This document summarizes guidelines for treating type 2 diabetes with a patient-centered approach. It discusses:
1) Glycemic targets and treatments should be individualized based on patient factors like age, weight, and comorbidities.
2) Lifestyle modifications like diet, exercise, and education are the foundation of diabetes treatment but may not be enough on their own.
3) When choosing medications, priorities include minimizing hypoglycemia risk, weight gain, and total costs while considering fasting and post-meal blood sugar levels.
4) Incretin-based therapies that augment the GLP-1 and DPP-4 pathways are reasonable initial or add-on options due to their effects on
John B. Buse, MD, PhD, discusses type 2 diabetes in this CME activity titled "Exploring the Science and Practice of GLP-1 Receptor Agonists: An Update on Current and Emerging Evidence." For the full presentation, downloadable infographics, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2oL19BK. CME credit will be available until October 21, 2020.
The Blood Glucose Postprandial (PP) Test is performed to measure glucose levels in the blood after a period of 2 hours from the start of last meal to screen for Prediabetes and Diabetes Types 1 and 2. The word ‘Postprandial’ means after eating a meal.
Reference: https://www.1mg.com/labs/test/glucose-postprandial-blood-1784
Safety and Efficacy of Sulfonylurea Drugs in Type 2 Diabetes MellitusApollo Hospitals
In subjects with type 2 diabetes mellitus, glycemic control will be established while patients use sulfonylurea drugs during the course of the disease. However, data regarding direct comparison between various sulfonylureas in this regard are lacking. Weight loss usually improves blood glucose levels for people with type 2 diabetes. However, many also need oral medications or insulin.
Early screening of Diabetes Mellitus can prevent the unwanted complications of Diabetes Mellitus like diabetic nephropathy, diabetic retinopathy, diabetic foot, etc.
John B. Buse, MD, PhD, discusses type 2 diabetes in this CME activity titled "Exploring the Science and Practice of GLP-1 Receptor Agonists: An Update on Current and Emerging Evidence." For the full presentation, downloadable infographics, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2oL19BK. CME credit will be available until October 21, 2020.
The Blood Glucose Postprandial (PP) Test is performed to measure glucose levels in the blood after a period of 2 hours from the start of last meal to screen for Prediabetes and Diabetes Types 1 and 2. The word ‘Postprandial’ means after eating a meal.
Reference: https://www.1mg.com/labs/test/glucose-postprandial-blood-1784
Safety and Efficacy of Sulfonylurea Drugs in Type 2 Diabetes MellitusApollo Hospitals
In subjects with type 2 diabetes mellitus, glycemic control will be established while patients use sulfonylurea drugs during the course of the disease. However, data regarding direct comparison between various sulfonylureas in this regard are lacking. Weight loss usually improves blood glucose levels for people with type 2 diabetes. However, many also need oral medications or insulin.
Early screening of Diabetes Mellitus can prevent the unwanted complications of Diabetes Mellitus like diabetic nephropathy, diabetic retinopathy, diabetic foot, etc.
Insulin is a peptide hormone, produced by beta cells of the pancreas, and is central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, skeletal muscles, and fat tissue to absorb glucose from the blood. In the liver and skeletal muscles, glucose is stored as glycogen, and in fat cells (adipocytes) it is stored as triglycerides.
10 Ways Your Boss Kills Employee MotivationOfficevibe
It’s so hard to have engaged employees. It’s such a delicate thing to try and get right because employees can be fragile.
As a manager, you have to do everything in your power to make sure employees are happy and engaged at all times.
Usually, the problem is the boss, and not things like the company, mission statement, or co-workers.
If you know that your boss is the biggest problem, there are ten things that they do to kill motivation. If you’re a manager and you’re reading this, make sure you avoid these mistakes to ensure that your employees are engaged during work.
The secret to good leadership is to be authentic. Be honest with your staff.
Read more on Officevibe blog:
https://www.officevibe.com/blog/10-kill-employee-motivation
like us on Facebook!:
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ADA EASD Management of hyperglycemia in type 2Mgfamiliar Net
Management of Hyperglycemia in Type 2 Diabetes:
A Patient-Centered Approach: Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD).
Inzucchi SE, Bergenstal RM, Buse JB, et al.
Diabetes Care. 2012 Apr 19.
