Review of Diabetes Therapies: Key Drivers of Disease Progression

Size: px
Start display at page:

Download "Review of Diabetes Therapies: Key Drivers of Disease Progression"

Transcription

1 Review of Diabetes Therapies: Key Drivers of Disease Progression David M. Kendall, MD Medical Director and Chief of Clinical and Professional Services Associate Professor of Medicine University of Minnesota Minneapolis, MN

2 Diabetes Therapies and Disease Progression: Discussion Outline Disease progression in Type 2 diabetes The role of beta cell function and insulin resistance Clinical consequences of disease progression Glycemic control and treatment failure Specific therapies effect on diabetes progression Diabetes prevention vs. disease progression A Glimpse of the Future Implications for Treatment Early intervention and diabetes treatment response Impact on the risk of complications

3 The Pathophysiology of Type 2 Diabetes Impaired Incretin Effect Insulin Resistance Relative Insulin Deficiency All rights reserved

4 Natural History of Type 2 Diabetes Glucose (mg/dl) Diabetes diagnosis Postmeal Glucose Fasting glucose Relative amount β cell function Incretin effect Insulin resistance Insulin level Onset Diabetes Years Kendall DM, Cuddihy, RM, Bergenstal RM All rights reserved

5 Diabetes Disease Progression: β cell Dysfunction and Early Hyperglycemia Ferrannini E. J Clin Endocrinol Metab 90: , 2005

6 Diabetes Disease Progression: Clinical Consequences Implications of disease progression Progressive deterioration in glycemic control (UKPDS) Increasing risk of complications Stepped, failure-based therapeutic approach delay in Rx HbA 1c (%) 9 8 Interval Before Rx Change Conventional (7.9%) Intensive therapy (7.0%) Brown JB, et al. Diabetes Care. 2004;27: UKPDS 33. Lancet 352: , Metformin only (n = 513) Sulfonylurea only (n = 3394) Years from randomization

7 Clinical Impact of Diabetes Therapy Diabetes Prevention and Disease Progression

8 Diabetes Disease Progression: Impact of Specific Therapies Therapy Improved Insulin Secretion Increased β cell mass Diabetes Prevention Disease Modification Lifestyle (MNT) Metformin Sulfonylurea Insulin Measures of fasting insulin Stimulated insulin response Beta cell mass Insulin content and mrna Stimulated (maximal) insulin secretion Prevent increase in FPG Maintain or restore normal glucose response Diabetes prevention Stability of glycemic control Limit need for added therapies AGI TZD Incretin based Rx

9 Diabetes Prevention Program (DPP) Prevention of Diabetes Placebo (n=1082) Metformin (n=1073, p<0.001 vs. PBO) Lifestyle (n=1079, p<0.001 vs. Met and PBO) 31% 58% The DPP Research Group, NEJM 346: , 2002

10 The STOP-NIDDM Study: Effect of Acarbose Therapy 100 Cumulative Probability (%) Placebo Acarbose 25% Relative Risk Reduction Days After Randomization Chiasson JL et al. Lancet 2002;359:2072 and JAMA 2003;290:486

11 Durability of Glycemic Control with Sulfonylurea Therapy 1 Change in A1C (%) 0-1 Glimepiride Gliclazide Glyburide Glyburide Hanefeld (n=500) Charbonnel (n=630) Glyburide CHICAGO (n=462) ADOPT (n=2897) UKPDS (n=1573) Time (yrs) Mazzone T. JAMA. 2006;296: Hanefeldd M. Cur Med Res Opin. 2006;22: Nissen SE. JAMA. 2008;299: UKPDS Study Group. Lancet.1998;352: Charbonnel B. Diabetoogia. 2005;48(6):

12 Intensive Treatment of Type 2 Diabetes: UKPDS HbA 1c (%) UKPDS 33. Lancet 352: , 1998 UKPDS 16. Diabetes 44: , 1995 Conventional (7.9%) Metformin Intensive therapy (7.0%) SU or insulin Years from randomization HOMA β-cell Function (%)

13 Diabetes Disease Progression: Impact of Specific Therapies Therapy Improved Insulin Secretion Increased β cell mass Diabetes Prevention Disease Modification Lifestyle (MNT) Metformin Sulfonylurea Insulin AGI TZD Incretin based Rx

14 Thiazolidinediones A Closer Look at β Cell Function and Diabetes Disease Progression

15 Effect of Early TZD Use on A1C

16 DREAM: Investigation of Diabetes Prevention or Delay Rate of new-onset diabetes or death Follow-up (years) Placebo Rosiglitazone 60% RRR HR 0.40 ( ) P < at risk Placebo Rosiglitazone DREAM Trial Investigators. Lancet 368(9541): , 2006

17 ADOPT Cumulative Incidence of Treatment Failure 40 Rosi vs metformin, 32% RRR P<0.001 Rosi vs glyburide, 63% RRR P<0.001 Glyburide Cumulative Incidence of Monotherapy Failure (%) Improved estimates of β cell function Metformin Rosiglitazone Years. at risk Rosiglitazone Metformin Glyburide Kahn SE, et al. N Engl J Med 2006;355:

18 ADOPT Impact of Initial Therapy on A1C Glycated Hemoglobin (%) Rosiglitazone vs metformin, -0.13% P=0.002 Rosiglitazone vs glyburide, -0.42% P<0.001 Annualized slope (95% CI) Rosiglitazone, 0.07 (0.06 to 0.09) Metformin, 0.14 (0.13 to 0.16)* Glyburide, 0.24 (0.23 to 0.26)* Years. of Patients *Significant difference rosiglitazone vs other treatment groups with Hochberg adjustment. Kahn SE, et al. N Engl J Med 2006;355:

19 Durability of Glycemic Control with Thiazolidindiones 1 Hanefeld (n=250) Tan (n=270) PERISCOPE (n=178) Chicago (n=232) ADOPT (n=1456) Change in A1C (%) 0-1 PIO PIO PIO PIO Rosiglitazone Time (yrs) Kahn SE. N Engl J Med. 2006;355: Mazzone T. JAMA. 2006;296: Hanefeld M. Cur Med Res Opin. 2006;22: Tan MH. Diabetes Care. 2005;28: Nissen SE, et al. JAMA. 2008;299:

20 Incretin Based Therapy with GLP-1 Potential Impact on Disease Progression Excess food intake CNS: promotes satiety and reduction of appetite Excess glucose production Liver: glucagon reduces hepatic glucose output Glucagon excess Alpha cell: glucagon secretion post-meal Impaired β-cell function Beta cell: enhances glucosedependent insulin secretion and β cell mass Stomach: regulates gastric emptying Rapid substrate delivery Flint A et al. J Clin Invest. 1998;101: Larsson H et al. Acta Physiol Scand. 1997;160: Nauck MA et al., Diabetologia. 1996;39: Drucker DJ. Diabetes. 1998;47:

21 Exenatide Improves Phasic Insulin Secretion in Type 2 Diabetes

22 Incretin Based Therapies and Disease Progression Impact of Exenatide Over 3 Years Change in A1c (%) Change in Body Weight (kg) ± 0.1% -1.0 ± 0.1% % % achieving A1C 7% 46% Treatment (wk) ± 0.4 kg Treatment (wk) Baseline Weight: 99 kg N = 217; Mean ± SE Klonoff DC, et al. Curr Med Res Opin 2008; 24:

23 Exenatide vs Glargine Over 1 Year Impact on C-peptide Secretion During Hyperglycaemic Clamp 10 4 P< AIR arg C-peptide (nmol/l) Ratio to baseline Glucose 15 mm Time (min) Mean (SE) Exenatide Glucose Bolus Arginine Bolus Bunck M. Diabetologia. EASD 2007/2008

24 The Temporal Pattern of Weight Loss with Exenatide Therapy Weight HbA1c Kendall DM et al. Diabetes ADA Annual Scientific Sessions

25 Impact of DPP-4 Inhibitor on Glycemic Control and Beta Cell Function Placebo LS Mean Change in A1C (%) Sitagliptin 100 mg Glipizide Insulin Secretion (pmol/min) Sitagliptin 100 mg Baseline (dashed) End-treatment period 1.5 Baseline A1C 7.7% Pooled monotherapy studies Week Glucose concentration (mg/dl) Nauck M. Diabetes Obes Metab, 2007; 9: Xu L, et al. Diabetes Obes Metab. 2008;10:

26 Impact of Type 2 Diabetes Therapy on Disease Progression: A Checklist Therapy Improved Insulin Secretion Increased β cell mass Diabetes Prevention Disease Modification Lifestyle (MNT) Metformin Sulfonylurea Insulin AGI TZD Incretin based Rx??

27 A Glimpse of the Future: Implications for Clinical Care Early intervention and diabetes treatment response Achieve and sustain glucose control Legacy effect on risk of complications Therapeutic Options Disease modification targeting pathophysiologic defects Sustain beta-cell responsiveness Early combination therapy Limit factors that negatively impact treatment response? Hypoglycemia? Weight gain? Treatment tolerability and concordance

28 Clinical Implications of Disease Progression: The Natural History of Type 2 Diabetes 9.5 Early 9.0 deterioration in glycemic control 8.5 Drives the risk for complications A1C (%) May limit later efforts at intensive glucose control? TIME (yrs since diagnosis) Adapted from Prof. Stefano del Prato. EASD Commentary, Rome ITALY, With permission

Insulin or GLP1 How to make this choice in Practice. Tara Kadis Lead Nurse - Diabetes & Endocrinology Mid Yorkshire Hospitals NHS Trust

Insulin or GLP1 How to make this choice in Practice. Tara Kadis Lead Nurse - Diabetes & Endocrinology Mid Yorkshire Hospitals NHS Trust Insulin or GLP1 How to make this choice in Practice Tara Kadis Lead Nurse - Diabetes & Endocrinology Mid Yorkshire Hospitals NHS Trust Workshop Over View Considerations/barriers to treatments in type 2

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

New Treatments for Type 2 Diabetes

New Treatments for Type 2 Diabetes New Treatments for Type 2 Diabetes Dr David Hopkins Clinical Director, Division of Ambulatory Care King s College Hospital NHS Foundation Trust Treatments for type 2 diabetes - old & new insulin sulphonylureas

More information

Combined Therapy with Insulin Plus Oral Agents. Is there Any Advantage?

