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both. To understand diabetes,

More information

Type 2 Diabetes Mellitus and Insulin resistance syndrome in Children

Type 2 Diabetes Mellitus and Insulin resistance syndrome in Children Type 2 Diabetes Mellitus and Insulin resistance syndrome in Children Anil R Kumar MD Pediatric Endocrinology MCV/VCU, Richmond VA Introduction Type 2 diabetes mellitus (T2 DM) has increased in children

More information

Insulin Resistance and Pre-diabetes

Insulin Resistance and Pre-diabetes 1 of 6 11/17/2009 9:38 PM Insulin Resistance and Pre-diabetes What is insulin resistance? What causes insulin resistance? Metabolic Syndrome What is pre-diabetes? What are the symptoms of insulin resistance

More information

The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery

The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery The Link Between Obesity and Diabetes The Rapid Evolution and Positive Results of Bariatric Surgery Michael E. Farkouh, MD, MSc Peter Munk Chair in Multinational Clinical Trials Director, Heart and Stroke

More information

The Arguments: T2DM - tremendous economic burden globally Lifestyle / Pharm Rx:

The Arguments: T2DM - tremendous economic burden globally Lifestyle / Pharm Rx: James Cromie The Arguments: T2DM - tremendous economic burden globally Lifestyle / Pharm Rx: INEFFECTIVE and UNSUSTAINED Bariatric surgery is an Effective and Durable treatment option Well established

More information

Non-alcoholic fatty liver disease: Prognosis and Treatment

Non-alcoholic fatty liver disease: Prognosis and Treatment Non-alcoholic fatty liver disease: Prognosis and Treatment Zachary Henry, M.D. Assistant Professor UVA Gastroenterology & Hepatology October 28, 2015 Overview Case Presentation Prognosis Effects of fibrosis

More information

TYPE 2 DIABETES IN CHILDREN DIAGNOSIS AND THERAPY. Ines Guttmann- Bauman MD Clinical Associate Professor, Division of Pediatric Endocrinology, OHSU

TYPE 2 DIABETES IN CHILDREN DIAGNOSIS AND THERAPY. Ines Guttmann- Bauman MD Clinical Associate Professor, Division of Pediatric Endocrinology, OHSU TYPE 2 DIABETES IN CHILDREN DIAGNOSIS AND THERAPY Ines Guttmann- Bauman MD Clinical Associate Professor, Division of Pediatric Endocrinology, OHSU Objectives: 1. To discuss epidemiology and presentation

More information

INSULIN AND INCRETIN THERAPIES: WHAT COMBINATIONS ARE RIGHT FOR YOUR PATIENT?

INSULIN AND INCRETIN THERAPIES: WHAT COMBINATIONS ARE RIGHT FOR YOUR PATIENT? INSULIN AND INCRETIN THERAPIES: WHAT COMBINATIONS ARE RIGHT FOR YOUR PATIENT? MARTHA M. BRINSKO, MSN, ANP-BC CHARLOTTE COMMUNITY HEALTH CLINIC CHARLOTTE, NC Diagnosed and undiagnosed diabetes in the United

More information

Treatment for Severely Obese Patients

Treatment for Severely Obese Patients Treatment for Severely Obese Patients Associate Professor Jimmy So Senior Consultant Surgeon Director, Centre for Obesity Management and Surgery (COMS) National University Hospital Obesity Shortens Lives

More information

Prevention of and the Screening for Diabetes Part I Insulin Resistance By James L. Holly, MD Your Life Your Health The Examiner January 19, 2012

Prevention of and the Screening for Diabetes Part I Insulin Resistance By James L. Holly, MD Your Life Your Health The Examiner January 19, 2012 Prevention of and the Screening for Diabetes Part I Insulin Resistance By James L. Holly, MD Your Life Your Health The Examiner January 19, 2012 In 2002, SETMA began a relationship with Joslin Diabetes

More information

Which diet is best for managing Type 2 Diabetes? Dr Rob Andrews Consultant Senior lecturer University of Bristol / Taunton NHS trust

Which diet is best for managing Type 2 Diabetes? Dr Rob Andrews Consultant Senior lecturer University of Bristol / Taunton NHS trust Taunton and Somerset NHS foundation trust NHS Which diet is best for managing Type 2 Diabetes? Dr Rob Andrews Consultant Senior lecturer University of Bristol / Taunton NHS trust If people let government

