This document discusses the classification, diagnosis, and management of diabetes. It begins by classifying diabetes into type 1, type 2, and other rare forms. Type 1 is characterized by beta cell destruction leading to insulin deficiency and is immune-mediated. Type 2 is defined by insulin resistance and relative insulin deficiency. The document then covers diagnosis of diabetes, prediabetes, and gestational diabetes. It provides diagnostic criteria based on symptoms and glucose levels. The final section discusses treatment approaches including lifestyle changes, oral hypoglycemic drugs, insulin, and glycemic goals. The main drug classes are described along with their mechanisms of action, efficacy, and side effects.
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
This particular presentation of mine covers salient features of recent drug developed for treatment of dyslipidaemia particularly familial hypercholesterolemia. This presentation also covers recent modifications in treatment guidelines.
Diabetic nephropathy is characterized by persistent albuminuria, declining kidney function, hypertension, and high risk of cardiovascular disease. It is primarily caused by excess accumulation of extracellular matrix in the kidneys over many years due to effects of hyperglycemia. Screening for diabetic nephropathy involves testing for microalbuminuria annually in diabetic patients. Treatment focuses on tight glycemic control, blood pressure control typically using RAAS inhibitors, and management of cardiovascular risk factors. Uncontrolled diabetes and hypertension can lead to a progressive decline in kidney function that ultimately requires renal replacement therapy if left untreated.
This document provides an overview of diabetes mellitus including its definition, classification, clinical features, investigations, treatment, and complications. It begins with defining the objectives of the lecture which are to define DM, classify its types, list predisposing factors and clinical features, and discuss drugs used in treatment. It then covers epidemiology, the main types of DM including type 1, type 2, and gestational diabetes. Key aspects of diagnosis and management are summarized such as diagnostic criteria, goals of treatment, and approaches including non-pharmacologic, pharmacologic, and surgical options.
Diabetic kidney disease, also known as diabetic nephropathy, is a complication of diabetes that affects the kidneys. It is characterized by persistent albuminuria, declining kidney function, and elevated blood pressure. Strict control of blood glucose and blood pressure can help prevent and slow the progression of diabetic kidney disease. Current treatments include ACE inhibitors, ARBs, SGLT2 inhibitors, and GLP-1 agonists, which have shown benefits in reducing proteinuria, slowing kidney function decline, and preventing cardiovascular disease in patients. Diabetic kidney disease remains a leading cause of chronic kidney disease and end-stage renal disease worldwide.
This document provides an overview of diabetic kidney disease. It discusses how diabetes is the leading cause of chronic kidney disease and end-stage renal disease. It covers the diagnosis of diabetic kidney disease based on albuminuria and decreased estimated glomerular filtration rate. Risk factors, pathogenesis, natural history, and management strategies such as glycemic control, blood pressure control, angiotensin inhibition, and reducing proteinuria are described in detail. The roles of various drug classes and lifestyle modifications in slowing the progression of diabetic kidney disease are also summarized.
This document provides information about insulin therapy. It defines insulin as a polypeptide hormone secreted by the pancreas that has profound effects on carbohydrate, fat, and protein metabolism. Insulin deficiency results in hyperglycemia and other metabolic defects. The discovery of insulin in the 1920s by Banting and Best was a major medical milestone. Insulin is now manufactured recombinantly and comes in various rapid, short, intermediate, and long-acting forms to match physiological insulin secretion. Basal bolus regimens using basal and pre-meal bolus insulin are commonly used. New delivery methods like insulin pumps provide more flexibility but also challenges. Proper insulin storage and administration technique are important for effectiveness and safety.
1) Diabetes is now the leading cause of end-stage renal disease (ESRD) in the United States, surpassing other causes like hypertension.
2) Diabetic nephropathy follows a typical progression from increased kidney function to protein in the urine to declining kidney function over many years.
3) Tight control of blood pressure, blood sugar, and use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) can slow the progression of diabetic nephropathy.
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
This particular presentation of mine covers salient features of recent drug developed for treatment of dyslipidaemia particularly familial hypercholesterolemia. This presentation also covers recent modifications in treatment guidelines.
Diabetic nephropathy is characterized by persistent albuminuria, declining kidney function, hypertension, and high risk of cardiovascular disease. It is primarily caused by excess accumulation of extracellular matrix in the kidneys over many years due to effects of hyperglycemia. Screening for diabetic nephropathy involves testing for microalbuminuria annually in diabetic patients. Treatment focuses on tight glycemic control, blood pressure control typically using RAAS inhibitors, and management of cardiovascular risk factors. Uncontrolled diabetes and hypertension can lead to a progressive decline in kidney function that ultimately requires renal replacement therapy if left untreated.
This document provides an overview of diabetes mellitus including its definition, classification, clinical features, investigations, treatment, and complications. It begins with defining the objectives of the lecture which are to define DM, classify its types, list predisposing factors and clinical features, and discuss drugs used in treatment. It then covers epidemiology, the main types of DM including type 1, type 2, and gestational diabetes. Key aspects of diagnosis and management are summarized such as diagnostic criteria, goals of treatment, and approaches including non-pharmacologic, pharmacologic, and surgical options.
Diabetic kidney disease, also known as diabetic nephropathy, is a complication of diabetes that affects the kidneys. It is characterized by persistent albuminuria, declining kidney function, and elevated blood pressure. Strict control of blood glucose and blood pressure can help prevent and slow the progression of diabetic kidney disease. Current treatments include ACE inhibitors, ARBs, SGLT2 inhibitors, and GLP-1 agonists, which have shown benefits in reducing proteinuria, slowing kidney function decline, and preventing cardiovascular disease in patients. Diabetic kidney disease remains a leading cause of chronic kidney disease and end-stage renal disease worldwide.
This document provides an overview of diabetic kidney disease. It discusses how diabetes is the leading cause of chronic kidney disease and end-stage renal disease. It covers the diagnosis of diabetic kidney disease based on albuminuria and decreased estimated glomerular filtration rate. Risk factors, pathogenesis, natural history, and management strategies such as glycemic control, blood pressure control, angiotensin inhibition, and reducing proteinuria are described in detail. The roles of various drug classes and lifestyle modifications in slowing the progression of diabetic kidney disease are also summarized.
This document provides information about insulin therapy. It defines insulin as a polypeptide hormone secreted by the pancreas that has profound effects on carbohydrate, fat, and protein metabolism. Insulin deficiency results in hyperglycemia and other metabolic defects. The discovery of insulin in the 1920s by Banting and Best was a major medical milestone. Insulin is now manufactured recombinantly and comes in various rapid, short, intermediate, and long-acting forms to match physiological insulin secretion. Basal bolus regimens using basal and pre-meal bolus insulin are commonly used. New delivery methods like insulin pumps provide more flexibility but also challenges. Proper insulin storage and administration technique are important for effectiveness and safety.
1) Diabetes is now the leading cause of end-stage renal disease (ESRD) in the United States, surpassing other causes like hypertension.
2) Diabetic nephropathy follows a typical progression from increased kidney function to protein in the urine to declining kidney function over many years.
3) Tight control of blood pressure, blood sugar, and use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) can slow the progression of diabetic nephropathy.
This document discusses obesity and related topics. It defines obesity as having excess adipose tissue that poses health risks, with a body weight 20% over the ideal weight considered obese. Obesity occurs when caloric intake exceeds utilization, which can be due to overeating, lack of physical activity, genetics, diet composition, or underlying diseases. Complications of obesity include diabetes, hypertension, dyslipidemia, heart disease, respiratory issues, cancers, and more. Leptin and other molecules released by adipose tissue help regulate energy levels and metabolism.