Combined Therapy with Insulin Plus Oral Agents. Is there Any Advantage? Combined Therapy with Insulin Plus Oral Agents Is there Any Advantage? Matthew C. Riddle, M.D. Professor of Medicine Oregon Health & Science University Portland, Oregon Is there Any Advantage in Combined

More information

Treatment Approaches to Diabetes

Treatment Approaches to Diabetes Treatment Approaches to Diabetes Dr. Sarah Swofford, MD, MSPH & Marilee Bomar, GCNS, CDE Quick Overview Lifestyle Oral meds Injectables not insulin Insulin Summary 1 Lifestyle & DM Getting to the point

More information

Translating Diabetes Medications into Protocol. Rich Bergenstal, MD International Diabetes Center

Translating Diabetes Medications into Protocol. Rich Bergenstal, MD International Diabetes Center Translating Diabetes Medications into Protocol Rich Bergenstal, MD International Diabetes Center Priorities of Care for Adults with Diabetes Diagnosis Prevention Dx Fasting Glucose > 126 Casual > 200 +

More information

Statins and Risk for Diabetes Mellitus. Background

Statins and Risk for Diabetes Mellitus. Background Statins and Risk for Diabetes Mellitus Kevin C. Maki, PhD, FNLA Midwest Center for Metabolic & Cardiovascular Research and DePaul University, Chicago, IL 1 Background In 2012 the US Food and Drug Administration

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

Does Diabetes Control Matter?

Does Diabetes Control Matter? Does Diabetes Control Matter? Laurence Kennedy, MD, FRCP Endocrinology Department Cleveland Clinic, OH Disclosures None Does Diabetes Control Matter? Generality of patients Relative Risk Complications

More information

Diabetes Medications in CKD. Dr Adam White, MD FRCPC Endocrinology and Metabolism UBC and SPH Division of Endocrinology

Diabetes Medications in CKD. Dr Adam White, MD FRCPC Endocrinology and Metabolism UBC and SPH Division of Endocrinology Diabetes Medications in CKD Dr Adam White, MD FRCPC Endocrinology and Metabolism UBC and SPH Division of Endocrinology Objectives Broadly review the current agents used for glycemic management in Type

More information

David Shu, MD, FRCPC Endocrinology, Royal Columbian Hospital October 8 th, 2010

David Shu, MD, FRCPC Endocrinology, Royal Columbian Hospital October 8 th, 2010 David Shu, MD, FRCPC Endocrinology, Royal Columbian Hospital October 8 th, 2010 Objectives At the end of the talk, the participants will be able to: 1. Identify the increasing prevalence of type 2 diabetes

More information

Type 2 diabetes is a progressive. status

Type 2 diabetes is a progressive. status Type 2 diabetes is a progressive disease: its treatment the current status Associate Professor Jonathan Shaw Why is type 2 diabetes so hard to treat? How to choose the right glucose-lowering g drug? Page

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

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

The basal plus strategy. Denis Raccah, MD, PhD Professor of Medicine University Hospital Sainte Marguerite Marseille FRANCE

The basal plus strategy. Denis Raccah, MD, PhD Professor of Medicine University Hospital Sainte Marguerite Marseille FRANCE The basal plus strategy Denis Raccah, MD, PhD Professor of Medicine University Hospital Sainte Marguerite Marseille FRANCE ADA/EASD guidelines recommend use of basal insulin as early as the second step

More information

Cardiovascular Disease in Diabetes

Cardiovascular Disease in Diabetes Cardiovascular Disease in Diabetes Where Do We Stand in 2012? David M. Kendall, MD Distinguished Medical Fellow Lilly Diabetes Associate Professor of Medicine University of MInnesota Disclosure - Duality

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

INSULIN INTENSIFICATION: Taking Care to the Next Level

INSULIN INTENSIFICATION: Taking Care to the Next Level INSULIN INTENSIFICATION: Taking Care to the Next Level By J. Robin Conway M.D., Diabetes Clinic, Smiths Falls, ON www.diabetesclinic.ca Type 2 Diabetes is an increasing problem in our society, due largely

More information

A Personalized Approach for A1C Goals

A Personalized Approach for A1C Goals PL Detail-Document #280708 This PL Detail-Document gives subscribers additional insight related to the Recommendations published in PHARMACIST S LETTER / PRESCRIBER S LETTER July 2012 A Personalized Approach

More information

Novel Trial Designs in T2D to Satisfy Regulatory Requirements for CV Safety

Novel Trial Designs in T2D to Satisfy Regulatory Requirements for CV Safety Novel Trial Designs in T2D to Satisfy Regulatory Requirements for CV Safety Anders Svensson MD, PhD Head of Global Clinical Development Metabolism, F Hoffmann LaRoche Ltd. Basel, Switzerland Overview of