More information

New and Future Treatments for Diabetes. Mary Charlton Specialty Doctor in Diabetes University Hospital Birmingham BARS Oct 2014

New and Future Treatments for Diabetes. Mary Charlton Specialty Doctor in Diabetes University Hospital Birmingham BARS Oct 2014 New and Future Treatments for Diabetes Mary Charlton Specialty Doctor in Diabetes University Hospital Birmingham BARS Oct 2014 Conflicts of interest Investigator Carmelina study of Linagliptin (Boehringer

More information

PIERO LUIGI ALMASIO CATTEDRA DI GASTROENTEROLOGIA UNIVERSITA OF PALERMO

PIERO LUIGI ALMASIO CATTEDRA DI GASTROENTEROLOGIA UNIVERSITA OF PALERMO Steatosi e Steatoepatite PIERO LUIGI ALMASIO CATTEDRA DI GASTROENTEROLOGIA UNIVERSITA OF PALERMO Alcoholic liver disease Liver damage resulting from long-term alcohol consumption Histological features:

More information

Central Florida Research Update

Central Florida Research Update Central Florida Research Update Ayala, Julio, PhD, Sanford-Burnham Medical Research Institute, Orlando, Florida Anorectic Mechanisms of Glp1r Agonists Obesity Jan 1, 2014 Dec 31, 2018 Integrated Physiology,

More information

The Influence of Infant Health on Adult Chronic Disease

The Influence of Infant Health on Adult Chronic Disease The Influence of Infant Health on Adult Chronic Disease Womb to Tomb Dr Clare MacVicar Introduction Many diseases in adulthood are related to growth patterns during early life Maternal nutrition important

More information

Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both.

Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both. Diabetes Definition Diabetes is a chronic (lifelong) disease marked by high levels of sugar in the blood. Causes Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused

More information

Unit 3 Lecture 11 METABOLISM

Unit 3 Lecture 11 METABOLISM Unit 3 Lecture METABOLISM Anabolism is defined as the chemical reactions that combine simple substances into more complex molecules (requires energy). Examples of anabolism include glycogenesis (conversion

More information

Diabetes and Weight-Loss Surgery

Diabetes and Weight-Loss Surgery WHITE PAPER Diabetes and Weight-Loss Surgery Treat the cause. Cure the symptom. Center of Excellence BARIATRIC SURGERY Written July 2011 Bariatric Surgery: The Cure for Type II Diabetes? For most individuals

More information

Overview of Diabetes Medications

Overview of Diabetes Medications Overview of Diabetes Medications Marie Frazzitta DNP, FNP c, CDE, MBA Senior Director of Disease Management North Shore LIJ Health Systems Normal Glucose Metabolism Insulin is produced by beta cells in

More information

Regulation of Metabolism. By Dr. Carmen Rexach Physiology Mt San Antonio College

Regulation of Metabolism. By Dr. Carmen Rexach Physiology Mt San Antonio College Regulation of Metabolism By Dr. Carmen Rexach Physiology Mt San Antonio College Energy Constant need in living cells Measured in kcal carbohydrates and proteins = 4kcal/g Fats = 9kcal/g Most diets are

More information

Nutrition. Type 2 Diabetes: A Growing Challenge in the Healthcare Setting NAME OF STUDENT

Nutrition. Type 2 Diabetes: A Growing Challenge in the Healthcare Setting NAME OF STUDENT 1 Nutrition Type 2 Diabetes: A Growing Challenge in the Healthcare Setting NAME OF STUDENT 2 Type 2 Diabetes: A Growing Challenge in the Healthcare Setting Introduction and background of type 2 diabetes:

More information

ADJUNCTIVE THERAPIES FOR TYPE 1 DIABETES

ADJUNCTIVE THERAPIES FOR TYPE 1 DIABETES ADJUNCTIVE THERAPIES FOR TYPE 1 DIABETES Dr. Mohammad Alhadj Ali, MD, PgDip, MSc, PhD (UK) with Prof. David Owens (UK) Outline Type 1 Diabetes Immunology of Type 1 Diabetes Treatment of Type 1 Diabetes

More information

WHAT DOES DYSMETABOLIC SYNDROME MEAN?

