From Metformin and Beyond: The Latest in Diabetes Therapies Mansur E. Shomali, MD, CM Associate Director, Diabetes & Endoc...
1500 b.c. Ebers papyrus 1922 Banting & Best 1993 DCCT published 2001 Leuven study 10,000   1,000  100   10    1 number of ...
Diabetes increases risk of M.I. or stroke by 4 X
22 million patients with Diabetes 300,000 die each year
Diabetes decreases life expectancy by about 10 years
What is the clinical evidence that treating diabetes can improve health and prolong life?
"It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was...
Hyperglycemia is bad for you.
Hypoglycemia is bad for you.
UKPDS Group . Lancet.  1998;352:837-853. Effect of Glycemic Control in UKPDS Any diabetes related* MI Stroke PVD Microvasc...
The Steno Diabetes Study reduce dietary fat regular exercise smoking cessation A1C <6.5% BP <130/80 t. chol <175 trig <150...
The Steno Diabetes Study
PROactive Study Dormandy JA  et al. Lancet  366 Oct 2005
PROactive Study Dormandy JA  et al. Lancet  366 Oct 2005 0 mmHg -3 mmHg sBP +10 +19 HDL -1.8 -11.4 Trig -0.3 -0.8 A1C plac...
Nissen S and Wolski K. N Engl J Med 2007;356:2457-2471 Myocardial Infarctions and Cardiovascular Deaths in Rosiglitazone T...
Nissen S and Wolski K. N Engl J Med 2007;356:2457-2471 Myocardial Infarctions and Cardiovascular Deaths in Rosiglitazone T...
ACCORD (Action to Control Cardiovascular Risk in Diabetes) 10,000 patients 5,000    < 6% 5,000    7-7.9% Deaths per 1000 p...
ENHANCE Trial ezetimibe/simvastatin (Vitorin)   vs simvastatin alone carotid intima-media thickness
Fehse F  et al. Diabetes  2004 Exenetide and beta cell responses
Kolterman OG  et al J Clin Endocrinol Metab  2003 Exenetide and beta cell responses
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  • Table 3. Myocardial Infarctions and Cardiovascular Deaths in Rosiglitazone Trials.
  • Table 4. Rates of Myocardial Infarction and Death from Cardiovascular Causes.
  • From Metform and Beyond: The Latest in Diabetes Therapies ...

    1. 1. From Metformin and Beyond: The Latest in Diabetes Therapies Mansur E. Shomali, MD, CM Associate Director, Diabetes & Endocrine Center, Union Memorial Hospital Program Director, Union Memorial Hospital Training Program in Endocrinology, Diabetes & Metabolism Clinical Assistant Professor of Medicine, University of Maryland School of Medicine
    2. 2. 1500 b.c. Ebers papyrus 1922 Banting & Best 1993 DCCT published 2001 Leuven study 10,000 1,000 100 10 1 number of years ago (log scale)
    3. 3. Diabetes increases risk of M.I. or stroke by 4 X
    4. 4. 22 million patients with Diabetes 300,000 die each year
    5. 5. Diabetes decreases life expectancy by about 10 years
    6. 6. What is the clinical evidence that treating diabetes can improve health and prolong life?
    7. 7. &quot;It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness, it was the epoch of belief, it was the epoch of incredulity…” -Dickens, C. … for clinical trials in diabetes…” -Shomali, M.
    8. 8. Hyperglycemia is bad for you.
    9. 9. Hypoglycemia is bad for you.
    10. 10. UKPDS Group . Lancet. 1998;352:837-853. Effect of Glycemic Control in UKPDS Any diabetes related* MI Stroke PVD Microvascular 40.9 14.7 5.6 1.1 8.6 46 17.4 5 1.6 11.4 0.029 0.052 0.52 0.15 0.0099 11 16 – – 25 (rate/1000 pt yrs) *Combined microvascular and macrovascular events Intensive % Decrease (rate/1000 pt yrs) P Conventional Endpoints
    11. 11. The Steno Diabetes Study reduce dietary fat regular exercise smoking cessation A1C <6.5% BP <130/80 t. chol <175 trig <150 aspirin dietary supplement (vit E, vit C, folate, chromium) ACE-I regardless of BP Gaude P et al. N Engl J Med 348:383–393, 2003
    12. 12. The Steno Diabetes Study
    13. 13. PROactive Study Dormandy JA et al. Lancet 366 Oct 2005
    14. 14. PROactive Study Dormandy JA et al. Lancet 366 Oct 2005 0 mmHg -3 mmHg sBP +10 +19 HDL -1.8 -11.4 Trig -0.3 -0.8 A1C placebo pioglitazone
    15. 15. Nissen S and Wolski K. N Engl J Med 2007;356:2457-2471 Myocardial Infarctions and Cardiovascular Deaths in Rosiglitazone Trials
    16. 16. Nissen S and Wolski K. N Engl J Med 2007;356:2457-2471 Myocardial Infarctions and Cardiovascular Deaths in Rosiglitazone Trials
    17. 17. ACCORD (Action to Control Cardiovascular Risk in Diabetes) 10,000 patients 5,000 < 6% 5,000 7-7.9% Deaths per 1000 patients per year 14 11 A1C
    18. 18. ENHANCE Trial ezetimibe/simvastatin (Vitorin) vs simvastatin alone carotid intima-media thickness
    19. 19. Fehse F et al. Diabetes 2004 Exenetide and beta cell responses
    20. 20. Kolterman OG et al J Clin Endocrinol Metab 2003 Exenetide and beta cell responses

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