More information

INSULIN TREATMENT FOR TYPE 2 DIABETES MANAGEMENT

INSULIN TREATMENT FOR TYPE 2 DIABETES MANAGEMENT INSULIN TREATMENT FOR TYPE 2 DIABETES MANAGEMENT APIRADEE SRIWIJITKAMOL DIVISION OF ENDOCRINOLOGY AND METABOLISM DEPARTMENT OF MEDICINE FACULTY OF MEDICINE SIRIRAJ HOSPITOL QUESTION 1 1. ท านเคยเป นแพทย

More information

Management of Diabetes: A Primary Care Perspective. Presentation Outline

Management of Diabetes: A Primary Care Perspective. Presentation Outline Management of Diabetes: A Primary Care Perspective Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest Presentation Outline

More information

GLP-1 Receptor Agonists (Byetta /Victoza ) Step Therapy Criteria

GLP-1 Receptor Agonists (Byetta /Victoza ) Step Therapy Criteria GLP-1 Receptor Agonists (Byetta /Victoza ) Step Therapy Criteria Brand Generic Dosage Form Byetta exenatide subcutaneous injection Victoza liraglutide subcutaneous injection PROGRAM OBJECTIVES The intent

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

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

CDA CPG 2016 Interim Update. Preferences & access to treatment. Program Director Knowledge Translation & Optimizing Care Models

CDA CPG 2016 Interim Update. Preferences & access to treatment. Program Director Knowledge Translation & Optimizing Care Models Safety of New Antihyperglycemics in Patients with Cardiovascular Disease Lori MacCallum, BScPhm, PharmD, RPh, CDE Assistant Professor, Leslie Dan Faculty of Pharmacy Sun Life Financial Professor in Wellness

More information

Harmony Clinical Trial Medical Media Factsheet

Harmony Clinical Trial Medical Media Factsheet Overview Harmony is the global Phase III clinical trial program for Tanzeum (albiglutide), a product developed by GSK for the treatment of type 2 diabetes. The comprehensive program comprised eight individual

More information

DO POSTPRANDIAL GLYCEMIC EXCURSIONS IMPACT CARDIOVASCULAR RISK?

DO POSTPRANDIAL GLYCEMIC EXCURSIONS IMPACT CARDIOVASCULAR RISK? ATDC Keystone Symposium, Practical Ways to Achieve Targets in Diabetes Care, July 17-20, 2014, Denver DO POSTPRANDIAL GLYCEMIC EXCURSIONS IMPACT CARDIOVASCULAR RISK? Dr.V.Mohan., MD., Ph.D., D.Sc., D.Sc

More information

Cardiovascular Effects of Drugs to Treat Diabetes

Cardiovascular Effects of Drugs to Treat Diabetes Cardiovascular Effects of Drugs to Treat Diabetes Steven E. Nissen MD Chairman, Department of Cardiovascular Medicine Cleveland Clinic Disclosure Consulting: Many pharmaceutical companies Clinical Trials:

More information

Volume 01, No. 08 November 2013

Volume 01, No. 08 November 2013 State of New Jersey Department of Human Services Division of Medical Assistance & Health Services New Jersey Drug Utilization Review Board Volume 01, No. 08 November 2013 TO: SUBJECT: PURPOSE: Physicians,

More information

Overdiagnosis and the Epidemic of Pre-Diabetes

Overdiagnosis and the Epidemic of Pre-Diabetes Overdiagnosis and the Epidemic of Pre-Diabetes John S. Yudkin Emeritus Professor of Medicine, University College London Outline The concept of Intermediate Hyperglycaemia - Predicting future diabetes

More information

Which drugs should be used to treat diabetes in cirrhotic patients?

Which drugs should be used to treat diabetes in cirrhotic patients? Which drugs should be used to treat diabetes in cirrhotic patients? Frankfurt am Main 10-12 September 2015 Jörg Bojunga Medizinische Klinik I Johann Wolfgang Goethe-Universität Frankfurt am Main Significance

More information

Diabetes Mellitus: Pharmacology and Disease Management

Diabetes Mellitus: Pharmacology and Disease Management Diabetes Mellitus: Pharmacology and Disease Management Michael King, MD Assistant Professor Residency Program Director University of Kentucky Dept. of Family & Community Medicine Objectives 1. Compare

More information

Take a moment Confer with your neighbour And try to solve the following word picture puzzle slides.

Take a moment Confer with your neighbour And try to solve the following word picture puzzle slides. Take a moment Confer with your neighbour And try to solve the following word picture puzzle slides. Example: = Head Over Heels Take a moment Confer with your neighbour And try to solve the following word

More information

Sponsor. Novartis Generic Drug Name. Vildagliptin. Therapeutic Area of Trial. Type 2 diabetes. Approved Indication. Investigational.

