Understanding diabetes Do the recent trials help?
|
|
- Christina Goodwin
- 8 years ago
- Views:
Transcription
1 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. The power of innovation.
2
3
4
5 Facts Diabetes affects > 10% of adults in developing countries Diabetics are 2 4 times more likely to develop severe cardiovascular outcome Most diabetics die from a cardiovascular cause
6
7 Diabetes work to soar under HbA1c switch European authorities are considering changing the diagnostic criteria for diabetes, in a move that could almost double the number of people classed as having the disease, Pulse has learned. The American diabetes Association formally switched to diagnosis of type 2 diabetes by HbA1c testing in January, after an international consensus statement last year recommended it is used instead of the oral glucose tolerance test.
8 Diagnosis of Diabetes Fasting blood sugar (mmol/l) Up to 6.0 (WHO, IDF) Normal Impaired fasting glycaemia 7.0 or Diabetes more (US) Impaired fasting glycaemia 7.0 or Diabetes more
9 What about FBS mmol/l? 62% abnormal: 19% had diabetes 43% I.G.T
10 Mortality rate for diabetic and nondiabetic adults Rate per 1000 person years Age Diabetics Non Diabetics Data Ratio NHANES I
11
12 Panzran study was: before HbA1c available before BSM before disposable syringes and needles before UKPDS before structured diabetes education
13 Differences between Type 1 and Type 2 Diabetes Type 1 Type 2 Thin Young Symptomatic Low insulin levels Quick onset Liable to ketosis Usually overweight Middle or old age May have no symptoms Insulin resistant Slow onset 12 years Not ketotic
14 Trials in Type I diabetes DCCT EDIC CSII Golden Years
15 DCCT 1441 patients with Type I Diabetes: Half standard treatment from usual physicians Half intensive treatment
16
17 DCCT Did good control reduce complications? Microvascular YES Macrovascular? (too few events)
18
19
20 CSII Continuous Subcutaneous Infusion of Insulin CSII MDI 20 patients 20 patients matched 3 year study of protein excretion
21
22
23 Golden Years Project 50 years of Diabetes and Insulin Nabarro Medal 60 years of Diabetes and Insulin Lawrence Medal 70 years of Diabetes and Insulin Macleod Medal
24 Golden Years Project 581 subjects Common features: Normal body mass Insulin sensitive Parental longevity High HDL (Mean = 1.84 mmol/l) Moderate alcohol Low BP Poor diabetic control
25 Trials in Type II Diabetes UKPDS Blood sugar control Blood pressure control ADVANCE ACCORD VADT UK GP Database analysis
26 UKPDS Blood Glucose Control Conventional HbA1c 7.9% Intensive HbA1c 7.0% 10-year Follow-up 24% reduction in microvascular events (P = 0.001) 15% reduction in myocardial infarction (P = 0.01) Conclusion must be a legacy effect i.e. ongoing benefit from early good control
27 UKPDS Blood Pressure Control Tight control <150/85 Less tight control <180/105 Initial benefit 44% reduction in stroke NS reduction in myocardial infarction Conclusion Benefit LOST within 2 years of completion of study No legacy effect
28 ADVANCE 11,140 patients with Type II Diabetes Intensive: HbA1c aim 6.5%, actual 6.3% Conventional: HbA1c aim 7.3%, actual 7.0% Result NS reduction in CV events 21% reduction in nephropathy and microalbuminuria
29 ACCORD 10,251 patients with Type II Diabetes Poor control (average HbA1c of 8.1%) Previous CV event or other risk factors Target Intensive control HbA1c 6.0% or less (actual - 6.4%) Standard control HbA1c 7-7.9% (actual 7.4%) Result 22% increase in mortality in intensive group TRIAL STOPPED
30 VADT 1,791 patients with Type II Diabetes Uncontrolled at entry HbA1c 9.4% Target Intensive control HbA1c aim 6.0% (actual - 6.9%) Standard control HbA1c 7.5% (actual 8.5%) Result No difference in CV events