DIABETES AND CARDIOVASCULAR DISEASE - THE CONTINUUMPraveen Nagula
DIABETES IS ONE OF THE MOST COMMON NONCOMMUNICABLE DISEASES WORLD WIDE.
EVERY 6 SECONDS ONE PERSON IS AFFECTED BY DIABETES..
THEME FOR 2014-2016
LETS UNITE FOR DIABETES
Update on diabetes treatment strategies 2017Indhu Reddy
This document discusses strategies for treating type 2 diabetes, including lifestyle changes and medication options. It provides guidelines on initiating treatment at diagnosis, individualizing treatment based on patient characteristics, and adjusting therapy over time to achieve glycemic targets. Intensive control is recommended to reduce microvascular and macrovascular complications, though treatment needs to be tailored based on each patient's situation to minimize risks like hypoglycemia. Both oral medications and insulin therapy are covered, along with considerations for renal function.
This document provides guidelines for the management of dyslipidemia from the European Society of Cardiology in 2016. It discusses lipid profiling, total cardiovascular risk assessment, treatment strategies, lifestyle modifications, treatment targets, and choice of treatment. Lipid profiling is recommended for those with cardiovascular disease, at increased risk, or for risk stratification. LDL-C is the primary treatment target, while non-HDL-C and apoB are secondary targets. Lifestyle changes and statin therapy are first-line treatment, with fibrates, nicotinic acid or PCSK9 inhibitors as options for additional lowering of lipids. Guidelines for treatment targets and special populations are also covered.
Imeglimin is a novel, first-in-class antidiabetic drug that targets mitochondrial function. It was shown to improve both insulin resistance and insulin secretion based on animal and human studies. Imeglimin received its first approval in Japan in 2021 based on positive results from the Phase III TIMES clinical trials program demonstrating its efficacy in lowering blood glucose levels and its safety both as monotherapy and in combination with other oral antidiabetic drugs or insulin. Imeglimin may also provide cardiovascular benefits given its effects on improving mitochondrial function in multiple tissues beyond just glycemic control.
This document provides guidelines and recommendations for lipid management:
1. It summarizes the 2013 ACC/AHA guidelines and 2016 ACC expert consensus, focusing on proven therapy rather than arbitrary lipid targets. Lifestyle changes like diet and exercise are encouraged for all.
2. Statins are recommended for four major groups to reduce ASCVD risk. High, moderate, and low intensity statin therapies are defined based on average LDL-C reduction.
3. For patients who are truly statin intolerant or require additional lowering, the document provides guidance on use of non-statin therapies like ezetimibe, basing selection on risk level and comorbidities.
This document discusses diabetes mellitus, including its causes, symptoms, diagnosis, and complications. It defines diabetes as a group of metabolic disorders characterized by high blood sugar levels over a prolonged period. The main types are type 1, where the body cannot produce enough insulin, and type 2, where tissues do not respond well to insulin. Complications of long-term high blood sugar levels include damage to small blood vessels (retinopathy, nephropathy), nerves (neuropathies), and increased risk of infections that can require amputation in severe cases of diabetic foot. The document also outlines risk factors, diagnostic tests, and the roles of insulin and other hormones in regulating blood sugar levels.
The document outlines management goals and treatment strategies for diabetes mellitus. The main goals are to eliminate hyperglycemia symptoms, reduce microvascular and macrovascular complications, and allow patients to achieve a normal lifestyle. To achieve these goals, physicians should identify an appropriate glycemic target for each patient and provide education, medications, and complication monitoring and treatment. Comprehensive diabetes care involves emphasis on nutrition, exercise, medication, and glycemic control monitoring, and often requires glucose-lowering medications.
The document discusses drug therapy for diabetes, including types of insulin, oral medications to treat type 2 diabetes, and guidelines for treatment. It provides details on short acting, intermediate acting, and long acting insulins. It also describes classes of oral medications like thiazolidinediones, biguanides, sulfonylureas, meglitinides, and alpha-glucosidase inhibitors. The document outlines targets for managing diabetes and discusses combination therapy options.
A complete knowledge about Diabetes Mellitus and its types including Type 1 Diabetes, Type 2 diabetes, gestational diabetes, pancreatic diabetes & monogenic diabetes along with clinical features, investigations and management
It also includes diabetic emergencies like Diabetic Ketoacidosis, Hyperglycaemic hyperosmolar state & hypoglycaemia.
It contains long term complications like neuropathy, nephropathy and retinopathy.
Lastly Diabetic Insipidus is also discussed here.
pathology and Complications of type 2 diabetes mellitusAiswarya Thomas
explains in detail abou various complications of diabetes mellitus and its pathophysiology. Described about the peripheral, microvascular, macrovascular comlpication
This document provides an outline and overview of diabetes mellitus, including its classification, clinical presentation, investigations, management, and complications. It discusses the main types of diabetes (type 1, type 2, gestational, and MODY), risk factors, pathophysiology, diagnostic criteria. Key tests for diagnosis and monitoring such as HbA1c, oral glucose tolerance test, and criteria for prediabetes are summarized. The document outlines the epidemiology, presentations, assessments including history and examinations, general treatment objectives and management approaches for diabetes.
The document summarizes clinical trials evaluating SGLT2 inhibitors:
1) The EMPA-REG trial found that empagliflozin reduced the risk of cardiovascular death, hospitalization for heart failure, and all-cause mortality compared to placebo in patients with type 2 diabetes at high cardiovascular risk.
2) The CANVAS trial found that canagliflozin reduced the risk of major adverse cardiovascular events and hospitalization for heart failure compared to placebo in patients with type 2 diabetes at high cardiovascular risk.
3) The DECLARE-TIMI 58 trial found that dapagliflozin did not increase the risk of major adverse cardiovascular events compared to placebo in patients with type 2 diabetes
Insulin therapy: art of initiation and titration Saikumar Dunga
The document outlines guidelines for initiating and titrating insulin therapy for type 2 diabetes. It recommends starting with either bedtime intermediate-acting or morning/bedtime long-acting insulin, and titrating the dose to reach fasting glucose targets. If HbA1c remains above 7% after 2-3 months, additional injections of rapid-acting insulin should be added at mealtimes based on pre-meal glucose levels. Further intensification, such as checking postprandial levels and adjusting prandial insulin, is recommended if HbA1c is still not at target. The guidelines provide a step-by-step approach to optimizing insulin regimens based on glucose monitoring.
This document provides an overview of dyslipidemia. It defines dyslipidemia as abnormal levels of lipids in the blood such as total cholesterol, LDL cholesterol, triglycerides, and others. The document then discusses the epidemiology of dyslipidemia, noting that over half of US adults over age 20 have total cholesterol levels at or above 200 mg/dL. It also summarizes the Fredrickson classification system for different types of hyperlipidemias based on abnormal lipid levels and lipoproteins. The document concludes by listing some of the primary genetic causes of hypercholesterolemia and hypertriglyceridemia.
Diabetes mellitus (DM) is a significant public health problem associated with many debilitating health conditions
This presentation will briefly tackle management of Diabetes
Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.
The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs.
Cardiovascular safety of anti-diabetic drugs.Cardiovascular Outcome Trials ...magdy elmasry
Cardiologists and diabetes.Target organs and action mechanism of antidiabetic drugs.Cardiovascular Outcome Trials
( CVOTs ) in Diabetes.Completed and ongoing CVOTs in type 2 diabetes.Diabetes Medications
and
Cardiovascular Impact.Recommendations for management of diabetes
Cardiovascular safety of anti-diabetic drugs.