Intensification Options after basal Insulin RevisitedUsama Ragab
Intensification Options revisited
By Dr. Usama Ragab Youssif
Add an OAD
Add a short-acting insulin at mealtime
Switch to premixed insulins
Novel insulin combinations
Basal insulin/GLP-1 RA combinations
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Memorias Conferencia Científica Anual sobre Síndrome Metabólico 2017 - Programa Científico
Futuro en el tratamiento de la DM2
Dr. Guillermo E. Umpierrez
Professor of Medicine in the Division of Endocrinology at Emory University School of Medicine, Section Head, Diabetes and Endocrinology. USA. Editor en Jefe del BJM Open Diabetes Research and Care
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
4. • Almost everyone has heard the saying, “If
you want to keep a friend, never talk about
religion or politics.” In regard to the
specific management of type 2 diabetes,
we can alter this phrase somewhat and
suggest, “If you want to keep a colleague,
never talk about diabetes guidelines!”
06:02:07
DIABETES CARE, VOLUME 35, JUNE 2012 1201
為了保有同事情誼
不要討論糖尿病治療指引
8. •糖尿病的藥物治療策略
1.依據證據醫學 ( 降血糖效果: A1C)
來選藥
2.依據病理生理學來矯正
3.Patient-Centered
ADA-EASD Position Statement
Management of Hyperglycemia in T2DM: A
Patient-Centered Approach
Diabetes Care April 2012
9. ADA consensus statement
DCCT and UKPDS : a strong correlation
between mean A1C levels over time and the
development and progression of retinopathy and
nephropathy
=> it is reasonable to judge and compare blood
glucose–lowering medications, as well as
combinations of such agents, primarily on the
basis of their capacity to decrease and maintain
A1C levels and according to their safety, specific
side effects, tolerability, ease of use, and
expense.
Diabetes Care 32:193–203, 2009
小血管病變的證據醫學:向 A1C 看齊
19. Figure 1
Diabetes Care, Diabetologia. 19 April 2012
(Adapted with permission from: Ismail-Beigi F, et al. Ann Intern Med 2011;154:554)
A1C 6-6.5% A1C 7.5-8%
25. KEY POINTS
• Glycemic targets & BG-lowering therapies must be
individualized.
• Diet, exercise, & education: foundation of any T2DM
therapy program
• Unless contraindicated, metformin = optimal 1st-line
drug.
• After metformin, data are limited.
with 1-2 other oral / injectable agents is reasonable;
minimize side effects.
• Ultimately, many patients will require insulin therapy
alone / in combination with other agents to maintain BG
control.
• All treatment decisions should be made in conjunction
with the patient (focus on preferences, needs & values.)
• Comprehensive CV risk reduction - a major focus of
therapy.
Diabetes Care, Diabetologia. 19 April 2012
Combination therapy
29. Adapted Recommendations: When Goal is to Avoid Weight Gain
• 血糖還是可以降不少
• 藥錢會花很大
• 但是賺到
• 不會低血糖
• 不會體重增加
• 保護 島細胞胰
不想變胖胖
錢花的 不值
得值 ?
30. Adapted Recommendations: When Goal is to Avoid Hypoglycemia
不要低血
糖
•血糖還是可以降不少
•藥錢會花很大
•但是賺到
•不會低血糖
•保護 島細胞胰
錢花得值
不 得值 ?
•TZD 增加體重、膀胱癌
(?)
31. Hazard Ratio
(HR lower
CL,
HR upper CL)
Hypoglycaemia – a major predictor of
cardiovascular death in the VADT study
Prior event
HbA1c
HDL
Age
3.116 (1.744, 5567)
1.213 (1.038,1.417)
0.699 (0.536, 0.910)
2.090 (1.518, 2877)
120 2 4 6 8 10
P Value
Hypoglycaemia 4.042 (1.449,11.276)
Duckworth W.(VADT): results. 2008. Available from
http://webcasts.prous.com/netadmin/webcast_viewer/Preview.aspx?
type=0&lid=3853, Accessed: 20 Oct 2009.
<0.01
0.02
0.01
<0.01
0.01
34. Metformin + other OADs 的降血糖效果
和低血糖風險
Adapted from: Phung, et al. JAMA. 2010;303(14):1410–1418
35. AACE 2010
Goals as priorities in the selection of medications
• Inclusion of major classes of FDA-approved glycemic
medication, including incretin-based therapies
• Minimizing risk and severity of hypoglycemia
• Minimizing risk and magnitude of weight gain
• Consideration of both fasting and postprandial
glucose levels as end points
• In many cases, delaying pharmacotherapy to allow for lifestyle
modifications is inappropriate because these interventions are usually not
adequate
• Consideration of total cost of therapy to the individual and
society at large, including costs related to medications, glucose monitoring
requirements, hypoglycemic events, drug-related adverse events, and
treatment of diabetes-associated complications
• The major cost is related to the treatment of the complications of diabetes. We
believe that identification of the safest and most efficacious agents is essential.
