This document discusses various studies on controlling blood glucose levels in prediabetes patients. It summarizes the results of several major studies that found intensive lifestyle interventions focusing on diet modification and increased physical activity reduced the risk of developing diabetes in prediabetes patients by 31-71% compared to placebo. One study found the effects of lifestyle intervention were sustained for up to 10 years after the initial study period. Metformin was also found to reduce diabetes risk compared to placebo by 25-72% in prediabetes patients in several studies.
The guidelines provide recommendations for screening, risk assessment, treatment goals, and management of dyslipidemia to prevent cardiovascular disease. Key points include screening adults based on age and risk factors, using LDL-C and other lipid levels to determine risk stratification and treatment goals, and employing lifestyle changes and pharmacologic therapies like statins and fibrates to manage lipid levels and reduce risk. The guidelines aim to optimize dyslipidemia treatment to lower cardiovascular disease risk.
This document summarizes strategies for preventing chronic kidney disease (CKD). It discusses several key risk factors for CKD, including diabetes, hypertension, obesity, and smoking. It then outlines primary and secondary prevention approaches. For primary prevention, lifestyle modifications and controlling risk factors like blood pressure and blood sugar are emphasized. For secondary prevention in patients with existing kidney disease, tight control of blood pressure and glucose is important, along with use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers to slow disease progression. Clinical trials demonstrate that controlling these modifiable risk factors can significantly reduce the risk of end-stage renal disease.
1) Patients with diabetes have more than double the risk of major adverse cardiovascular events like myocardial infarction, stroke, and heart failure compared to those without diabetes.
2) Lifestyle changes like diet, exercise, and not smoking along with controlling blood pressure and lipids through medication are more important for reducing cardiovascular risk than glycemic control alone.
3) Cardiovascular disease risk is significantly increased in those with diabetes, with women seeing higher relative risks than men. Multiple factors contribute to diabetes being a major risk factor for cardiovascular disease.
THE ROLLER COASTER RIDE OF DYSLIPIDEMIA & CADSunil Wadhwa
This document discusses the history of understanding and managing dyslipidemia and cardiovascular disease risk. Some key points:
- Early studies found associations between coffee, smoking and heart disease that were later proved misleading as smokers were more likely to drink coffee.
- Diabetes was found to significantly increase cardiovascular risk in the Framingham study.
- Autopsies of young soldiers in the 1950s first revealed the prevalence of atherosclerosis.
- Later studies through the 1990s established the relationships between serum cholesterol, cardiovascular events and mortality.
- Risk factors like inflammation (CRP), calcium scoring, carotid intima-media thickness, and arterial stiffness are now also considered.
- Guidelines now recommend tailored stat
The document discusses guidelines for managing dyslipidemia and cardiovascular disease risk, including:
1) It provides risk levels (very high, high, moderate, low) based on calculated cardiovascular risk and clinical factors and recommends LDL-C treatment targets for each level.
2) It discusses statin treatment for different risk levels, recommending the highest tolerated dose to reach LDL-C targets.
3) It summarizes trials comparing different statins and their average LDL-C reduction, finding some are more effective than others at reducing LDL-C.
Goal attainments and their discrepancies for low density lipoprotein choleste...Paul Schoenhagen
Purpose: Low density lipoprotein cholesterol (LDL-C) is primary treatment target for patients with dislipidemia. The apolipoprotein B (apo B), an emerging biomarker for cardiovascular risk prediction, appears to be superior to the LDL-C. However, little is known about goal attainments and their discrepancies for LDL-C and apo B in Chinese patients with known CAD or DM.
- The document summarizes research on cilostazol for the treatment of intermittent claudication from peripheral artery disease.
- Studies showed cilostazol significantly improved treadmill walking distance and quality of life measures compared to placebo over 6 months.
- The long-term CASTLE study of over 1400 patients found cilostazol did not increase cardiovascular risk over 3 years and may reduce stroke risk compared to placebo.
Dyslipidemia management an evidence based approachDr Vivek Baliga
How is dyslipidemia managed in clinical practice? Here is a short review on how current guidelines are shaping clinical practice, and how saroglitazar is playing a role in it.
The guidelines provide recommendations for screening, risk assessment, treatment goals, and management of dyslipidemia to prevent cardiovascular disease. Key points include screening adults based on age and risk factors, using LDL-C and other lipid levels to determine risk stratification and treatment goals, and employing lifestyle changes and pharmacologic therapies like statins and fibrates to manage lipid levels and reduce risk. The guidelines aim to optimize dyslipidemia treatment to lower cardiovascular disease risk.
This document summarizes strategies for preventing chronic kidney disease (CKD). It discusses several key risk factors for CKD, including diabetes, hypertension, obesity, and smoking. It then outlines primary and secondary prevention approaches. For primary prevention, lifestyle modifications and controlling risk factors like blood pressure and blood sugar are emphasized. For secondary prevention in patients with existing kidney disease, tight control of blood pressure and glucose is important, along with use of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers to slow disease progression. Clinical trials demonstrate that controlling these modifiable risk factors can significantly reduce the risk of end-stage renal disease.
1) Patients with diabetes have more than double the risk of major adverse cardiovascular events like myocardial infarction, stroke, and heart failure compared to those without diabetes.
2) Lifestyle changes like diet, exercise, and not smoking along with controlling blood pressure and lipids through medication are more important for reducing cardiovascular risk than glycemic control alone.
3) Cardiovascular disease risk is significantly increased in those with diabetes, with women seeing higher relative risks than men. Multiple factors contribute to diabetes being a major risk factor for cardiovascular disease.
THE ROLLER COASTER RIDE OF DYSLIPIDEMIA & CADSunil Wadhwa
This document discusses the history of understanding and managing dyslipidemia and cardiovascular disease risk. Some key points:
- Early studies found associations between coffee, smoking and heart disease that were later proved misleading as smokers were more likely to drink coffee.