This document provides an overview of diabetes mellitus including definitions, classification, epidemiology, pathophysiology of type 1 and type 2 diabetes, and goals of treatment. Key points include:
- Type 1 diabetes results from autoimmune destruction of pancreatic beta cells in genetically predisposed individuals and requires lifelong insulin treatment.
- Type 2 diabetes involves both insulin resistance and impaired insulin secretion and is strongly associated with obesity and physical inactivity. It can often be managed through lifestyle modifications and oral medications.
- Medical nutrition therapy, physical activity, weight loss (if indicated), glucose monitoring, and pharmacologic therapy including insulin are important components of diabetes management and prevention of complications.
This document discusses the classification and treatment of diabetes mellitus. It describes the main types of diabetes as type 1, type 2, and other specific types. Type 1 is characterized by beta-cell destruction leading to insulin deficiency, while type 2 involves insulin resistance with relative insulin deficiency or a secretory defect. The document then discusses the pharmacological and non-pharmacological treatment and management of diabetes, including medications, diet, exercise and patient education. It also covers diabetes complications if not properly managed.
This document discusses obesity and related topics. It defines obesity as having excess adipose tissue that poses health risks, with a body weight 20% over the ideal weight considered obese. Obesity occurs when caloric intake exceeds utilization, which can be due to overeating, lack of physical activity, genetics, diet composition, or underlying diseases. Complications of obesity include diabetes, hypertension, dyslipidemia, heart disease, respiratory issues, cancers, and more. Leptin and other molecules released by adipose tissue help regulate energy levels and metabolism.
DIABETES AND CARDIOVASCULAR DISEASE - THE CONTINUUMPraveen Nagula
DIABETES IS ONE OF THE MOST COMMON NONCOMMUNICABLE DISEASES WORLD WIDE.
EVERY 6 SECONDS ONE PERSON IS AFFECTED BY DIABETES..
THEME FOR 2014-2016
LETS UNITE FOR DIABETES
Update on diabetes treatment strategies 2017Indhu Reddy
This document discusses strategies for treating type 2 diabetes, including lifestyle changes and medication options. It provides guidelines on initiating treatment at diagnosis, individualizing treatment based on patient characteristics, and adjusting therapy over time to achieve glycemic targets. Intensive control is recommended to reduce microvascular and macrovascular complications, though treatment needs to be tailored based on each patient's situation to minimize risks like hypoglycemia. Both oral medications and insulin therapy are covered, along with considerations for renal function.
This document provides guidelines for the management of dyslipidemia from the European Society of Cardiology in 2016. It discusses lipid profiling, total cardiovascular risk assessment, treatment strategies, lifestyle modifications, treatment targets, and choice of treatment. Lipid profiling is recommended for those with cardiovascular disease, at increased risk, or for risk stratification. LDL-C is the primary treatment target, while non-HDL-C and apoB are secondary targets. Lifestyle changes and statin therapy are first-line treatment, with fibrates, nicotinic acid or PCSK9 inhibitors as options for additional lowering of lipids. Guidelines for treatment targets and special populations are also covered.
Imeglimin is a novel, first-in-class antidiabetic drug that targets mitochondrial function. It was shown to improve both insulin resistance and insulin secretion based on animal and human studies. Imeglimin received its first approval in Japan in 2021 based on positive results from the Phase III TIMES clinical trials program demonstrating its efficacy in lowering blood glucose levels and its safety both as monotherapy and in combination with other oral antidiabetic drugs or insulin. Imeglimin may also provide cardiovascular benefits given its effects on improving mitochondrial function in multiple tissues beyond just glycemic control.
This document provides guidelines and recommendations for lipid management:
1. It summarizes the 2013 ACC/AHA guidelines and 2016 ACC expert consensus, focusing on proven therapy rather than arbitrary lipid targets. Lifestyle changes like diet and exercise are encouraged for all.
2. Statins are recommended for four major groups to reduce ASCVD risk. High, moderate, and low intensity statin therapies are defined based on average LDL-C reduction.
3. For patients who are truly statin intolerant or require additional lowering, the document provides guidance on use of non-statin therapies like ezetimibe, basing selection on risk level and comorbidities.
This document discusses diabetes mellitus, including its causes, symptoms, diagnosis, and complications. It defines diabetes as a group of metabolic disorders characterized by high blood sugar levels over a prolonged period. The main types are type 1, where the body cannot produce enough insulin, and type 2, where tissues do not respond well to insulin. Complications of long-term high blood sugar levels include damage to small blood vessels (retinopathy, nephropathy), nerves (neuropathies), and increased risk of infections that can require amputation in severe cases of diabetic foot. The document also outlines risk factors, diagnostic tests, and the roles of insulin and other hormones in regulating blood sugar levels.
The document outlines management goals and treatment strategies for diabetes mellitus. The main goals are to eliminate hyperglycemia symptoms, reduce microvascular and macrovascular complications, and allow patients to achieve a normal lifestyle. To achieve these goals, physicians should identify an appropriate glycemic target for each patient and provide education, medications, and complication monitoring and treatment. Comprehensive diabetes care involves emphasis on nutrition, exercise, medication, and glycemic control monitoring, and often requires glucose-lowering medications.
The document discusses drug therapy for diabetes, including types of insulin, oral medications to treat type 2 diabetes, and guidelines for treatment. It provides details on short acting, intermediate acting, and long acting insulins. It also describes classes of oral medications like thiazolidinediones, biguanides, sulfonylureas, meglitinides, and alpha-glucosidase inhibitors. The document outlines targets for managing diabetes and discusses combination therapy options.
A complete knowledge about Diabetes Mellitus and its types including Type 1 Diabetes, Type 2 diabetes, gestational diabetes, pancreatic diabetes & monogenic diabetes along with clinical features, investigations and management
It also includes diabetic emergencies like Diabetic Ketoacidosis, Hyperglycaemic hyperosmolar state & hypoglycaemia.
It contains long term complications like neuropathy, nephropathy and retinopathy.
Lastly Diabetic Insipidus is also discussed here.
pathology and Complications of type 2 diabetes mellitusAiswarya Thomas
explains in detail abou various complications of diabetes mellitus and its pathophysiology. Described about the peripheral, microvascular, macrovascular comlpication
This document provides an outline and overview of diabetes mellitus, including its classification, clinical presentation, investigations, management, and complications. It discusses the main types of diabetes (type 1, type 2, gestational, and MODY), risk factors, pathophysiology, diagnostic criteria. Key tests for diagnosis and monitoring such as HbA1c, oral glucose tolerance test, and criteria for prediabetes are summarized. The document outlines the epidemiology, presentations, assessments including history and examinations, general treatment objectives and management approaches for diabetes.
The document summarizes clinical trials evaluating SGLT2 inhibitors:
1) The EMPA-REG trial found that empagliflozin reduced the risk of cardiovascular death, hospitalization for heart failure, and all-cause mortality compared to placebo in patients with type 2 diabetes at high cardiovascular risk.
2) The CANVAS trial found that canagliflozin reduced the risk of major adverse cardiovascular events and hospitalization for heart failure compared to placebo in patients with type 2 diabetes at high cardiovascular risk.
3) The DECLARE-TIMI 58 trial found that dapagliflozin did not increase the risk of major adverse cardiovascular events compared to placebo in patients with type 2 diabetes
Insulin therapy: art of initiation and titration Saikumar Dunga
The document outlines guidelines for initiating and titrating insulin therapy for type 2 diabetes. It recommends starting with either bedtime intermediate-acting or morning/bedtime long-acting insulin, and titrating the dose to reach fasting glucose targets. If HbA1c remains above 7% after 2-3 months, additional injections of rapid-acting insulin should be added at mealtimes based on pre-meal glucose levels. Further intensification, such as checking postprandial levels and adjusting prandial insulin, is recommended if HbA1c is still not at target. The guidelines provide a step-by-step approach to optimizing insulin regimens based on glucose monitoring.