WHAT DOES DYSMETABOLIC SYNDROME MEAN? ! WHAT DOES DYSMETABOLIC SYNDROME MEAN? Dysmetabolic syndrome (also referred to as syndrome X, insulin resistance syndrome, and metabolic syndrome ) is a condition in which a group of risk factors for

More information

Type 2 diabetes Definition

Type 2 diabetes Definition Type 2 diabetes Definition Type 2 diabetes is a lifelong (chronic) disease in which there are high levels of sugar (glucose) in the blood. Type 2 diabetes is the most common form of diabetes. Causes Diabetes

More information

Type 2 Diabetes. Aims and Objectives. What did you consider? Case Study One: Miss S. Which to choose?!?! Modes of Action

Type 2 Diabetes. Aims and Objectives. What did you consider? Case Study One: Miss S. Which to choose?!?! Modes of Action Aims and Objectives This session will outline the increasing complexities of diabetes care, and the factors that differentiate the combinations of therapy, allowing individualisation of diabetes treatment.

More information

Diabetes and Heart Disease

Diabetes and Heart Disease Diabetes and Heart Disease Diabetes and Heart Disease According to the American Heart Association, diabetes is one of the six major risk factors of cardiovascular disease. Affecting more than 7% of the

More information

The Diabetes Epidemic

The Diabetes Epidemic The Diabetes Epidemic O 2118 Wilshire Blvd. Ste. 723 O Santa Monica, California 90403 O www.susandopart.com O susan@susandopart.com What to look for and how you can help your clients O 310-828-4476 Trends

More information

Pediatric Metabolic Syndrome

Pediatric Metabolic Syndrome University of Michigan Hospitals and Health Centers Pediatric Metabolic Syndrome A growing epidemic Shannon Russell Dietetic Intern June 2012 Overview Causes Risk Factors Signs and Symptoms Identification/Diagnosis

More information

Introduction. Pathogenesis of type 2 diabetes

Introduction. Pathogenesis of type 2 diabetes Introduction Type 2 diabetes mellitus (t2dm) is the most prevalent form of diabetes worldwide. It is characterised by high fasting and high postprandial blood glucose concentrations (hyperglycemia). Chronic

More information

Diabetes Mellitus 1. Chapter 43. Diabetes Mellitus, Self-Assessment Questions

Diabetes Mellitus 1. Chapter 43. Diabetes Mellitus, Self-Assessment Questions Diabetes Mellitus 1 Chapter 43. Diabetes Mellitus, Self-Assessment Questions 1. A 46-year-old man presents for his annual physical. He states that he has been going to the bathroom more frequently than

More information

Overview of Metabolism. Peds 231 April 9, 2009 Julie Theriot

Overview of Metabolism. Peds 231 April 9, 2009 Julie Theriot Overview of Metabolism Peds 231 April 9, 2009 Julie Theriot Outline What is metabolism and why should you care about it? Summary of human carbohydrate metabolism and connections to diabetes Metabolism

More information

Diabetes? Does Metabolic Surgery. Experts disagree about how surgery treats diabetes but agree more research needs to be done.

Diabetes? Does Metabolic Surgery. Experts disagree about how surgery treats diabetes but agree more research needs to be done. Does Metabolic Surgery The combination of type 2 diabetes and being significantly overweight is a huge burden. Doctors tell you to lose weight, in essence, to save your life. Weight loss, in addition to

More information

Update on the management of Type 2 Diabetes

Update on the management of Type 2 Diabetes Update on the management of Type 2 Diabetes Mona Nasrallah M.D Assistant Professor, Endocrinology American University of Beirut 10 th Annual Family Medicine Conference October 14,2011 Global Prevalence

More information

嘉 義 長 庚 醫 院 藥 劑 科 Speaker : 翁 玟 雯

嘉 義 長 庚 醫 院 藥 劑 科 Speaker : 翁 玟 雯 The Clinical Efficacy and Safety of Sodium Glucose Cotransporter-2 (SGLT2) Inhibitors in Adults with Type 2 Diabetes Mellitus 嘉 義 長 庚 醫 院 藥 劑 科 Speaker : 翁 玟 雯 Diabetes Mellitus : A group of diseases characterized

More information

Understanding diabetes Do the recent trials help?

Understanding diabetes Do the recent trials help? Understanding diabetes Do the recent trials help? Dr Geoffrey Robb Consultant Physician and Diabetologist CMO RGA UK Services and Partnership Assurance AMUS 25 th March 2010 The security of experience.