Sponsor. Novartis Generic Drug Name. Vildagliptin. Therapeutic Area of Trial. Type 2 diabetes. Approved Indication. Investigational. Clinical Trial Results Database Page 1 Sponsor Novartis Generic Drug Name Vildagliptin Therapeutic Area of Trial Type 2 diabetes Approved Indication Investigational Study Number CLAF237A2386 Title A single-center,

More information

Comparative Review of Oral Hypoglycemic Agents in Adults

Comparative Review of Oral Hypoglycemic Agents in Adults SECTION 18.5 Comparative Review of Oral Hypoglycemic Agents in Adults Harinder Chahal For WHO Secretariat Table of Contents Acronyms:... 3 I. Background and Rationale for the review:... 4 II. Medications

More information

Subcutaneous Infusion of GLP-1 for 7 Days Improves Glycemic Control Over a Broad Dose Range in Patients with Type 2 Diabetes

Subcutaneous Infusion of GLP-1 for 7 Days Improves Glycemic Control Over a Broad Dose Range in Patients with Type 2 Diabetes Subcutaneous Infusion of GLP-1 for 7 Days Improves Glycemic Control Over a Broad Dose Range in Patients with Type 2 Diabetes Mario R. Ehlers, 1,2 Roderick E. Harley, 1 Annette L. Mathisen, 1 Roberta Schneider,

More information

My Doctor Says I Need to Take Diabetes Pills and Insulin What Do I Do Now? BD Getting Started Combination Therapy

My Doctor Says I Need to Take Diabetes Pills and Insulin What Do I Do Now? BD Getting Started Combination Therapy My Doctor Says I Need to Take Diabetes Pills and Insulin What Do I Do Now? BD Getting Started Combination Therapy Combination Therapy Adding medication and/or insulin to better manage diabetes What is

More information

Insulin myths and facts

Insulin myths and facts london medicines evaluation network Insulin myths and facts Statement 1 Insulin is the last resort for patients with Type 2 diabetes After initial metformin and sulfonylurea therapy, NICE and SIGN suggest

More information

Improving drug prescription in elderly diabetic patients. FRANCESC FORMIGA Hospital Universitari de Bellvitge

Improving drug prescription in elderly diabetic patients. FRANCESC FORMIGA Hospital Universitari de Bellvitge Improving drug prescription in elderly diabetic patients FRANCESC FORMIGA Hospital Universitari de Bellvitge High prevalence, but also increases the incidence. The older the patients, the higher the percentages

More information

THE PATHOPHYSIOLOGIC BASIS FOR DIABETES TREATMENT: EVALUATING THE EFFECT OF INCRETIN-BASED THERAPIES * Jack Leahy, MD

THE PATHOPHYSIOLOGIC BASIS FOR DIABETES TREATMENT: EVALUATING THE EFFECT OF INCRETIN-BASED THERAPIES * Jack Leahy, MD THE PATHOPHYSIOLOGIC BASIS FOR DIABETES TREATMENT: EVALUATING THE EFFECT OF INCRETIN-BASED THERAPIES * Jack Leahy, MD ABSTRACT Type 2 diabetes is a persistent public health challenge that requires innovative

More information

Long term Weight Management in Obese Diabetic Patients Osama Hamdy, MD, PhD, FACE

Long term Weight Management in Obese Diabetic Patients Osama Hamdy, MD, PhD, FACE Long term Weight Management in Obese Diabetic Patients Osama Hamdy, MD, PhD, FACE Medical Director, Obesity Clinical Program, Director of Inpatient Diabetes Management, Joslin Diabetes Center Assistant

More information

MANAGEMENT OF HYPERGLYCEMIA IN THE NONCRITICAL CARE SETTING

MANAGEMENT OF HYPERGLYCEMIA IN THE NONCRITICAL CARE SETTING MANAGEMENT OF HYPERGLYCEMIA IN THE NONCRITICAL CARE SETTING 1 RECOGNITION AND DIAGNOSIS OF HYPERGLYCEMIA IN NONCRITICALLY ILL PATIENTS 2 RECOGNITION AND DIAGNOSIS OF HYPERGLYCEMIA AND DIABETES IN THE HOSPITAL

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

The majority of patients destined to develop

The majority of patients destined to develop RATIONALE FOR DIFFERENT AND EFFECTIVE TREATMENT APPROACHES IN TYPE 2 DIABETES * Martin J. Abrahamson, MD ABSTRACT The most common cause of mortality in diabetes is macrovascular disease, specifically coronary

More information

DIABETES MEDICATION-ORAL AGENTS AND OTHER HYPOGLYCEMIC AGENTS

DIABETES MEDICATION-ORAL AGENTS AND OTHER HYPOGLYCEMIC AGENTS Section Two DIABETES MEDICATION-ORAL AGENTS AND OTHER HYPOGLYCEMIC AGENTS This section will: Describe oral agents (pills) are specific for treating type 2 diabetes. Describe other hypoglycemic agents used

More information

Treatment of Type 2 Diabetes with Special Consideration to Reduce Hypoglycemia

Treatment of Type 2 Diabetes with Special Consideration to Reduce Hypoglycemia Treatment of Type 2 Diabetes with Special Consideration to Reduce Hypoglycemia Learning Objectives After participating in this educational activity, participants should be able to: 1. Apply strategies

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

Diabetes increased 70% among people age in approximately the last decade

Diabetes increased 70% among people age in approximately the last decade Hypoglycemia: A Complication When Targeting Type 2 Diabetes Jeffrey S. Freeman DO FACOI Professor of Internal Medicine Chairman Division of Endocrinology and Metabolism Philadelphia College of Osteopathic

More information

Comparing Medications for Adults With Type 2 Diabetes Focus of Research for Clinicians