This document provides an overview of dyslipidemia. It defines dyslipidemia as abnormal levels of lipids in the blood such as total cholesterol, LDL cholesterol, triglycerides, and others. The document then discusses the epidemiology of dyslipidemia, noting that over half of US adults over age 20 have total cholesterol levels at or above 200 mg/dL. It also summarizes the Fredrickson classification system for different types of hyperlipidemias based on abnormal lipid levels and lipoproteins. The document concludes by listing some of the primary genetic causes of hypercholesterolemia and hypertriglyceridemia.
Diabetes mellitus (DM) is a significant public health problem associated with many debilitating health conditions
This presentation will briefly tackle management of Diabetes
Diabetes mellitus (DM) is a group of diseases characterized by high levels of blood glucose resulting from defects in insulin production, insulin action, or both.
The term diabetes mellitus describes a metabolic disorder of multiple aetiology characterized by chronic hyperglycaemia with disturbances of carbohydrate, fat and protein metabolism resulting from defects in insulin secretion, insulin action, or both.
The effects of diabetes mellitus include long–term damage, dysfunction and failure of various organs.
Cardiovascular safety of anti-diabetic drugs.Cardiovascular Outcome Trials ...magdy elmasry
Cardiologists and diabetes.Target organs and action mechanism of antidiabetic drugs.Cardiovascular Outcome Trials
( CVOTs ) in Diabetes.Completed and ongoing CVOTs in type 2 diabetes.Diabetes Medications
and
Cardiovascular Impact.Recommendations for management of diabetes
Cardiovascular safety of anti-diabetic drugs.
This document provides an overview of diabetes mellitus including definitions, classification, epidemiology, pathophysiology of type 1 and type 2 diabetes, and goals of treatment. Key points include:
- Type 1 diabetes results from autoimmune destruction of pancreatic beta cells in genetically predisposed individuals and requires lifelong insulin treatment.
- Type 2 diabetes involves both insulin resistance and impaired insulin secretion and is strongly associated with obesity and physical inactivity. It can often be managed through lifestyle modifications and oral medications.
- Medical nutrition therapy, physical activity, weight loss (if indicated), glucose monitoring, and pharmacologic therapy including insulin are important components of diabetes management and prevention of complications.
This document discusses the classification and treatment of diabetes mellitus. It describes the main types of diabetes as type 1, type 2, and other specific types. Type 1 is characterized by beta-cell destruction leading to insulin deficiency, while type 2 involves insulin resistance with relative insulin deficiency or a secretory defect. The document then discusses the pharmacological and non-pharmacological treatment and management of diabetes, including medications, diet, exercise and patient education. It also covers diabetes complications if not properly managed.
This document discusses the classification and types of diabetes mellitus. It covers the following key points:
1) Diabetes is classified into type 1, type 2, and other specific types based on etiology. Type 1 is characterized by beta cell destruction and insulin deficiency. Type 2 involves insulin resistance with relative insulin deficiency or secretory defects.
2) Other types include genetic defects of beta cell function or insulin action, diseases of the pancreas, and diabetes due to other causes like drugs.
3) Diagnosis of diabetes is based on symptoms and elevated blood glucose levels based on standards from ADA and WHO. Treatment involves lifestyle changes, oral medications, and insulin for management of blood sugar levels and prevention of complications
This document discusses diabetes mellitus and its management. It provides information on:
1) The classification and prevalence of diabetes in Saudi Arabia, finding an overall prevalence of 23.7% with higher rates in males.
2) The diagnostic criteria and thresholds for diabetes based on HbA1c, fasting plasma glucose, and oral glucose tolerance tests. Screening is recommended for those over 45 or with risk factors.
3) Treatment involves lifestyle modifications, metformin as first line therapy, and additional oral medications or insulin as needed to achieve glycemic targets. Managing associated cardiovascular risk factors is also emphasized.
Modern Modalities for Management of Diabetes Dr Mahir Jallo Gulf Medical Univ...Mahir Khalil Ibrahim Jallo
This document discusses modern modalities for managing diabetes. It begins with an overview of the different types of diabetes, including type 1, type 2, and gestational diabetes. It then discusses diabetes complications, both microvascular complications that affect small blood vessels, and macrovascular complications that affect larger blood vessels. The document notes that up to 80% of adults with diabetes will die of cardiovascular disease. It examines reasons for the increasing epidemic of diabetes, including physical inactivity, diet, aging populations, and urbanization. The rest of the document discusses various treatment options and medications for managing blood glucose levels in type 2 diabetes.
This document discusses various drug classes used to treat type 2 diabetes, including their mechanisms of action, pharmacokinetics, and side effects. It describes sulfonylureas, metformin, thiazolidinediones, meglitinide analogues, DPP-4 inhibitors, GLP-1 receptor agonists, alpha-glucosidase inhibitors, amylin analogues, and SGLT2 inhibitors. For each class, it provides details on representative drugs, how they work, considerations around use, and common adverse effects. The document aims to comprehensively cover oral and injectable pharmacologic options for managing hyperglycemia in type 2 diabetes.
This document discusses the management of diabetes mellitus. It covers non-pharmacological and pharmacological treatment methods, goals of treatment for type 1 and type 2 diabetes, steps in glycemic control, drug classifications including sulfonylureas, metformin, alpha-glucosidase inhibitors, thiazolidinediones, and incretins. It also discusses indications for insulin use, characteristics of insulin preparations, hypoglycemia, and combination therapy approaches.
Sitagliptin an oral anti-diabetic agentAmruta Vaidya
A concise presentation on the DPP-IV inhibitor Sitagliptin an oral anti-diabetic agent. Its general mechanism of action, pharmacokinetics, safety is included.
This document provides an overview of antidiabetic drugs, classifying them based on their mechanisms of action and summarizing their uses, side effects, and contraindications. The main classes described include biguanides (e.g. metformin), sulfonylureas, meglitinides, incretin mimetics, DPP-4 inhibitors, SGLT-2 inhibitors, alpha-glucosidase inhibitors, and thiazolidinediones. Metformin is noted as the first-line oral medication for type 2 diabetes due to its efficacy, safety profile, and cost-effectiveness. All antidiabetic drugs require careful consideration of risks like hypoglycemia and drug interactions when prescribing based on a
This document provides an overview of oral hypoglycemic agents used to treat diabetes mellitus. It discusses the different types of diabetes and mechanisms of several classes of oral hypoglycemic drugs. The classes covered include sulfonylureas, meglitinides, biguanides, thiazolidinediones, DPP-4 inhibitors, GLP-1 receptor agonists, alpha-glucosidase inhibitors, SGLT2 inhibitors, bile acid sequestrants, and amylin analogues. For each class, the document discusses mechanisms of action, pharmacokinetics, advantages, disadvantages, and contraindications. It concludes that lifestyle modifications and metformin are usually first-line treatments for diabetes
Modern modalities for management of diabetes dr mahir jallo gulf medical univ...Mahir Khalil Ibrahim Jallo
This document discusses modern modalities for managing diabetes. It begins by defining the main types of diabetes - type 1, type 2, and gestational diabetes. It then discusses diabetes complications and treatments, including various classes of oral medications and insulins to manage blood glucose levels. Newer classes of medications that work by different mechanisms, such as DPP-4 inhibitors and SGLT2 inhibitors, are also covered. The document emphasizes the importance of a multifactorial treatment approach to diabetes management.