31 but Short history of DM (less than 12 years) BENEFIT from intensive treatment Long history of DM (more than 12 years) HAZARD from intensive treatment
32 UK GP Database analysis Survival Study Lancet 6th Feb ,965 intensified treatment with tablets (A) 20,005 intensified treatment with insulin (B)
33
34 Table 1 Metabolic effects of conventional bariatric procedures 1 Improvement LAGB RYGB BPD Resolution of T2DM Rates of improvement (%) after surgery Resolution of hypertension Improvement of hyperlipidaemia Excess weight loss (% of excess body weight [actual weight minus ideal body weight] that is loss with surgery Abbreviations: BPD, biliopancreatic diversion; LAGB, laparoscopic adjustable gastric banding; RYGB, Roux-en-Y gastric bypass; T2DM, type 2 diabetes mellitus
35
36 Table 1 Metabolic effects of conventional bariatric procedures 1 Improvement LAGB RYGB BPD Resolution of T2DM Rates of improvement (%) after surgery Resolution of hypertension Improvement of hyperlipidaemia Excess weight loss (% of excess body weight [actual weight minus ideal body weight] that is loss with surgery Abbreviations: BPD, biliopancreatic diversion; LAGB, laparoscopic adjustable gastric banding; RYGB, Roux-en-Y gastric bypass; T2DM, type 2 diabetes mellitus
37
38 Table 1 Metabolic effects of conventional bariatric procedures 1 Improvement LAGB RYGB BPD Resolution of T2DM Rates of improvement (%) after surgery Resolution of hypertension Improvement of hyperlipidaemia Excess weight loss (% of excess body weight [actual weight minus ideal body weight] that is loss with surgery Abbreviations: BPD, biliopancreatic diversion; LAGB, laparoscopic adjustable gastric banding; RYGB, Roux-en-Y gastric bypass; T2DM, type 2 diabetes mellitus
39 Problem Areas HbA1c Microalbuminuria (early nephropathy) Blood pressure Lipids Retinopathy
40 HbA1c Glycated Haemoglobin Reflects average glucose levels over 2-3 month period ADA advise HbA1c level to diagnose diabetes threshold 6.5% Not point of care assay Readings unreliable with haemoglobinopathy, anaemia and renal failure
41 HbA1c for diagnosis? Logic Assay standardised Current difference between USA and WHO/IDF More accurately reflects CV risk Readings unreliable with haemoglobinopathy, anaemic and renal failure
42 Hazard ratio for CHD according to HbA1c HbA1c HR for CHD Less than Over
43 BUT
44 For all cause mortality curve is J shaped
45 HbA1c Target HbA1c target is < 7.0% Except: recent onset, young age and no IHD aim lower with co-morbidities, older, long-standing DM accept higher
46 Microalbuminuria (early nephropathy) Common cause of end-stage renal disease Marker of increased CVD risk
47
48 What is Microalbuminuria? Definitions and prevalence Levels of urinary albumin above the normal range, but lower than dipstick-positive proteinuria below are termed microalbuminuria Microalbuminuria is found in: 5-7% of the healthy population 12-30% of the hypertensive population Morning urine sample (mg/l) Morning urine sample Albumin to Creatinine Ratio (mg/mmol) Normal Microalbuminuria <20 Males <2.5 Females < Males Females Macroalbuminuria (proteinuria) >200 Males >25 Females >25
49 Microalbuminuria and Mortality 2138 Type 2 patients followed for 6.4 years Odds ratio for total mortality 2.4 ( ) Odds ratio for cardiovascular death and morbidity 2.0 ( ) Annual mortality rate with normoalbuminuria 2.7%, annual mortality rate with microalbuminuria 5.9%
50 Standards of Medical Care Table 15 Stages of CKD GFR Stage Description (ml/min per 1.73m 2 body surface area) 1 Kidney damage* with normal or increased GFR >90 2 Kidney damage* with mildly decreased GFR Moderately decreased GFR Severely decreased GFR Kidney failure <15 or dialysis * Kidney damage defined as abnormalities on pathologic, urine, blood or imaging tests. Adapted from ref 283.