More information

Diabetes: Beyond the D50. Leslie Huntington, BS, Paramedic Mobile Training Unit Oregon OHA-EMS and Trauma Systems

Diabetes: Beyond the D50. Leslie Huntington, BS, Paramedic Mobile Training Unit Oregon OHA-EMS and Trauma Systems Diabetes: Beyond the D50 Leslie Huntington, BS, Paramedic Mobile Training Unit Oregon OHA-EMS and Trauma Systems The EMS View of Diabetes Management BG low? Give some form of sugar. Hero! BG somewhere

More information

Second- and Third-Line Approaches for Type 2 Diabetes Workgroup: Topic Brief

Second- and Third-Line Approaches for Type 2 Diabetes Workgroup: Topic Brief Second- and Third-Line Approaches for Type 2 Diabetes Workgroup: Topic Brief March 7, 2016 Session Objective: The objective of this workshop is to assess the value of undertaking comparative effectiveness

More information

ESPEN Congress Geneva 2014 LLL LIVE COURSE: NUTRITION IN OBESITY

ESPEN Congress Geneva 2014 LLL LIVE COURSE: NUTRITION IN OBESITY ESPEN Congress Geneva 2014 LLL LIVE COURSE: NUTRITION IN OBESITY Pre-operative medical assessment, post-operative follow-up and clinical outcome in bariatric surgery patients A. Thorell (SE) Nutrition

More information

REACH Risk Evaluation to Achieve Cardiovascular Health

REACH Risk Evaluation to Achieve Cardiovascular Health Dyslipidemia and type 1 diabetes mellitus History: A 15-year-old girl is seen in the endocrinology clinic for a routine follow-up visit for type 1 diabetes. She was diagnosed with diabetes at 12 years

More information

PREVALENCE OF TYPE 2 DIABETES MELLITUS IN PATIENTS WITH HEPATITIS C VIRUS INFECTION IN SANA'A, YEMEN.

PREVALENCE OF TYPE 2 DIABETES MELLITUS IN PATIENTS WITH HEPATITIS C VIRUS INFECTION IN SANA'A, YEMEN. PREVALENCE OF TYPE 2 DIABETES MELLITUS IN PATIENTS WITH HEPATITIS C VIRUS INFECTION IN SANA'A, YEMEN. Prepared by: Dr/ Saeed Mana Almaidamah Under supervision of Ass. Prof. Dr/ Mohammed Ba Mashmos IS THERE

More information

Position Statement Weight Loss Surgery (Bariatric Surgery) and its Use in Treating Obesity or Treating and Preventing Diabetes

Position Statement Weight Loss Surgery (Bariatric Surgery) and its Use in Treating Obesity or Treating and Preventing Diabetes Position Statement Weight Loss Surgery (Bariatric Surgery) and its Use in Treating Obesity or Treating and Preventing Diabetes People with diabetes Losing excess weight will assist in the management of

More information

Am I at Risk for type 2 Diabetes? Taking Steps to Lower the Risk of Getting Diabetes NATIONAL DIABETES INFORMATION CLEARINGHOUSE

Am I at Risk for type 2 Diabetes? Taking Steps to Lower the Risk of Getting Diabetes NATIONAL DIABETES INFORMATION CLEARINGHOUSE NATIONAL DIABETES INFORMATION CLEARINGHOUSE Am I at Risk for type 2 Diabetes? Taking Steps to Lower the Risk of Getting Diabetes U.S. Department of Health and Human Services National Institutes of Health

More information

Primary Care Guidance Program: Non-Alcohol related Fatty Liver Disease (NAFLD) Guidance on Management in Primary Care

Primary Care Guidance Program: Non-Alcohol related Fatty Liver Disease (NAFLD) Guidance on Management in Primary Care Primary Care Guidance Program: Non-Alcohol related Fatty Liver Disease (NAFLD) Guidance on Management in Primary Care This advice has been developed to help GPs with shared care of patients with Non- Alcohol

More information

UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS. - Summary

UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS. - Summary UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS - Summary CHRONIC COMPLICATIONS IN PATIENTS WITH TYPE 1 DIABETES MELLITUS - Epidemiological study - PhD Manager: Professor PhD.

More information

Pharmaceutical Management of Diabetes Mellitus

Pharmaceutical Management of Diabetes Mellitus 1 Pharmaceutical Management of Diabetes Mellitus Diabetes Mellitus (cont d) Signs and symptoms 2 Elevated fasting blood glucose (higher than 126 mg/dl) or a hemoglobin A1C (A1C) level greater than or equal

More information

Diabetes mellitus is a chronic condition that occurs as a result of problems with the production and/or action of insulin in the body.