Manish yadav .M Pharm First year
Pharmacology . Under -guidence of
Professor Dr. Govind Singh .
M.D.University Rohtak
Department Pharmaceutical science
ueda2012 -incretin based therapy of type 2 diabetes mellitus_d.adelueda2015
(1) Sitagliptin is an oral dipeptidyl peptidase-IV (DPP-IV) inhibitor that works by inhibiting the breakdown of glucagon-like peptide-1 (GLP-1), allowing endogenous GLP-1 to remain active for longer and improve glycemic control. (2) In clinical trials comparing sitagliptin to sulfonylurea as an add-on to metformin, sitagliptin provided comparable reductions in HbA1c levels over 52 weeks and two years with a lower risk of hypoglycemia and weight gain. (3) The efficacy of sitagliptin in reducing HbA1c was associated with higher
The document provides an overview of the pancreas and its role in producing hormones that regulate blood glucose levels. It discusses types of diabetes, including type 1 caused by lack of insulin and type 2 caused by insulin resistance. It describes classes of anti-diabetic medications, including insulin secretagogues like sulfonylureas and meglitinides that stimulate insulin release, and insulin sensitizers like biguanides and thiazolidinediones that improve insulin response without affecting secretion. Common adverse effects and considerations for use are outlined for each drug class.
This document discusses the drug management of diabetes mellitus. It begins by classifying the different types of diabetes and criteria for diagnosis. It then discusses the therapeutic aims of glycemic control and treatment of associated conditions. The main therapeutic strategies discussed are medical nutrition therapy, exercise, and pharmacologic therapy including insulin for type 1 diabetes and oral glucose lowering agents or insulin for type 2 diabetes. Finally, it summarizes the mechanisms and examples of common classes of oral glucose lowering drugs including sulfonylureas, meglitinides, biguanides, and alpha-glucosidase inhibitors.
Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from defects in insulin secretion, insulin action.
Diabetes mellitus
Hyperglycemia
metabolism
health
Health
I am Divya Singh from SHUATS Prayagraj it's all about Debates Mellitus, types, and classes of drugs. also, it is using full for medical students, pharmacies, and researchers who are doing research in the field of Diabetes.
1) Diabetes is a chronic disease characterized by high blood glucose levels resulting from defects in insulin production, insulin action, or both. The main types are type 1 diabetes and type 2 diabetes.
2) Newer drug classes for diabetes treatment include GLP-1 receptor agonists, DPP-4 inhibitors, SGLT2 inhibitors, amylin mimetics, and newer insulin formulations.
3) Lifestyle modifications including diet, exercise, and weight control remain fundamental to diabetes management. Multiple drug classes are often combined to achieve optimal blood glucose control.
This project status report provides an overview of the current state of a project, including progress made against milestones and any issues encountered. It outlines the project scope and goals, status on tasks completed and any delays to the schedule or budget. Upcoming milestones, risks, and next steps are also reviewed along with dependencies on other teams and an appendix with additional documents.
This document provides an overview of dyslipidemia including the physiology of lipid metabolism, the role of lipoproteins in atherosclerosis, screening and treatment approaches. It covers topics such as the exogenous and endogenous pathways of lipid metabolism, key enzymes involved, how lipids contribute to atherosclerosis, diagnostic evaluation, and management with an emphasis on statin therapy and other lipid-lowering drug classes and their mechanisms of action and side effects.
The document discusses immuno-oncology and the relationship between cancer and the immune system. It provides an overview of topics that will be covered in an upcoming webinar, including advances in immuno-oncology for different cancer types and combination immunotherapy approaches. The document then reviews key topics in more depth, including how immuno-oncology focuses on improving the body's immune response against cancer and recent immunotherapy approvals. It also discusses how cancer can evade the immune system and strategies for cancer immunotherapy, such as manipulating co-stimulatory signals, enhancing antigen presenting cells, and using cytokines, monoclonal antibodies, and cancer vaccines.
This document summarizes the current status of stem cell research and therapy for cardiac repair. It discusses the types of stem cells used, including embryonic, bone marrow-derived, and resident cardiac stem cells. Methods of stem cell delivery like intravenous, intracoronary, and direct injection are presented. The mechanisms by which stem cells home to the heart and differentiate are described. Clinical trials using mesenchymal stem cells for acute myocardial infarction and heart failure are mentioned. While benefits are seen, long-term effects and several unresolved issues are still being investigated.
1. The document discusses guidelines and strategies for the prevention, treatment, and control of hypertension.
2. It outlines 4 stages of intervention for hypertension: preventive, primary, secondary, and resistant hypertension. Treatment approaches differ depending on the stage.
3. The challenges of controlling hypertension include special patient populations, factors influencing drug choice, and issues related to resistant hypertension when blood pressure remains high despite treatment with 3 drug classes.
Infliximab is a chimeric monoclonal antibody used to treat various autoimmune diseases by binding to and inhibiting tumor necrosis factor-alpha (TNF-α), a key part of the autoimmune response. It was originally developed as a mouse antibody but was modified to contain mostly human antibody sequences. Infliximab is administered via intravenous infusion every 6-8 weeks and is approved by the FDA to treat Crohn's disease, ulcerative colitis, psoriasis, psoriatic arthritis, rheumatoid arthritis, and ankylosing spondylitis.
Chlorthalidone has been shown to be more effective at lowering blood pressure than hydrochlorothiazide, especially at night, due to its longer half-life. Evidence from large clinical trials also indicates that chlorthalidone reduces cardiovascular outcomes more than hydrochlorothiazide when used for hypertension. As a result, clinical guidelines now recommend chlorthalidone as the first-line thiazide-type diuretic for treating hypertension.
Management of nutrition in patients with renal failure is challenging as malnutrition occurs in up to 40% of such patients and is associated with increased morbidity and mortality. Malnutrition has multiple contributing factors, including decreased food intake due to gastrointestinal symptoms. Providing appropriate calorie and protein intake tailored to the patient's stage of kidney disease is important to permit adequate nutrition without unnecessary restrictions. Nutritional assessment, monitoring guidelines for calories, proteins and minerals, and specialized nutrition support are crucial for managing the nutrition of renal failure patients.
This document discusses an approach to cough management. It begins by describing cough as both a defense mechanism and a factor in disease spread. It then outlines the most common causes of acute and chronic cough, including postnasal drip syndrome, asthma, and gastroesophageal reflux disease. The document proposes a 6-step empiric treatment algorithm beginning with treating postnasal drip and proceeding through evaluations and treatments for asthma, chest abnormalities, GERD, and less common causes before considering psychogenic cough.
This document discusses the interactions between HIV and malaria. It begins by introducing the topic and noting that the high fever found in immunosuppressed HIV patients can lead to missed malaria diagnoses. Several studies are then summarized that show HIV negatively impacts the body's ability to develop immunity and produce antibodies against malaria. The document continues by discussing how malaria may increase HIV viral load and transmission risk. It notes that the greatest interaction occurs when one disease is highly prevalent and the other is low. The implications for treatment are that malaria must be diagnosed and treated in HIV patients to control viral load. In areas of high malaria and HIV, the diseases have less impact on mortality. Overall, the document examines the bidirectional relationship between the two diseases.