51 Blood Pressure Target less than 130/80 Drugs 1 st choice ACE (e.g. Ramipril) or ARB (e.g. Irbesartan) 2 nd choice diuretic (USA), calcium blocker (UK) Most need 3-6 different drugs for good control
52 Lipids Target Total cholesterol less than 4 mmol/l LDL cholesterol less than 2 mmol/l (70 mg/dl) HDL cholesterol more than 1.3 mmol/l (50 mg/dl) Achieve by lifestyle advice Statin (not in pregnancy) + fibrate (?) + niacin (?)
53 Retinopathy Background risk to vision, not to life Proliferative risk to both Treatment available Good diabetic care Laser photocoagulation Anti VEGF injections
54
55 Conclusion What s Important Smoking Lipid control Blood pressure Proteinuria Microalbuminuria Macroalbuminuria Gender Family history of premature death Glucose control especially in early years of condition
56 Thank you Any questions? Cases Dr Geoffrey Robb AMUS 25th March 2010 The security of experience. The power of innovation.
Diabetic Nephropathy
Diabetic Nephropathy Kidney disease is common in people affected by diabetes mellitus Definition Urinary albumin excretion of more than 300mg in a 24 hour collection or macroalbuminuria Abnormal renal
More informationDiabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria.
Kidney Complications Diabetic Nephropathy Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria. The peak incidence of nephropathy is usually 15-25 years
More informationRenal Disease in Type 2 Diabetes Mellitus
Renal Disease in Type 2 Diabetes Mellitus 6th Collaborative DiGP/HSE/UCC Conference 25 th September 2013 Dr. Eoin O Sullivan Consultant Endocrinologist Bon Secours Hospital Cork Case 69 year old woman
More informationDiabetes Complications
Managing Diabetes: It s s Not Easy But It s s Worth It Presenter Disclosures W. Lee Ball, Jr., OD, FAAO (1) The following personal financial relationships with commercial interests relevant to this presentation
More informationGuidelines for the management of hypertension in patients with diabetes mellitus
Guidelines for the management of hypertension in patients with diabetes mellitus Quick reference guide In the Eastern Mediterranean Region, there has been a rapid increase in the incidence of diabetes
More informationDiabetes and the Kidneys
Diabetes and the Kidneys Aim(s) and objective(s) This guideline focuses on the detection, prevention, and management of kidney disease in people with diabetes. The management of end-stage renal disease
More informationADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes
ADVANCE: a factorial randomised trial of blood pressure lowering and intensive glucose control in 11,140 patients with type 2 diabetes Effects of a fixed combination of the ACE inhibitor, perindopril,
More informationGuideline for Microalbuminuria Screening
East Lancashire Diabetes Network Guideline for Microalbuminuria Screening Produced by: Task and Finish Group, Clinical Standards Group Produced: August 2006 Approved by: East Lancashire Diabetes Network
More informationManaging diabetes in the post-guideline world. Dr Helen Snell Nurse Practitioner PhD, FCNA(NZ)
Managing diabetes in the post-guideline world Dr Helen Snell Nurse Practitioner PhD, FCNA(NZ) Overview Pathogenesis of T2DM Aims of treatment The place of glycaemic control Strategies to improve glycaemic
More informationThe 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 informationType 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 informationUse of Glycated Hemoglobin and Microalbuminuria in the Monitoring of Diabetes Mellitus
Agency for Healthcare Research and Quality Evidence Report/Technology Assessment Number 84 Use of Glycated Hemoglobin and Microalbuminuria in the Monitoring of Diabetes Mellitus Summary Overview Clinical
More informationCardiovascular 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 informationHow To Determine The Prevalence Of Microalbuminuria