Comparing Medications for Adults With Type 2 Diabetes Focus of Research for Clinicians Clinician Research Summary Diabetes Type 2 Diabetes Comparing Medications for Adults With Type 2 Diabetes Focus of Research for Clinicians A systematic review of 166 clinical studies published between

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

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

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

Management of Type 2 Diabetes Mellitus in the Elderly

Management of Type 2 Diabetes Mellitus in the Elderly Management of Type 2 Diabetes Mellitus in the Elderly ANDREA FERENCZI, M.D. BANNER ARIZONA MEDICAL CLINIC DEPARTMENT OF ENDOCRINOLOGY Incidence and Prevalence of Diabetes in the United States County-level

More information

Type 2 Diabetes in Children

Type 2 Diabetes in Children Type 2 Diabetes in Children February 19, 2005 Brandon Nathan, MD Endocrinology Department of Pediatrics University of Minnesota Medical School University of Minnesota Masonic Children s Hospital Agenda

More information

Management of Diabetes in the Elderly. Sylvia Shamanna Internal Medicine (R1)

Management of Diabetes in the Elderly. Sylvia Shamanna Internal Medicine (R1) Management of Diabetes in the Elderly Sylvia Shamanna Internal Medicine (R1) Case 74 year old female with frontal temporal lobe dementia admitted for prolonged delirium and frequent falls (usually in the

More information

Pathophysiology of Type 2 Diabetes and Its Treatment Policy

Pathophysiology of Type 2 Diabetes and Its Treatment Policy Research and Reviews Pathophysiology of Type 2 Diabetes and Its Treatment Policy JMAJ 53(1): 41 46, 2010 Kohei KAKU* 1 Abstract Impaired insulin secretion and increased insulin resistance, the main pathophysiological

More information

Britni Hebert, MD PGY-1

Britni Hebert, MD PGY-1 Britni Hebert, MD PGY-1 Importance of Diabetes treatment Types of treatment Comparison of treatment/article Review Summary Example cases 1 out of 13 Americans have diabetes Complications include blindness,

More information

New Non-Insulin Therapies for Type 2 Diabetes Mellitus

New Non-Insulin Therapies for Type 2 Diabetes Mellitus New Non-Insulin Therapies for Type 2 Diabetes Mellitus Ally P.H. Prebtani Associate Professor of Medicine Internal Medicine, Endocrinology & Metabolism McMaster University Canada Disclosure Relationships

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

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

CASE A1 Hypoglycemia in an Elderly T2DM Patient with Heart Failure

CASE A1 Hypoglycemia in an Elderly T2DM Patient with Heart Failure Hypoglycemia in an Elderly T2DM Patient with Heart Failure 1 I would like to introduce you to Sophie, an elderly patient with long-standing type 2 diabetes, who has a history of heart failure, a common

More information

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

There seem to be inconsistencies regarding diabetic management in

There seem to be inconsistencies regarding diabetic management in Society of Ambulatory Anesthesia (SAMBA) Consensus Statement on Perioperative Blood Glucose Management in Diabetic Patients Undergoing Ambulatory Surgery Review of the consensus statement and additional

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

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

Prediabetes: A Woman s Perspective

Prediabetes: A Woman s Perspective Prediabetes: A Woman s Perspective AMERICAN COLLEGE OF ENDOCRINOLOGY CONSENSUS STATEMENT ON THE DIAGNOSIS AND MANAGEMENT OF PRE-DIABETES IN THE CONTINUUM OF HYPERGLYCEMIA Joanne Kaiser-Smith, D.O., FACOI,

More information

Optimizing Oral Diabetes Medications (Treating to Goal) The Organs Affected by Diabetes. Progressive Nature of Type 2 Diabetes.

Optimizing Oral Diabetes Medications (Treating to Goal) The Organs Affected by Diabetes. Progressive Nature of Type 2 Diabetes. Optimizing Oral Diabetes Medications (Treating to Goal) Maria Blanco-Castellanos, RN, CDE Nurse Health Educator Orange Health Pavilion Kaiser Permanente Clinical Nurse Researcher Charles Drew University/UCLA

More information

Routinely assessing glycemic variability is challenging. Consider these two patients who look virtually the same clinically

Routinely assessing glycemic variability is challenging. Consider these two patients who look virtually the same clinically Routinely assessing glycemic variability is challenging A1C average glucose levels can vary widely between patients, and fasting and infrequent fingerstick glucoses often miss glucose peaks and their durations.

More information

Overview of the Gliptin Class (Dipeptidyl Peptidase-4 Inhibitors) in Clinical Practice

Overview of the Gliptin Class (Dipeptidyl Peptidase-4 Inhibitors) in Clinical Practice clinical features Overview of the Gliptin Class (Dipeptidyl Peptidase-4 Inhibitors) in Clinical Practice Nancy Bohannon, MD 1 1 Monteagle Medical Center, San Francisco, CA Correspondence: Nancy Bohannon,

More information

Clinical Efficacy of Gliptins for Glycemic Control in Type 2 Diabeties Mellitus

Clinical Efficacy of Gliptins for Glycemic Control in Type 2 Diabeties Mellitus World Applied Sciences Journal 7 (1): 01-06, 2009 ISSN 1818-4952 IDOSI Publications, 2009 REVIEW ARTICLE Clinical Efficacy of Gliptins for Glycemic Control in Type 2 Diabeties Mellitus 1 2 3 1 2 Atif Sitwat

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

Is hypoglycemia an issue in type 2 diabetes?