Cilnidipine is a dual-acting calcium channel blocker that blocks both L-type and N-type calcium channels. It is used to treat hypertension. Studies have shown that cilnidipine is as effective at lowering blood pressure as amlodipine, but it does not cause reflex tachycardia and has a lower risk of side effects like ankle edema. Combining cilnidipine with drugs that inhibit the renin-angiotensin-aldosterone system provides improved blood pressure control and reduces cardiac remodeling compared to other calcium channel blockers. Cilnidipine's unique dual blocking properties also help regulate leptin secretion, reducing atherosclerosis risk in obese hypertensive patients
This document discusses acute kidney injury (AKI), its current diagnosis methods, prognostic markers, and emerging biomarkers. It notes that AKI is commonly diagnosed late using creatinine levels, after significant renal function has already been lost. Several promising emerging biomarkers are described that may allow for earlier AKI diagnosis before creatinine rises, including:
- Neutrophil gelatinase-associated lipocalin (NGAL), which is expressed in epithelial cells during periods of apoptosis.
- Kidney injury molecule 1 (KIM-1), which is upregulated in proximal tubules after ischemia. Studies show it can detect AKI earlier than creatinine.
- Interluekin-18 (IL-18
1) Telmisartan has the longest half-life, largest volume of distribution, highest lipophilicity, and lowest renal excretion of clinically available ARBs, resulting in the longest duration of action.
2) Telmisartan binds insurmountably to the AT1 receptor and has a much longer dissociation half-life compared to losartan, providing tighter, more sustained blockade of the RAS.
3) Telmisartan is the preferred ARB for patients with renal impairment due to its renal excretion profile and superior blood pressure lowering in renal disease compared to other ARBs like losartan.
The AMH test measures levels of anti-Mullerian hormone in a woman's blood, which is a good indicator of her ovarian reserve and number of remaining eggs. A low AMH level suggests a reduced ovarian reserve and fewer eggs remaining, making pregnancy through natural or assisted means less likely. The AMH test can help fertility specialists determine treatment options and dosages, and women understand their biological clock and chances of achieving pregnancy at their current age. While informative, an AMH test must be interpreted by a specialist and in context of other factors, as implications of a low level may vary depending on a woman's individual circumstances.
Karyotyping is a technique used in prenatal diagnosis to detect chromosomal abnormalities in fetuses. Chromosomal abnormalities like Down syndrome, Trisomy 18, and sex chromosome trisomies can occur when errors occur during cell division. Prenatal diagnosis helps detect these abnormalities and allows parents to decide whether to continue or terminate the pregnancy. The document discusses techniques like amniocentesis and chorionic villus sampling that are used to obtain fetal cells for karyotyping. Karyotyping analyzes the number and structure of chromosomes to detect extra or missing chromosomes that can cause developmental delays, birth defects, or other health problems. Common chromosomal abnormalities that can be detected include Down syndrome, Trisomy 18, and
CA-125 is a protein marker that is elevated in many ovarian cancer patients. While it returns a true positive result in only 50% of stage I ovarian cancer, serial CA-125 testing over time can achieve a high specificity of 99.6%. Combining CA-125 testing with transvaginal ultrasound and examination increases accuracy for detection. HE4 is another protein marker that is elevated in epithelial ovarian cancer and not benign gynecological conditions. Using both CA-125 and HE4 tests in an algorithm called ROMA can help determine likelihood of malignancy in women with ovarian masses, outperforming CA-125 alone. ROMA and ultrasound are useful first-line tests to select high risk patients for referral and further diagn
Rising age of motherhood has led to more women facing infertility issues. Anti-Mullerian hormone (AMH) levels can help predict ovarian reserve and remaining fertility as they reflect the number of follicles in the ovaries. AMH is produced from early fetal development through menopause, peaks in the mid-20s, and declines with age as ovarian reserve decreases. AMH levels are a stronger predictor of ovarian response to fertility treatments than age alone and can help determine initial fertility drug doses. AMH may also help diagnose conditions like polycystic ovarian syndrome and assess chemotherapy-induced damage to ovarian reserve.
The document discusses TORCH testing, which screens for 5 infections - Toxoplasmosis, Other (Syphilis), Rubella, Cytomegalovirus, and Herpes Simplex Virus. These infections can be transmitted from mother to fetus and cause birth defects if acquired during pregnancy. TORCH testing measures IgG and IgM antibodies in blood to determine if a woman has had or has a current infection. Serial testing allows detection of a recent infection based on a rise in antibody levels. Positive IgM indicates a current/recent infection while only IgG indicates a past infection. TORCH screening helps identify women and infants at risk of congenital or neonatal infections.
1. Maternal serum screening uses markers like AFP, hCG, and uE3 to detect pregnancies at risk of neural tube defects, Down syndrome, and trisomy 18. Between 15-22 weeks, the triple screen analyzes levels of these three serum markers.
2. Abnormal marker levels may indicate need for further tests like ultrasound or amniocentesis to clarify risks. The triple screen detects around 85% of neural tube defects, 80% of Down syndrome cases, and 80% of trisomy 18 cases.
3. While a normal triple screen reduces risks, it does not rule out all possibilities, so counseling is important to discuss screening limitations and need for follow up if results
This document discusses heart rate variability (HRV), heart rate turbulence (HRT), and baroreflex function as indices of autonomic imbalance that can help with risk stratification in patients with cardiovascular diseases. It describes how HRV and HRT reflect autonomic regulation of the heart through the baroreflex arc. Reduced HRV and abnormal HRT values obtained through time/frequency domain analysis of ECG recordings have been associated with increased mortality in conditions like acute myocardial infarction and heart failure. Measurement of these autonomic indices along with markers of structural damage can improve risk assessment in cardiac patients.
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- 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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
4. Classification
Type 1 diabetes
Type 2 diabetes
Other
1. Genetic defects of beta cell function
2. Genetic defects in insulin action
3. Diseases of the exocrine pancreas
4. Endocrinopathies
5. Drug/ chemical - induced
6. Infections
7. Uncommon forms of immune-mediated diabetes
8. Genetic syndromes sometimes associated with diabetes
Gestational diabetes mellitus
5. Type 1 diabetes
Type 1 diabetes is characterized by β-cell
destruction, usually leading to absolute
insulin deficiency.
A. Immune-mediated
B. Idiopathic
* Diagnosis and Classification of Diabetes Mellitus. ADA 2009.
6. * Atkinson MA and Eisenbarth GS. Lancet 2001;358:221-229.
Type 1 diabetes - progression
7. Type 1 diabetes – immune mediated
Absolute insulin deficiency
Usually due to autoimmune destruction of the
pancreatic beta cells
Islet-cell antibodies (ICA) or
other autoantibodies
antibodies to glutamic acid decarboxylase [anti-GAD] and
anti-insulin)
9. Type 2 diabetes - causes
Hyperglycemia in type 2 diabetes can be due to 2 causes:
Pancreas
Insulin Resistance
Liver
Hyperglycemia
Islet Cell Degranulation;
Reduced Insulin Content
Muscle Adipose Tissue
Decreased Glucose
Transport & Activity
(expression)
of GLUT4
Increased
Lipolysis
↑Glucose
Production
↓Glucose
Uptake
Reduced
Plasma Insulin
Increased Glucose Output
Cell Dysfunction
Elevated
Plasma FFA
10. Type 2 diabetes & declining β–cell function :
UKPDS
Dashed line = extrapolation from UKPDS data
Lebovitz HE, Diabetes reviews, 1999;7: 139-153
11. Maturity–onset diabetes of the young (MODY)
6 subtypes:
MODY 1 - Mutation in HNF-4-alpha (transcription factor),
chromosome 20
MODY 2 - Mutation in glucokinase gene, chromosome 7
MODY 3 - Mutation in HNF-1-alpha (transcription factor),
chromosome 12 (most common form)
MODY 4 - Mutation in insulin promoter factor-1 (IPF-1),
chromosome 13
MODY 5 - Mutation in HNF-1-beta, chromosome 17
MODY 6 - Mutation in Neurogenic Differentiation Factor-
1 (NEUROD1) , chromosome 2
Other specific types of diabetes:
Genetic defects in β-cell function
12. Other specific types of diabetes:
Genetic defects in insulin action
Type A insulin resistance
Leprechaunism
Rabson- Mendenhall syndrome
Lipoatrophic diabetes
Others
13. *A clinical screening tool identifies autoimmune diabetes in adults. Fourlanos S; Perry C; Stein MS; Stankovich J; Harrison LC; Colman
PG. Diabetes Care. 2006 May;29(5):970-5
Latent Autoimmune Diabetes in Adults
(LADA)
Adult-onset diabetes with circulating islet
antibodies but not requiring insulin therapy
initially
Adults who should be considered for antibody
testing*:
age of onset <50 years
acute symptoms
BMI <25 kg/m2
personal or family history of autoimmune disease
14. Gestational DM
Any degree of impaired glucose tolerance with
onset or first recognition during pregnancy
Gestational diabetes (GDM) occurs when
pancreatic function is not sufficient to overcome
the insulin resistance created by changes in
diabetogenic hormones during pregnancy.