Research Journal of Pharmaceutical, Biological and Chemical Sciences Prevalence of Microalbuminuria in relation to HbA1c among known Type2 Diabetic Patients in Puducherry population Muraliswaran P 1 *,
More informationChronic Kidney Disease and the Electronic Health Record. Duaine Murphree, MD Sarah M. Thelen, MD
Chronic Kidney Disease and the Electronic Health Record Duaine Murphree, MD Sarah M. Thelen, MD Definition of Chronic Kidney Disease (CKD) Defined by the National Kidney Foundation Either a decline in
More informationTYPE 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 informationThe 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 informationDCCT and EDIC: The Diabetes Control and Complications Trial and Follow-up Study
DCCT and EDIC: The Diabetes Control and Complications Trial and Follow-up Study National Diabetes Information Clearinghouse U.S. Department of Health and Human Services NATIONAL INSTITUTES OF HEALTH What
More informationPrimary prevention of chronic kidney disease: managing diabetes mellitus to reduce the risk of progression to CKD
Primary prevention of chronic kidney disease: managing diabetes mellitus to reduce the risk of progression to CKD Date written: July 2012 Author: Kate Wiggins, Graeme Turner, David Johnson GUIDELINES We
More informationHow To Know If You Have Microalbuminuria
3 PREVALENCE AND PREDICTORS OF MICROALBUMINURIA IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: A CROSS-SECTIONAL OBSERVATIONAL STUDY Dr Ashok S Goswami *, Dr Janardan V Bhatt**; Dr Hitesh Patel *** *Associate
More informationCardiovascular Risk in Diabetes
Cardiovascular Risk in Diabetes Lipids Hypercholesterolaemia is an important reversible risk factor for cardiovascular disease and should be tackled aggressively in all diabetic patients. In Type 1 patients,
More informationPrediction of Kidney Disease Progression in Patients with Diabetes
Prediction of Kidney Disease Progression in Patients with Diabetes John Arthur, MD, PhD Medical University of South Carolina SEKDC Meeting September 8, 2012 Objectives Understand the importance of predicting
More informationDiabetes Mellitus. Melissa Meredith M.D. Diabetes Mellitus
Melissa Meredith M.D. Diabetes mellitus is a group of metabolic diseases characterized by high blood glucose resulting from defects in insulin secretion, insulin action, or both Diabetes is a chronic,
More informationMicroalbuminuria: We are in the midst of an epidemic: the epidemic. So What s a Little Protein? Malcolm s diabetes. How much is too much?
Focus on CME at the University of Saskatchewan Microalbuminuria: So What s a Little Protein? By Judith T. Klassen, BSc, MD, FRCPC University of Saskatchewan Practical Management of Common Medical Problems
More information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 informationTreatment 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 informationInDependent Diabetes Trust
InDependent Diabetes Trust Kidneys and Diabetes Updated July 2015 Registered Company Number 3148360 Registered Charity No 1058284 Contents Introduction Healthy Kidneys Kidney disease and diabetes The use
More informationStatins 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 informationOverview and update of modern type 2 Diabetes philosophy and management. Dr Steve Stanaway Consultant Endocrinologist BCU
Overview and update of modern type 2 Diabetes philosophy and management Dr Steve Stanaway Consultant Endocrinologist BCU Diabetes economics 2009: 2.6M adults with DM in UK (90% type 2) 2025: est. > 4M
More informationMetabolic 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 informationPrevalence and risk factor of chronic kidney disease in elderly diabetic patients in Korea 성애병원 내과 김정한
Prevalence and risk factor of chronic kidney disease in elderly diabetic patients in Korea 성애병원 내과 김정한 Introduction CKD의 정의와 egfr의 측정 CKD의 risk factor와 mechanism 한국의 CKD prevalence 와 prognosis CKD의 치료와