Diabetes mellitus is a chronic condition that occurs as a result of problems with the production and/or action of insulin in the body. International Diabetes Federation Diabetes Background Information Diabetes mellitus is a chronic condition that occurs as a result of problems with the production and/or action of insulin in the body.

More information

Diabetes 101: A Brief Overview of Diabetes and the American Diabetes Association What Happens When We Eat?

Diabetes 101: A Brief Overview of Diabetes and the American Diabetes Association What Happens When We Eat? Diabetes 101: A Brief Overview of Diabetes and the American Diabetes Association What Happens When We Eat? After eating, most food is turned into glucose, the body s main source of energy. 1 Normal Blood

More information

Distinguishing between Diabetes Mellitus Type 1 and Type 2, (with Overview of Treatment Strategies)

Distinguishing between Diabetes Mellitus Type 1 and Type 2, (with Overview of Treatment Strategies) Distinguishing between Diabetes Mellitus Type 1 and Type 2, (with Overview of Treatment Strategies) Leann Olansky, MD, FACP, FACE Cleveland Clinic Endocrinology Glucose Tolerance Categories FPG Diabetes

More information

Glucose Tolerance Categories. Distinguishing between Diabetes Mellitus Type 1 and Type 2, (with Overview of Treatment Strategies)

Glucose Tolerance Categories. Distinguishing between Diabetes Mellitus Type 1 and Type 2, (with Overview of Treatment Strategies) Distinguishing between Diabetes Mellitus Type 1 and Type 2, (with Overview of Treatment Strategies) Leann Olansky, MD, FACP, FACE Cleveland Clinic Endocrinology Glucose Tolerance Categories FPG Diabetes

More information

Treatment of diabetes In order to survive, people with type 1 diabetes must have insulin delivered by a pump or injections.

Treatment of diabetes In order to survive, people with type 1 diabetes must have insulin delivered by a pump or injections. National Diabetes Statistics What is diabetes? Diabetes mellitus is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.

More information

Diabetes and SCI 2007

Diabetes and SCI 2007 Diabetes and SCI 2007 Long term spinal cord injury (SCI) and diabetes? Some research suggests the two go hand in hand with as many as 20 percent of spinal cord injured people having adult-onset diabetes.

More information

Is Insulin Effecting Your Weight Loss and Your Health?

Is Insulin Effecting Your Weight Loss and Your Health? Is Insulin Effecting Your Weight Loss and Your Health? Teressa Alexander, M.D., FACOG Women s Healthcare Associates www.rushcopley.com/whca 630-978-6886 Obesity is Epidemic in the US 2/3rds of U.S. adults

More information

Subject Index. Bariatric surgery, obesity management 134

Subject Index. Bariatric surgery, obesity management 134 Subject Index Acromegaly, PCOS differential diagnosis 149, 150, 154, 155 Adipokines, see specific adipokines Adiponectin, metabolic syndrome role 41 43 Adolescents, PCOS diagnosis 16, 17 Adrenal hyperplasia,

More information

MEDICAL COVERAGE POLICY. SERVICE: Bariatric (Weight Loss) Surgery Policy Number: 053 Effective Date: 5/27/2014 Last Review: 4/24/2014

MEDICAL COVERAGE POLICY. SERVICE: Bariatric (Weight Loss) Surgery Policy Number: 053 Effective Date: 5/27/2014 Last Review: 4/24/2014 Page 1 of 6 MEDICAL COVERAGE POLICY Important note Even though this policy may indicate that a particular service or supply is considered covered, this conclusion is not necessarily based upon the terms

More information

DRUGS FOR GLUCOSE MANAGEMENT AND DIABETES

DRUGS FOR GLUCOSE MANAGEMENT AND DIABETES Page 1 DRUGS FOR GLUCOSE MANAGEMENT AND DIABETES Drugs to know are: Actrapid HM Humulin R, L, U Penmix SUNALI MEHTA The three principal hormones produced by the pancreas are: Insulin: nutrient metabolism:

More information

Role of Body Weight Reduction in Obesity-Associated Co-Morbidities

Role of Body Weight Reduction in Obesity-Associated Co-Morbidities Obesity Role of Body Weight Reduction in JMAJ 48(1): 47 1, 2 Hideaki BUJO Professor, Department of Genome Research and Clinical Application (M6) Graduate School of Medicine, Chiba University Abstract:

More information

Metabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007

Metabolic Syndrome Overview: Easy Living, Bitter Harvest. Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Metabolic Syndrome Overview: Easy Living, Bitter Harvest Sabrina Gill MD MPH FRCPC Caroline Stigant MD FRCPC BC Nephrology Days, October 2007 Evolution of Metabolic Syndrome 1923: Kylin describes clustering

More information

Catholic Medical Center & Androscoggin Valley Hospital. Surgical Weight Loss Options For a Healthier Tomorrow

Catholic Medical Center & Androscoggin Valley Hospital. Surgical Weight Loss Options For a Healthier Tomorrow Catholic Medical Center & Androscoggin Valley Hospital Surgical Weight Loss Options For a Healthier Tomorrow Presentation Overview Obesity Health Related Risks Who Qualifies for Weight Loss Surgery? Gastric-bypass

More information

4/4/2013. Mike Rizo, Pharm D, MBA, ABAAHP THE PHARMACIST OF THE FUTURE? METABOLIC SYNDROME AN INTEGRATIVE APPROACH

4/4/2013. Mike Rizo, Pharm D, MBA, ABAAHP THE PHARMACIST OF THE FUTURE? METABOLIC SYNDROME AN INTEGRATIVE APPROACH METABOLIC SYNDROME AN INTEGRATIVE APPROACH AN OPPORTUNITY FOR PHARMACISTS TO MAKE A DIFFERENCE Mike Rizo, Pharm D, MBA, ABAAHP THE EVOLUTION OF THE PHARMACIST 1920s 1960s 2000s THE PHARMACIST OF THE FUTURE?

More information

Mary Bruskewitz APN, MS, RN, BC-ADM Clinical Nurse Specialist Diabetes

Mary Bruskewitz APN, MS, RN, BC-ADM Clinical Nurse Specialist Diabetes Mary Bruskewitz APN, MS, RN, BC-ADM Clinical Nurse Specialist Diabetes Objectives Pathophysiology of Diabetes Acute & Chronic Complications Managing acute emergencies Case examples 11/24/2014 UWHealth

More information

Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI)

Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) Preservation and Incorporation of Valuable Endoscopic Innovations (PIVI) The American Society for Gastrointestinal Endoscopy PIVI on Endoscopic Bariatric Procedures (short form) Please see related White

More information

COST ANALYSIS OF ANTIDIABETIC DRUGS FOR DIABETES MELLITUS OUTPATIENT IN KODYA YOGYAKARTA HOSPITAL

COST ANALYSIS OF ANTIDIABETIC DRUGS FOR DIABETES MELLITUS OUTPATIENT IN KODYA YOGYAKARTA HOSPITAL Malaysian Journal of Pharmaceutical Sciences, Vol. 5, No. 1, 19 23 (2007) COST ANALYSIS OF ANTIDIABETIC DRUGS FOR DIABETES MELLITUS OUTPATIENT IN KODYA YOGYAKARTA HOSPITAL TRI MURTI ANDAYANI* AND IKE IMANINGSIH

More information

Section 2. Overview of Obesity, Weight Loss, and Bariatric Surgery

Section 2. Overview of Obesity, Weight Loss, and Bariatric Surgery Section 2 Overview of Obesity, Weight Loss, and Bariatric Surgery What is Weight Loss? How does surgery help with weight loss? Short term versus long term weight loss? Conditions Improved with Weight Loss

More information

Effects of macronutrients on insulin resistance and insulin requirements

Effects of macronutrients on insulin resistance and insulin requirements Effects of macronutrients on insulin resistance and insulin requirements Dr Duane Mellor RD Assistant Professor in Dietetics, The University of Nottingham, UK Outline of Discussion Issues of determining

More information

PATHWAYS TO TYPE 2 DIABETES. Vera Tsenkova, PhD Assistant Scientist Institute on Aging University of Wisconsin-Madison

PATHWAYS TO TYPE 2 DIABETES. Vera Tsenkova, PhD Assistant Scientist Institute on Aging University of Wisconsin-Madison PATHWAYS TO TYPE 2 DIABETES Vera Tsenkova, PhD Assistant Scientist Institute on Aging University of Wisconsin-Madison Overview Diabetes 101 How does diabetes work Types of diabetes Diabetes in numbers