Most have impaired glucose tolerance that begins
in pregnancy
Some have previous undiagnosed type 2 diabetes.
10% have circulating islet cell antibodies
17. Diagnosis: Diabetes mellitus
Symptoms of diabetes (polydipsia, polyuria,
unexplained weight loss) PLUS a random plasma
glucose >200 mg/dL (11.1 mmol/L)
or
Fasting plasma glucose > 126 mg/dL (7.0 mmol /
L) after overnight (at least 8 hours) fast
or
Two-hour plasma glucose> 200mg/dL (11.1
mmol / L) during a standard 75g oral glucose
tolerance test
Any of these criteria establishes the diagnosis but needs to be confirmed on a later day
24. Oral antihyperglycemic drugs:
Biguanides
Metformin & Extended-
release metformin now
available
decrease hepatic glucose
output
lower fasting glycemia
reduce HbA1c by 1.5%
adverse effects: lactic
acidosis, gastro-
intestinal disturbances
AMPK - adenosine
monophosphate-activated protein
kinase, ACC - acteyl-CoA
carboxylase, SREPB-1 - sterol-
regulatory-element-binding-
protein-1
Diagram adapted from Alice Y.Y. Cheng, I. George Fantus, 'Oral antihyperglycemic therapy for type 2 diabetes mellitus' Canadian Medical Association Journal
172(2),2005 pp213-226
25. Oral antihyperglycemic drugs:
Metformin titration
1. Begin with low-dose metformin (500 mg) taken once or twice
per day with meals (breakfast and/or dinner).
2. After 5–7 days, if GI side effects have not occurred, advance
dose to 850 or 1,000 mg before breakfast and dinner.
3. If GI side effects appear as doses advanced, can decrease to
previous lower dose and try to advance dose at a later time.
4. The maximum effective dose is usually 850 mg twice per day,
with modestly greater effectiveness with doses up to 3 g per
day. GI side effects may limit the dose that can be used.
5. Based on cost considerations, generic metformin is the first
choice of therapy. A longer-acting formulation is available in
some countries and can be given once per day.
26. Oral antihyperglycemic drugs:
Sulfonylureas
1st generation no longer used: Chlorpropamide Tolbutamide
2nd generation : Glyburide, Glipizide, Glimepiride
enhance insulin secretion
lower HbA1c by 1.5 %
side effects: hypoglycemia, weight gain
27. Black C, Donnelly P, McIntyre L et al. Meglitinide analogues for type 2 diabetes mellitus. Cochrane Database Syst Rev. 2007 Apr
18;(2):CD004654.
Oral antihyperglycemic drugs:
Meglitinide analogs
Repaglinide
Nateglinide
enhance insulin secretion (early-phase insulin release)
lower HbA1c by 0.1- 2.1 % (repaglinide) and by 0.2- 0.6%
(nateglinide)
side effects: weight gain, hypoglycemia
28. Oral antihyperglycemic drugs:
Thiazolidinediones (TZDs)
Rosiglitazone & Pioglitazone
peroxisome proliferator-activated receptor γ
modulators (PPAR γ)
insulin sensitizers (increase the sensitivity of muscle,
fat and liver to endogenous and exogenous insulin)
lower HbA1c by 0.5 - 1.4 %
adverse effects: weight gain, fluid retention
29. Oral antihyperglycemic drugs:
-Glucosidase Inhibitors
Acarbose
Miglitol
reduce the rate of digestion of polysaccharides in
the proximal small intestine, primarily lowering
post-prandial glucose levels
lower HbA1c by 0.5 – 0.8 %
side effects: increased gas production and
gastro-intestinal symptoms
30. Oral antihyperglycemic drugs:
DPP-IV inibitors
Sitagliptin : DPP-IV inhibitor
Dipeptidyl peptidase IV (DPP-
IV) is a ubiquitous enzyme
that deactivates a variety of
bioactive peptides, including
GIP and GLP-1
Used alone or in combination
with metformin or TZDs
Reduces HbA1c by 0.5 – 0.7 %
Side effects: increased rate of
respiratory infections,
headaches
31. Other antihyperglycemic drugs:
Incretins
Glucagon-like peptide 1 (GLP-1) agonist
Exenatide - active ingredient in Exenatide
(Byetta) is a synthetic version of a protein
present in the saliva of the Gila monster
32. Glucagon-like Peptide - 1
The majority of GLP-1 producing cells are in the
terminal ileum and proximal colon.
GLP-1 levels in the blood increase rapidly after a meal.
Half-life is very short, approximately one minute.
GLP-1 binding to its G-protein coupled receptor on ß-
cells increases glucose stimulated insulin secretion
GLP-1 infused into healthy subjects decreases gastric
emptying, causes a sensation of satiety, and decreases
appetite.
Effects:
enhances insulin secretion
limits postprandial hyperglycemia.
33. Other antihyperglycemic drugs:
Incretins [Exenatide]
Added to
metformin or
sulfonylureas will
reduce HbA1c by
0.4-0.6 %
Side effects:
nausea (dose-
depended, declines
with time)
acute pancreatitis
(some necrotizing
or hemorrhagic
pancreatitis cases
reported as well)
34. Figure 1. Insulin levels following oral vs IV glucose
administration in healthy individuals. Despite
identical glucose concentrations, plasma insulin
levels peaked much earlier and were greater in
response to an oral vs IV dose of glucose.
Figure 2. Insulin levels following oral vs IV glucose
administration in patients with type 2 diabetes. The
markedly reduced early peak of insulin after oral
glucose, along with the smaller differences in insulin
levels in response to oral and IV glucose doses,
illustrate the diminished incretin effect.
Data extrapolated from Perley, et al. @ http://www.byettahcp.com/hcp/hcp_incretin_effect.jsp
Incretin Effect
35. Antihyperglycemic drugs: Others
Pramlintide (Symlin)
synthetic analog of amylin
Delays gastric emptying,
suppresses glucagon
secretion, decreases
appetite
Associated with weight loss
(1 - 1.5 kg over 6 months)
Used only in conjunction
with insulin treatment
↓ HbA1c by 0.5- 0.7 %
Side effects: nausea, gastro-
intestinal symptoms
36. Amylin
Stored in insulin secretory granules in the ß-
cells
Co-secreted with insulin
Decreases glucagon
Satiety signal?