More informationDR. Trinh Thi Kim Hue
TYPE 2 DIABETES IN THE CHILD AND ADOLESCENT DR. Trinh Thi Kim Hue CONTENTS Definition Diagnosis Treatment Comorbidities and Complications Comorbidities and Complications Screening for T2D References DEFINITION
More informationPRESCRIBING GUIDELINES FOR LIPID LOWERING TREATMENTS for SECONDARY PREVENTION
Hull & East Riding Prescribing Committee PRESCRIBING GUIDELINES FOR LIPID LOWERING TREATMENTS for SECONDARY PREVENTION For guidance on Primary Prevention please see NICE guidance http://www.nice.org.uk/guidance/cg181
More informationCASE 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 informationTYPE 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 informationGUIDELINES FOR THE TREATMENT OF DIABETIC NEPHROPATHY*
71 GUIDELINES FOR THE TREATMENT OF DIABETIC NEPHROPATHY* Ryuichi KIKKAWA** Asian Med. J. 44(2): 71 75, 2001 Abstract: Diabetic nephropathy is the most devastating complication of diabetes and is now the
More informationBARIATRIC SURGERY. Prerequisites. Authorization, Notification and Referral
BARIATRIC SURGERY Policy NHP reimburses participating providers for specific types of medically necessary bariatric surgery when needed to either alleviate or correct medical problems caused by severe
More informationNutrition Therapy in Diabetes Mellitus. Dorothy Debrah Diabetes Specialist Dietitian University Hospital, Llandough. Wales, UK February 2012
Nutrition Therapy in Diabetes Mellitus. Dorothy Debrah Diabetes Specialist Dietitian University Hospital, Llandough. Wales, UK February 2012 University Hospital Llandough DIABETES MELLITUS. Definition:
More informationDISCLOSURES RISK ASSESSMENT. Stroke and Heart Disease -Is there a Link Beyond Risk Factors? Daniel Lackland, MD
STROKE AND HEART DISEASE IS THERE A LINK BEYOND RISK FACTORS? D AN IE L T. L AC K L AN D DISCLOSURES Member of NHLBI Risk Assessment Workgroup RISK ASSESSMENT Count major risk factors For patients with
More informationChronic Kidney Disease and Diabetes
Anyone with diabetes can get kidney disease. Diabetes and high blood pressure are the most common causes of kidney disease, and people often have both. Chronic (long term) kidney disease (CKD) caused by
More informationType 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 informationDiabetes Brief. Pre diabetes occurs when glucose levels are elevated in the blood, but are not as high as someone who has diabetes.
Diabetes Brief What is Diabetes? Diabetes mellitus is a disease of abnormal carbohydrate metabolism in which the level of blood glucose, or blood sugar, is above normal. The disease occurs when the body
More informationDIABETES A chronic, debilitating and often deadly disease A global epidemic Diabetes in Africa
DIABETES A chronic, debilitating and often deadly disease Diabetes is a chronic condition that arises when the pancreas does not produce enough insulin, or when the body cannot effectively use the insulin
More informationBaskets of Care Diabetes Subcommittee
Baskets of Care Diabetes Subcommittee Disclaimer: This background information is not intended to be a comprehensive scientific discussion of the topic, but rather an attempt to provide a baseline level
More informationStarting 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 informationTrends in Prescribing of Drugs for Type 2 Diabetes in General Practice in England (Chart 1) Other intermediate and long-acting insulins
Type 2 Diabetes Type 2 diabetes is the most common form of diabetes, accounting for 90 95% of cases. 1 Charts 1 and 2 reflect the effect of increasing prevalence on prescribing and costs of products used
More informationMortality Associated with Diabetes
Mortality Associated with Diabetes A review paper prepared for the 7th Global Conference of Actuaries, New Delhi, 15-16 February, 2005 Dr. David Muiry, MB;BS, FIA, FASI David_Muiry@swissre.com Introduction