More information

Drug Treatment for Weight Loss: New Advances

Drug Treatment for Weight Loss: New Advances Drug Treatment for Weight Loss: New Advances William G. Haynes FRCP MD Professor of Internal Medicine Divisions of Endocrinology and Cardiovascular Medicine University of Iowa Outline Why should we use

More information

Diabetes Medications: Insulin Therapy

Diabetes Medications: Insulin Therapy Diabetes Medications: Insulin Therapy Courtesy Univ Texas San Antonio Eric L. Johnson, M.D. Department of Family and Community Medicine Diabetes and Insulin Type 1 Diabetes Autoimmune destruction of beta

More information

Menopause. Weight Loss. A Special Report on Weight Gain During Menopause. contact us. FROM THE DESK OF: Carolyn J. Cederquist, M.D. Dr.

Menopause. Weight Loss. A Special Report on Weight Gain During Menopause. contact us. FROM THE DESK OF: Carolyn J. Cederquist, M.D. Dr. Weight Loss & A Special Report on Weight Gain During Menopause Menopause FROM THE DESK OF: Carolyn J. Cederquist, M.D. Dr. Cederquist Caroline J. Cederquist, M.D., has appeared as a weight-management expert

More information

Cancer treatment and diabetes

Cancer treatment and diabetes Cancer treatment and diabetes Dr Daniel Morganstein Consultant Endocrinologist, 1 2 Diabetes and cancer Cancer and its treatment also poses challenges to managing diabetes Surgery Altered appetite Cachexia

More information

Type 1 Diabetes ( Juvenile Diabetes)

Type 1 Diabetes ( Juvenile Diabetes) Type 1 Diabetes W ( Juvenile Diabetes) hat is Type 1 Diabetes? Type 1 diabetes, also known as juvenile-onset diabetes, is one of the three main forms of diabetes affecting millions of people worldwide.

More information

GDM: Gestational Diabetes Mellitus

GDM: Gestational Diabetes Mellitus GDM: Gestational Diabetes Mellitus KATELYN ASHBAUGH KNH 406 MATUSZAK 10, APRIL 2010 Description of Patient Veronica Delgado Age: 31 22 nd week of pregnancy Family hx of diabetes Hispanic decent Wt. 175lbs-

More information

WEIGHT LOSS SURGERY. Pre-Clinic Conference Jennifer Kinley, MD 12/15/2010

WEIGHT LOSS SURGERY. Pre-Clinic Conference Jennifer Kinley, MD 12/15/2010 WEIGHT LOSS SURGERY Pre-Clinic Conference Jennifer Kinley, MD 12/15/2010 EDUCATIONAL OBJECTIVES: Discuss the available pharmaceutical options for weight loss and risks of these medications Explain the

More information

Weight Loss Surgery and Bariatric Nutrition. Jeanine Giordano, MS, RD, CDN

Weight Loss Surgery and Bariatric Nutrition. Jeanine Giordano, MS, RD, CDN Weight Loss urgery and Bariatric Nutrition Jeanine Giordano, M, RD, CDN UA: Mean BMI trends (age standardized) Prevalence of Obesity Among Adults United tates 68% Australia 59% Russia 54% United Kingdom

More information

4/11/14. Medical Director, Bariatric Surgery Mountainview Regional Medical Center. ! None. ! Discuss the ongoing epidemic of obesity

4/11/14. Medical Director, Bariatric Surgery Mountainview Regional Medical Center. ! None. ! Discuss the ongoing epidemic of obesity Medical Director, Bariatric Surgery Mountainview Regional Medical Center! None! Discuss the ongoing epidemic of obesity! Discuss current treatment options! Discuss the role of bariatric surgery! Review

More information

SHORT CLINICAL GUIDELINE SCOPE

SHORT CLINICAL GUIDELINE SCOPE NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SHORT CLINICAL GUIDELINE SCOPE 1 Guideline title Type 2 diabetes: newer agents for blood glucose control in type 2 diabetes 1.1 Short title Type 2

More information

Reconciling Current Diabetes Guidelines

Reconciling Current Diabetes Guidelines Reconciling Current Diabetes Guidelines Jaime A. Davidson, MD, FACP. FACE Part 1. Diagnosis Welcome. I am Dr. Jaime Davidson, a clinical professor of medicine in the Department of Internal Medicine, Division

More information