48. • Age: Older adults
– Reduced life expectancy
– Higher CVD burden
– Reduced GFR
– At risk for adverse events from polypharmacy
– More likely to be compromised from
hypoglycemia
Less ambitious target
HbA1c <7.5–8.0% if tighter targets not easily achieved
Focus on drug safety
Less ambitious target
HbA1c <7.5–8.0% if tighter targets not easily achieved
Focus on drug safety
49. 老人有沒有效?
a pooled analysis of five monotherapy trials comparing the effects of 24 weeks
of vildagliptin treatment in younger (<65 years, n = 1231) and older (>65 years, n
= 238) patients
Diabetes Obes Metab. 2011;13:55–64.
Depiction of the elements of decision-making used to determine appropriate efforts to achieve glycaemic targets. Greater concerns about a particular domain are represented by increasing height of the ramp. Thus, characteristics/predicaments towards the left justify more stringent efforts to lower HbA1c, whereas those towards the right are compatible with less stringent efforts. Where possible, such decisions should be made in conjunction with the patient, reflecting his or her preferences, needs and values. This ‘scale’ is not designed to be applied rigidly but to be used as a broad construct to help guide clinical decisions. Adapted with permission from Ismail-Beigi et al [ref 20]
Fig. 2C should be considered when the goal is to minimize costs. This reflects prevailing costs in the North America and Europe in early 2012; costs of certain drugs may vary considerably from country to country and as generic formulations become available.
Fig. 2A should be considered when the goal is to avoid hypoglycemia. Note that "hidden" agents may obviously still be used when required, but additional care is needed to avoid adverse events. Here, the risk of hypoglycemia when using the hidden agents will be, in part, dependent on the baseline degree of hyperglycemia, the treatment target, and the adequacy of patient education.
Fig. 2B should be considered when the goal is to avoid weight gain. Note that "hidden" agents may obviously still be used when required, but additional care is needed to avoid adverse events. Here, the chances of weight gain when using the hidden agents will be mitigated by more rigorous adherence to dietary recommendations and optimal dosing.
In the VADT study, hypoglycaemia, together with HbA 1c levels, HDL levels, age and a history of prior events, was a major predictor of cardiovascular mortality Reference: Duckworth W ( VADT): results. 2008. Available from http:// webcasts.prous.com/netadmin/webcast_viewer/Preview.aspx?type=0&lid=3853, Accessed: 20 Oct 2009.
Hypoglycemic events may trigger inflammation by inducing the release of C-reactive protein (CRP), IL-6, and vascular endothelial growth factor (VEGF). Hypoglycemia also induces increased platelet and neutrophil activation. The sympathoadrenal response during hypoglycemia increases adrenaline secretion and may induce arrhythmias and increase cardiac workload. Underlying endothelial dysfunction leading to decreased vasodilation may also contribute to cardiovascular risk. Desouza CV et al. Hypoglycemia, Diabetes, and Cardiovascular Events. Diabetes Care. 2010; 33: 1389-1394.
Episodes of hypoglycemia, even asymptomatic episodes, impair defenses against subsequent hypoglycemia by causing hypoglycemia-associated autonomic failure (HAAF), the clinical syndromes of defective glucose counterregulation and hypoglycemia unawareness, and therefore a vicious cycle of recurrent hypoglycemia. The shift of the glycemic thresholds for sympathoadrenal responses to lower plasma glucose concentrations caused by recent antecedent hypoglycemia (or by sleep or prior exercise) could be the result of alterations in the peripheral afferent or efferent components of the autonomic nervous system or within the CNS. Cryer PE. Mechanisms of sympathoadrenal failure and hypoglycemia in diabetes. J. Clin. Invest. 2006;116:1470–1473
Model of ischemia-induced neovascularization in normal and high glucose. A, In the presence of normal glucose concentration, ischemia-stabilized HIF-1α forms heterodimers with ARNT which bind the coactivator p300. This complex binds to the hypoxia response element (HRE) and activates expression of genes required for neovascularization. B, High glucose–induced methylglyoxal (MG) modifies HIF-1α and p300, inhibiting complex binding to the HREs of genes required for neovascularization. Data are from Thangarajah et al34 and Ceradini et al.35 (Illustration Credit: Ben Smith/Cosmocyte).