Is hypoglycemia an issue in type 2 diabetes? King s Diabetes Research Group Is hypoglycemia an issue in type 2 diabetes? Stephanie A Amiel RD Lawrence Professor of Diabetic Medicine King s College London Conflicts of interest None! (Currently working

More information

Once-Weekly Exenatide as Adjunct Treatment of Type 1 Diabetes Mellitus in Patients Receiving Continuous Subcutaneous Insulin Infusion Therapy

Once-Weekly Exenatide as Adjunct Treatment of Type 1 Diabetes Mellitus in Patients Receiving Continuous Subcutaneous Insulin Infusion Therapy St. John Fisher College Fisher Digital Publications Pharmacy Faculty Publications Wegmans School of Pharmacy 8-2014 Once-Weekly Exenatide as Adjunct Treatment of Type 1 Diabetes Mellitus in Patients Receiving

More information

Managing Patients Newly Diagnosed with Diabetes. Sud Dharmalingam MD, FRCPC Staff Endocrinologist William Osler Health System Brampton, ON

Managing Patients Newly Diagnosed with Diabetes. Sud Dharmalingam MD, FRCPC Staff Endocrinologist William Osler Health System Brampton, ON Managing Patients Newly Diagnosed with Diabetes Sud Dharmalingam MD, FRCPC Staff Endocrinologist William Osler Health System Brampton, ON 1 Conflict Disclosure Information Conflict Disclosure Information

More information

A NEW TAKE ON DIABETES MEDICATIONS: RISKS AND BENEFITS, OLD MEDICATIONS VERSUS NEW, AND NEW INFORMATION ON OLD MEDICATIONS

A NEW TAKE ON DIABETES MEDICATIONS: RISKS AND BENEFITS, OLD MEDICATIONS VERSUS NEW, AND NEW INFORMATION ON OLD MEDICATIONS A NEW TAKE ON DIABETES MEDICATIONS: RISKS AND BENEFITS, OLD MEDICATIONS VERSUS NEW, AND NEW INFORMATION ON OLD MEDICATIONS JESSICA CONKLIN, PHARMD, PHC, BCACP, CDE VISITING ASSISTANT PROFESSOR UNM COLLEGE

More information

Basal/Bolus Insulin: Better Pattern Control in Type 2 Diabetes. Kim L Kelly, PharmD, BCPS, FCCP, CDTC, CPC, CEC

Basal/Bolus Insulin: Better Pattern Control in Type 2 Diabetes. Kim L Kelly, PharmD, BCPS, FCCP, CDTC, CPC, CEC Basal/Bolus Insulin: Better Pattern Control in Type 2 Diabetes Kim L Kelly, PharmD, BCPS, FCCP, CDTC, CPC, CEC What we ll cover Basal Insulin Basal initiation Basal alone vs. biphasic vs. prandial alone

More information

Type II diabetes: How to use the new oral medications

Type II diabetes: How to use the new oral medications Type II diabetes: How to use the new oral medications A TWO-PART INTERVIEW WITH NANCY J.V. BOHANNON, MD, BY DAVID B. JACK, MD Several new oral drugs have been approved for the management of type II diabetes.

More information

A Simplified Approach to Initiating Insulin. 4. Not meeting glycemic goals with oral hypoglycemic agents or

A Simplified Approach to Initiating Insulin. 4. Not meeting glycemic goals with oral hypoglycemic agents or A Simplified Approach to Initiating Insulin When to Start Insulin: 1. Fasting plasma glucose (FPG) levels >250 mg/dl or 2. Glycated hemoglobin (A1C) >10% or 3. Random plasma glucose consistently >300 mg/dl

More information

2011: New Drugs for Diabetes Treatment

2011: New Drugs for Diabetes Treatment Cardiology Update 2011 Davos, February 14, 2011 2011: New Drugs for Diabetes Treatment Roger Lehmann Department of Unresolved Problems in the Treatment of Type 2 Diabetes Diabetes Duration Consequences:

More information

Case Study. Case Study. Glycemic Control-2001 How Low Can You Go? Evidence for Glycemic Control- So What? Now What?