More informationPowerPoint 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 informationPrevention and management of chronic kidney disease in type 2 diabetes
162..194 NEPHROLOGY 2010; 15, S162 S194 doi:10.1111/j.1440-1797.2010.01240.x Prevention and management of chronic kidney disease in type 2 diabetes Date written: April 2009nep_1240 Final submission: April
More informationDIABETES CARE. Advice. Blood Pressure. Cholesterol. Diabetes control. Eyes. Feet. Guardian Drugs
DIABETES CARE What happens if you follow the Alphabet Strategy? As patients reach their targets, the chances of developing serious complications of diabetes will be reduced! 1 Stroke Eye disease Heart
More informationAggressive Lowering of Blood Pressure in type 2 Diabetes Mellitus: The Diastolic Cost
Aggressive Lowering of Blood Pressure in type 2 Diabetes Mellitus: The Diastolic Cost Naftali Stern Institute of Endocrinology, Metabolism and Hypertension Tel Aviv -Sourasky Medical Center and Sackler
More informationDiabetes, hypertension and a lot more `in the elderly` JORIS SCHAKEL INTERNIST- CLINICAL GERIATRICIAN JGSCHAKEL@SEHOS.CW
Diabetes, hypertension and a lot more `in the elderly` JORIS SCHAKEL INTERNIST- CLINICAL GERIATRICIAN JGSCHAKEL@SEHOS.CW IT`S HARD TO GIVE GENERAL ADVICE! ``The Elderly`` Heterogeneous group ;widely varying
More informationIn many diabetes units, people with type
Renal Microalbuminuria: Screening and management in type 2 diabetes Julia Arundale Introduction In many diabetes units, patients with type 1 or type 2 diabetes are screened for proteinuria. Screening for
More informationBARIATRIC 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 informationHow To Know If Low Protein Diet Is Beneficial For Kidney Health
Protein Intake and Diabetic Kidney Disease Robert C. Stanton Joslin Diabetes Center 1/Serum Creatinine Plot Low Protein Protects in Renal Ablation Model 24% Protein Diet 6% Protein Diet Right Nephrectomy
More informationDiabetes and Life Insurance. A Special Report by LifeInsure.co.uk
Diabetes and Life Insurance A Special Report by LifeInsure.co.uk Introduction Securing life insurance as a diabetic can be a difficult and costly process. Many insurers will refuse cover, or will set very
More informationComplicanze del diabete nel bambino e nell adolescente
Clinica Pediatrica Università di Chieti Complicanze del diabete nel bambino e nell adolescente Franco Chiarelli XVII Congresso Nazionale SIPPS Parma, 25 Novembre 2005 Type 1 diabetes in childhood: Only
More informationDiabetes 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 informationScottish Diabetes Survey 2013. Scottish Diabetes Survey Monitoring Group
Scottish Diabetes Survey 2013 Scottish Diabetes Survey Monitoring Group Contents Contents... 2 Foreword... 4 Executive Summary... 6 Prevalence... 8 Undiagnosed diabetes... 18 Duration of Diabetes... 18
More information( Diabetic nephropathy) ( Microalbuminuria ) ( Macroalbuminuria )
2006 17 99-105 2006 20-40% ( ESRD ) 30 299 mg ( ) ( 300 mgday ) DCCBs ) dihydropyridine calcium channel blockers ( non- DCCBs ( -blockers ( diuretics ) 10%) 0.8 ( 60 mlmin per 1.73 m 2 30 mlmin per 1.73
More informationDefinition of Diabetes Mellitus
Definition of Diabetes Mellitus Diabetes mellitus consists of a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action or both. U.S. Diabetes
More informationAbsolute cardiovascular disease risk assessment
Quick reference guide for health professionals Absolute cardiovascular disease risk assessment This quick reference guide is a summary of the key steps involved in assessing absolute cardiovascular risk
More informationTherapeutic Approach in Patients with Diabetes and Coronary Artery Disease
Home SVCC Area: English - Español - Português Therapeutic Approach in Patients with Diabetes and Coronary Artery Disease Martial G. Bourassa, MD Research Center, Montreal Heart Institute, Montreal, Quebec,