Decreases GI motility
37. * Onset and duration are rough estimates. They can vary greatly within
the range listed and from person to person
** Human insulin is made by recombinant DNA technology
Available insulin preparations
38. Summary of antidiabetic interventions as
monotherapy
Interventions
Expected
decrease in
A1C (%)
Advantages Disadvantages
Step 1: initial
Lifestyle to decrease weight
and increase activity
1–2 Low cost, many benefits Fails for most in 1st year
Metformin 1.5
Weight neutral,
inexpensive
GI side effects, rare lactic acidosis
Step 2: additional therapy
Insulin 1.5–2.5
No dose limit,
inexpensive, improved
lipid profile
Injections, monitoring, hypoglycemia, weight
gain
Sulfonylureas 1.5 Inexpensive Weight gain, hypoglycemia*
TZDs 0.5–1.4 Improved lipid profile Fluid retention, weight gain, expensive
Other drugs
α-Glucosidase inhibitors 0.5–0.8 Weight neutral
Frequent GI side effects, three times/day dosing,
expensive
Exenatide 0.5–1.0 Weight loss
Injections, frequent GI side effects, expensive,
little experience
Glinides 1–1.5† Short duration Three times/day dosing, expensive
Pramlintide 0.5–1.0 Weight loss
Injections, three times/day dosing, frequent GI
side effects, expensive, little experience
40. * Postprandial measurements should be made 1-2 h after the beginning of the meal, generally peak levels in patients with diabetes.
Standards of Medical Care in Diabetes–2009. ADA Position Statement. Diabetes Care;32:S13-S61.
Glycemic goals: non-pregnant adults with
diabetes
Key concepts in setting glycemic goals
HbA1c is the primary target for glycemic
control
HbA1c < 7.0%
Preprandial capillary plasma glucose 70-130
mg/dl (3.9-7.2 mmol/l)
Peak postprandial capillary plasma glucose <
180 mg/dl (< 10.0 mmol/l)*
41. * Postprandial measurements should be made 1-2 h after the beginning of the meal, generally peak levels in patients with diabetes.
Standards of Medical Care in Diabetes–2009. ADA Position Statement. Diabetes Care;32:S13-S61.
Glycemic goals: non-pregnant adults with
diabetes
Goals should be individualized based on:
duration of diabetes
age/life expectancy
comorbid conditions
known CVD or advanced microvascular complications
hypoglycemia unawareness
individual patient considerations
More or less stringent glycemic goals may be
appropriate for individual patients
Postprandial glucose may be targeted if HbA1c goals
are not met despite reaching preprandial glucose
goals
42. Glycemic goals - pregnant adults with
diabetes
Women with GDM
Maternal capillary
glucose concentrations:
preprandial:≤95 mg/dl
(5.3 mmol/l) and either
1-h postmeal: ≤140
mg/dl (7.8 mmol/l)
Women with
preexisting diabetes
who become pregnant
Maternal capillary
glucose concentrations:
premeal, bedtime, and
overnight: 60-99mg/dl
Peak postprandial: 100-
129 mg/dl
HbA1c <6.0%
43. Road map to achieve glycaemic goals:
Naive to type 2 therapy
45. Algorithm for the metabolic management of type 2 diabetes; Reinforce lifestyle interventions at every visit and check A1C every 3 months
until A1C is <7% and then at least every 6 months. The interventions should be changed if A1C is ≥7%. a)Sulfonylureas other than
glybenclamide (glyburide) or chlorpropamide. b)Insufficient clinical use to be confident regarding safety.
ADA Treatment Algorithm
46. Algorithm for the metabolic management of type 2 diabetes. Reinforce lifestyle intervention at every visit. *Check A1C every 3 months until
<7% and then at least every 6 months. +Although three oral agents can be used, initiation and intensification of insulin therapy is preferred
based on effectiveness and expense.
ADA Treatment Algorithm
47. Initiation and adjustment of insulin regimens. Insulin regimens should be designed taking lifestyle and meal schedule into account. The algorithm
can only provide basic guidelines for initiation and adjustment of insulin. See reference 90 for more detailed instructions. aPremixed insulins not
recommended during adjustment of doses; however, they can be used conveniently, usually before breakfast and/or dinner, if proportion of rapid-
and intermediate-acting insulins is similar to the fixed proportions available. bg, blood glucose.
ADA Treatment Algorithm
48. Initiation and adjustment of insulin regimens. Insulin regimens should be designed taking lifestyle and meal schedule into account. The
algorithm can only provide basic guidelines for initiation and adjustment of insulin. See ref. 71 for more detailed instructions. +Premixed
insulins are not recommended during adjustment of doses; however, they can be used conveniently, usually before breakfast and/or dinner if
proportion of rapid- and intermediate-acting insulins is similar to the fixed proportions available. bg, blood glucose.
ADA Treatment Algorithm
49. Initiation and adjustment of insulin regimens. Insulin regimens should be designed taking lifestyle and meal schedule into account. The
algorithm can only provide basic guidelines for initiation and adjustment of insulin. See ref. 71 for more detailed instructions. +Premixed
insulins are not recommended during adjustment of doses; however, they can be used conveniently, usually before breakfast and/or dinner if
proportion of rapid- and intermediate-acting insulins is similar to the fixed proportions available. bg, blood glucose.
ADA Treatment Algorithm
50. Clarifications on the watch list
Insulin therapy in outpatient and inpatient settings
Glycemic control and inpatient outcomes
Does a perfect eating plan exist?
Medical Nutrition Therapy for Diabetes
Review goals and outcomes of Medical Nutrition
Therapy [MNT]
Discuss basic recommendations for MNT
Review specific recommendations for patient
population groups
51. Road Maps to Achieve
Glycemic Control in Type 2
Diabetes Mellitus
ACE/AACE Diabetes Road Map
Task Force
Editor's Notes
-Cell Dysfunction and Insulin Resistance Produce Hyperglycemia in Type 2 Diabetes Dual Impairment Impaired insulin action (Insulin Resistance) Impaired insulin secretion (Impaired -cell function) In adipose tissue resistant to the effects of insulin, there is increased lipolysis resulting in elevated level of plasma free fatty acids (FFA). Elevated FFA lead to an increase in hepatic glucose production and decrease in glucose uptake in the muscle. Impaired -cell function and -cell degranulation lead to a reduction in circulating insulin. This reduction in circulating insulin leads to hyperglycemia. Impaired insulin action or insulin resistance results in a decreased response to insulin in insulin sensitive tissues. In the liver, insulin resistance results in an increase in hepatic glucose production. Whether the impairment is to insulin secretion or action, the resulting hyperglycemia has a negative effect on muscle and adipose tissue by decreasing expression of GLUT4 which, in turn, limits glucose transport into insulin-sensitive tissues. Key words: Type 2 Defects Beta cell Insulin resistance
had anatomical evidence of significant atherosclerosis, albuminuria, left ventricular hypertrophy, or at least two additional risk factors for cardiovascular disease (dyslipidemia, hypertension, current status as a smoker, or obesity).
Mean duration of DM – 8 yrs
½ w/o and ½ with clinical retinopathy
Glycosylated hemoglobin values were measured quarterly and fasting lipid levels, serum creatinine values, and other risk factors for cardiovascular disease were measured annually in a central laboratory. Microalbuminuria and albuminuria were defined by urinary albumin excretion of at least 40 mg in a 24-hour period and of at least 300 mg in a 24-hour period, respectively. Renal disease was defined by the development of a serum creatinine level of at least 2 mg per deciliter (177 µmol per liter) or the need for dialysis or kidney transplantation. Electrocardiograms were obtained and examined annually by readers who were unaware of patients' treatment assignments. During the EDIC follow-up study, the methods used in the DCCT were continued, but glycosylated hemoglobin was measured annually and fasting lipid levels and renal function were measured in alternate years.