Case Study. Case Study. Glycemic Control-2001 How Low Can You Go? Evidence for Glycemic Control- So What? Now What? Age-Adjusted Prevalence of Diagnosed Diabetes per 100 Adult Population, by State, United States, 1994 Evidence for Glycemic Control- So What? Now What? 1994 Cindy Sayre, MN, ARNP University of Washington

More information

Dr. Robyn Houlden Professor, Division of Endocrinology Queen s University

Dr. Robyn Houlden Professor, Division of Endocrinology Queen s University Diabetes in the elderly Dr. Robyn Houlden Professor, Division of Endocrinology Queen s University Disclosures Grants/research support: AstraZeneca, Eli Lilly, Pfizer Speakers bureau/honoraria: NovoNordisk,

More information

Diabetes is a. A case for prevention of type 2 diabetes mellitus

Diabetes is a. A case for prevention of type 2 diabetes mellitus A case for prevention of type 2 diabetes mellitus Joseph Cook, DO Diabetes is a disease that has reached epidemic proportions in the United States and around the world. This is troubling because, as bad

More information

The Effect of the Change in the Definition of Type 2 Diabetes on Patient Demographics

The Effect of the Change in the Definition of Type 2 Diabetes on Patient Demographics Int J Endocrinol Metab 2009;2: 51-55 The Effect of the Change in the Definition of Type 2 Diabetes on Patient Demographics ORIGINAL ARTICLE Tildesley HD a,b, Wise JS b, Mazanderani AB a, Aydin CA b, Fraser

More information

Finding weight loss strategies that work in primary care

Finding weight loss strategies that work in primary care Finding weight loss strategies that work in primary care Article: Wilson C. Obesity: Finding weight loss strategies that work in primary care. Nat Rev Endocrinol. 2013;9(3):126. Review: In this Research

More information

Type 1 and Type 2 Diabetes in Pediatric Practice

Type 1 and Type 2 Diabetes in Pediatric Practice Type 1 and Type 2 Diabetes in Pediatric Practice Chirag R. Kapadia, MD Division of Endocrinology, Phoenix Children s Hospital Clinical Assistant Professor, U of A College of Medicine Presentation outline

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

Type 2 Diabetes Mellitus 2014

Type 2 Diabetes Mellitus 2014 Type 2 Diabetes Mellitus 2014 Michael T. McDermott MD Director, Endocrinology and Diabetes Practice University of Colorado Hospital Michael.mcdermott@ucdenver.edu Disclosure Michael McDermott MD No Conflict

More information

Management of the Athlete with Diabetes Mellitus. Kristin Harmon, M.D. Endocrinologist Tallahassee Primary Care Associates June 8, 2012

Management of the Athlete with Diabetes Mellitus. Kristin Harmon, M.D. Endocrinologist Tallahassee Primary Care Associates June 8, 2012 Management of the Athlete with Diabetes Mellitus Kristin Harmon, M.D. Endocrinologist Tallahassee Primary Care Associates June 8, 2012 Outline Definition of Diabetes Diagnosis Treatment Hypoglycemia and

More information

Treatment of Type 2 Diabetes: One Size Does Not Fit All

Treatment of Type 2 Diabetes: One Size Does Not Fit All Treatment of Type 2 Diabetes: One Size Does Not Fit All Lisa Kroon, PharmD, CDE, FCSHP Professor and Chair, Clinical Pharmacy School of Pharmacy, University of California San Francisco Disclosure No conflict

More information

When and how to start insulin: strategies for success in type 2 diabetes

When and how to start insulin: strategies for success in type 2 diabetes 1 When and how to start insulin: strategies for success in type diabetes Treatment of type diabetes in 199: with each step treatment gets more complex Bruce H.R. Wolffenbuttel, MD PhD Professor of Endocrinology

More information

Treatment of Type 2 Diabetes

Treatment of Type 2 Diabetes Improving Patient Care through Evidence Treatment of Type 2 Diabetes This information is based on a comprehensive review of the evidence for best practices in the treatment of type 2 diabetes and is sponsored

More information

Starting Insulin Sooner Than Later

Starting Insulin Sooner Than Later Starting Insulin Sooner Than Later Rotorua GP Insulin Seminar 13 June 2014 Kingsley Nirmalaraj MBBS, FRACP, FACE Consultant Endocrinologist and Physician Tauranga Hospital/ Bay Endocrinology Ltd Declaration

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

Type 2 Diabetes. Jonathon M. Firnhaber, MD. Assistant Professor, Residency Program Director East Carolina University Greenville, North Carolina

Type 2 Diabetes. Jonathon M. Firnhaber, MD. Assistant Professor, Residency Program Director East Carolina University Greenville, North Carolina Type 2 Diabetes Jonathon M. Firnhaber, MD Assistant Professor, Residency Program Director East Carolina University Greenville, North Carolina Verbal Disclosure It is the policy of the AAFP that all individuals

More information

Homeostatic Model Assessment (HOMA)

Homeostatic Model Assessment (HOMA) Homeostatic Model Assessment (HOMA) Historically, insulin resistance (IR) was measured with an invasive test called a euglycemic clamp test. Basically it s a test to measure how much insulin a person needs

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

INVESTIGATIONS IN DIABETES MELLITUS

INVESTIGATIONS IN DIABETES MELLITUS 1. Routine investigations CBC INVESTIGATIONS IN DIABETES MELLITUS 2. Laboratory tests for diagnosis of diabetes The tests for the diagnosis of diabetes are given in Table 1. Table 1 Laboratory tests for

More information

Management of Diabetes in the CKD Patient

Management of Diabetes in the CKD Patient Management of Diabetes in the CKD Patient Heather Naylor, BScPharm, ACPR Clinical Pharmacy Practice Leader, Nephrology Saint John Regional Hospital Horizon Health Network, Zone 2 May 26, 2012 Learning

More information