More informationType 2 Diabetes. Tabinda Dugal GP Day 4/05/16
Type 2 Diabetes Tabinda Dugal GP Day 4/05/16 Diabetes Diabetes.a growing health crisis in Britain 869m per year 10% of NHS budget Projections.. 5 million by 2025 Youngest patient? T2DM Type 2 diabetes
More informationMarkham Stouffville Hospital
Markham Stouffville Hospital Adult Diabetes Education Frequently Asked Questions What is diabetes? Diabetes is a disease in which blood glucose levels are above normal. Most of the food we eat is turned
More informationDiabetes 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 informationCoding to be more efficient and accurate
Why we need to code well! Coding to be more efficient and accurate Diabetes without Complication Diabetes with opthamologic or unspecified complication Diabetes with acute complication $1833 $2931 $3836
More informationCalculating the stage of Renal Disease
Calculating the stage of Renal Disease When the Refresh Template/Check Labs button is depressed, the box next to MDRD, will be automatically checked. In order to use this in the calculation of the stage
More informationAn Interprofessional Approach to Diabetes Management
Disclosures An Interprofessional Approach to Diabetes Management Principal in DiabetesReframed, LLC. Inventor of U.S. Provisional Patent Application No. 61/585,483 METHODS OF USING A DIABETES CROSS- DISCIPLINARY
More informationDIABETES MELLITUS TYPE 2 PROTOCOL CELLO
DIABETES MELLITUS TYPE 2 PROTOCOL CELLO Leiden November 2010 Mw. M. van Mierlo, practice nurse Mw. C. Gieskes, diabetes nurse 1 Contents Introduction 1. Way of working at CELLO for patients with Diabetes
More informationG:\ CDM\BHCIG Diabetes Pathway FINAL September 05.doc 1
G:\ CDM\BHCIG Diabetes Pathway FINAL September 05.doc 1 BHCiG: TYPE 2 DIABETES MANAGEMENT PATHWAY MODEL INTRODUCTION What is the aim of the model? To improve the capacity of primary care health practitioners
More information2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk
2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Athersclerotic Risk Lynne T Braun, PhD, CNP, FAHA, FAAN Professor of Nursing, Nurse Practitioner Rush University Medical Center 2
More informationPROCEEDINGS DIABETIC NEPHROPATHY: DETECTION AND TREATMENT OF RENAL DISEASE IN PATIENTS WITH DIABETES* Jiten Vora, MA, MD, FRCP ABSTRACT
DIABETIC NEPHROPATHY: DETECTION AND TREATMENT OF RENAL DISEASE IN PATIENTS WITH DIABETES* Jiten Vora, MA, MD, FRCP ABSTRACT Diabetic nephropathy affects people with either type 1 or type 2 diabetes mellitus.
More informationInsulin 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 informationType 2 Diabetes. What is diabetes? Understanding blood glucose and insulin. What is Type 2 diabetes? Page 1 of 5
Page 1 of 5 Type 2 Diabetes Type 2 diabetes occurs mainly in people aged over 40. The 'first-line' treatment is diet, weight control and physical activity. If the blood glucose level remains high despite
More informationRoux-en-Y Gastric Bypass
Roux-en-Y Gastric Bypass Restrictive and malabsorptive procedure Most frequently performed bariatric procedure in the US First done in 1967 Laparoscopic since 1993 75% EWL in 18-24 months 50% EWL is still
More informationType 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 informationDRUG UTILIZATION EVALUATION OF ANTIHYPERTENSIVE DRUGS IN DIABETIC PATIENTS WITH CKD
WORLD JOURNAL OF PHARMACY AND PHARMACEUTICAL SCIENCES Elhami et al. SJIF Impact Factor 5.210 Volume 4, Issue 11, 1159-1166 Research Article ISSN 2278 4357 DRUG UTILIZATION EVALUATION OF ANTIHYPERTENSIVE
More informationUnderstanding Diabetes
Understanding Diabetes What is diabetes? Diabetes is a condition where there is too much glucose (a type of sugar) in your blood. Your blood glucose level is regulated with the help of insulin, a hormone
More informationThis information explains the advice about type 2 diabetes in adults that is set out in NICE guideline NG28.
Information for the public Published: 2 December 2015 nice.org.uk About this information NICE guidelines provide advice on the care and support that should be offered to people who use health and care
More informationDiabetes 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 informationImproving cardiometabolic health in Major Mental Illness
Improving cardiometabolic health in Major Mental Illness Dr. Adrian Heald Consultant in Endocrinology and Diabetes Leighton Hospital, Crewe and Macclesfield Research Fellow, Manchester University Metabolic
More informationMain Effect of Screening for Coronary Artery Disease Using CT
Main Effect of Screening for Coronary Artery Disease Using CT Angiography on Mortality and Cardiac Events in High risk Patients with Diabetes: The FACTOR-64 Randomized Clinical Trial Joseph B. Muhlestein,
More informationDefinition, Prevalence, Pathophysiology and Complications of CKD. JM Krzesinski CHU Liège-ULg Core curriculum Nephrology September 28 th 2013
Definition, Prevalence, Pathophysiology and Complications of CKD JM Krzesinski CHU Liège-ULg Core curriculum Nephrology September 28 th 2013 KI supplements January 2013 Objectives of the course on CKD:
More informationWHAT IS DIABETES MELLITUS? CAUSES AND CONSEQUENCES. Living your life as normal as possible
WHAT IS DIABETES MELLITUS? CAUSES AND CONSEQUENCES DEDBT01954 Lilly Deutschland GmbH Werner-Reimers-Straße 2-4 61352 Bad Homburg Living your life as normal as possible www.lilly-pharma.de www.lilly-diabetes.de
More informationDrug Treatment in Type 2 Diabetes with Hypertension
Hypertension is 1.5 2 times more prevalent in Type 2 diabetes (prevalence up to 80 % in diabetic subjects). This exacerbates the risk of cardiovascular disease by ~ two-fold. Drug therapy reduces the risk
More informationMicroalbuminuria: An increasingly recognized risk factor for CVD
Microalbuminuria: An increasingly recognized risk factor for CVD Long known to be associated with kidney disease, the importance of protein in the urine is now becoming recognized as a sensitive, accessible
More informationStatistics of Type 2 Diabetes
Statistics of Type 2 Diabetes Of the 17 million Americans with diabetes, 90 percent to 95 percent have type 2 diabetes. Of these, half are unaware they have the disease. People with type 2 diabetes often
More informationDiabetes 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 informationDiabetes, Type 2. RelayClinical Patient Education Sample Topic Diabetes, Type 2. What is type 2 diabetes? How does it occur?
What is type 2 diabetes? Type 2 diabetes is a disorder that happens when your body does not make enough insulin or is unable to use its own insulin properly. The inability to use insulin is called insulin
More informationCriteria: CWQI HCS-123 (This criteria is consistent with CMS guidelines for External Infusion Insulin Pumps)
Moda Health Plan, Inc. Medical Necessity Criteria Subject: Origination Date: 05/15 Revision Date(s): 05/2015 Developed By: Medical Criteria Committee 06/24/2015 External Infusion Insulin Pumps Page 1 of
More informationDiabetes 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 informationNutrition. 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 informationCardiovascular disease physiology. Linda Lowe-Krentz Bioscience in the 21 st Century October 14, 2011
Cardiovascular disease physiology Linda Lowe-Krentz Bioscience in the 21 st Century October 14, 2011 Content Introduction The number 1 killer in America Some statistics Recommendations The disease process
More informationNational Evidence Based Guideline for Blood Glucose Control in Type 2 Diabetes
National Evidence Based Guideline for Blood Glucose Control in Type 2 Diabetes Prepared by: The Boden Institute of Obesity, Nutrition and Exercise The University of Sydney In collaboration with: The Diabetes
More informationDiabetes: The Numbers
Diabetes: The Numbers Changing the Way Diabetes is Treated. What is Diabetes? Diabetes is a group of diseases characterized by high levels of blood glucose (blood sugar) Diabetes can lead to serious health
More informationAbsolute cardiovascular disease risk
Guidelines for the management of Absolute cardiovascular disease risk An initiative of the National Vascular Disease Prevention Alliance About the National Vascular Disease Prevention Alliance The National
More informationHypertension Guidelines
Overview Hypertension Guidelines Aim to reduce Blood Pressure to 140/90 or less (140/80 for diabetics), adding drugs as needed until further treatment is inappropriate or declined. N.B. patients do not
More informationNorth of Tyne Area Prescribing Committee
North of Tyne Area Prescribing Committee ANTIPSYCHOTICS IN PSYCHOSIS, BIPOLAR DISORDER AND AUGMENTATION THERAPY IN TREATMENT RESISTANT DEPRESSION Information for Primary Care Updated November 2013 This
More informationdefinition and diagnosis of diabetes mellitus and intermediate hyperglycemia Report of a WHO/IDF Consultation
definition and diagnosis of diabetes mellitus and intermediate hyperglycemia Report of a WHO/IDF Consultation WHO Library Cataloguing-in-Publication Data Definition and diagnosis of diabetes mellitus and
More information