- Diabetes was found to significantly increase cardiovascular risk in the Framingham study.
- Autopsies of young soldiers in the 1950s first revealed the prevalence of atherosclerosis.
- Later studies through the 1990s established the relationships between serum cholesterol, cardiovascular events and mortality.
- Risk factors like inflammation (CRP), calcium scoring, carotid intima-media thickness, and arterial stiffness are now also considered.
- Guidelines now recommend tailored stat
The document discusses guidelines for managing dyslipidemia and cardiovascular disease risk, including:
1) It provides risk levels (very high, high, moderate, low) based on calculated cardiovascular risk and clinical factors and recommends LDL-C treatment targets for each level.
2) It discusses statin treatment for different risk levels, recommending the highest tolerated dose to reach LDL-C targets.
3) It summarizes trials comparing different statins and their average LDL-C reduction, finding some are more effective than others at reducing LDL-C.
Goal attainments and their discrepancies for low density lipoprotein choleste...Paul Schoenhagen
Purpose: Low density lipoprotein cholesterol (LDL-C) is primary treatment target for patients with dislipidemia. The apolipoprotein B (apo B), an emerging biomarker for cardiovascular risk prediction, appears to be superior to the LDL-C. However, little is known about goal attainments and their discrepancies for LDL-C and apo B in Chinese patients with known CAD or DM.
- The document summarizes research on cilostazol for the treatment of intermittent claudication from peripheral artery disease.
- Studies showed cilostazol significantly improved treadmill walking distance and quality of life measures compared to placebo over 6 months.
- The long-term CASTLE study of over 1400 patients found cilostazol did not increase cardiovascular risk over 3 years and may reduce stroke risk compared to placebo.
Dyslipidemia management an evidence based approachDr Vivek Baliga
How is dyslipidemia managed in clinical practice? Here is a short review on how current guidelines are shaping clinical practice, and how saroglitazar is playing a role in it.
Management of CAD in Diabetes the cardiovascular equivalent is challenging.The slides take you from the epidemiology,ADD,and CV benefit and how to manage CAD
1) LDL-C levels are a major risk factor for acute coronary syndrome (ACS) and lowering LDL-C through intensive statin therapy leads to significant reductions in recurrent events and mortality after ACS.
2) Guidelines recommend initiating high-dose statins early for ACS patients and achieving an LDL-C reduction of at least 50% from baseline and an LDL-C level below 55 mg/dL to reduce risk.
3) Studies show high-dose rosuvastatin preloading before percutaneous coronary intervention (PCI) significantly reduces major adverse cardiac events and peri-procedural myocardial injury compared to no preloading or lower statin doses.
This document discusses treatment options after metformin for type 2 diabetes, comparing sulfonylureas and gliptins. It provides the following key points:
1. Sulfonylureas are more effective at reducing HbA1c levels and achieving glycemic control targets compared to gliptins. They lower HbA1c by 1-2% on average versus 0.5-1% for gliptins.
2. Studies show sulfonylureas may better preserve beta-cell function in the long-term compared to metformin or gliptins. They have been shown to enhance insulin secretion from beta and alpha cells.
3. While older studies linked sulfonylureas
Reduciendo eventos cardiovasculares en pacientes con DM2: nuevas evidencias
23/06/16 18:00h Casa del Corazón, Madrid
http://ecvdm2.secardiologia.es
#ECVDM2
Resultados de nuevos estudios: más allá de la no inferioridad
Dr. Luis Masmiquel Comas, Endocrinólogo. Hospital Son Llàtzer (Palma de Mallorca)
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
EMPA-REG: un punto de inflexión en el tratamiento de la diabetes
18/11/15 20:00h Casa del Corazón (Madrid)
http://empareg.secardiologia.es
#EMPAREG
Resultados del estudio EMPA-REG
Dr. Domingo Marzal Martín, Complejo Hospitalario de Mérida (Badajoz)
@domingomarzal
Syndrome metabolique et maladies vasculaires s novosfa_angeiologie
This document summarizes a presentation on detecting preclinical atherosclerosis and evaluating cardiovascular risk. It discusses the metabolic syndrome and its association with future cardiovascular events. The summary is:
1) The presentation discusses preclinical atherosclerosis, metabolic syndrome, and their ability to predict future cardiovascular events over long-term follow-up of patients.
2) Metabolic syndrome was found to double the risk of cardiovascular events over 20 years of follow-up compared to healthy patients.
3) Preclinical atherosclerosis detected by carotid ultrasound also independently predicted cardiovascular outcomes, with higher rates of events in patients showing thickening of carotid arteries.
Newer Approach in management of Angina & CHF: Heart rate modulation and beyond..Arindam Pande
1) A study evaluated the addition of ivabradine to metoprolol in patients with stable angina pectoris and found that it significantly reduced mean resting heart rate, weekly angina attacks, and use of short-acting nitrates over 4 months compared to baseline.
2) The mean heart rate fell by 19.7 bpm, weekly angina attacks decreased 8-fold, and quality of life scores increased with the combination therapy.
3) Heart rate reductions and clinical benefits were greater in patients who had higher baseline heart rates of 70 bpm or more.
Atorvastatin: Statins in CVD management. Is just lipid lowering enough Dr Vivek Baliga
This document discusses the benefits of statin drugs beyond their lipid-lowering effects. It summarizes several key studies that show statins reduce cardiovascular events in patients with diabetes or chronic kidney disease, even when baseline lipid levels are normal. The document highlights that atorvastatin and simvastatin have evidence from primary prevention trials of reducing cardiovascular outcomes in diabetes, whereas other statins do not. It also notes that atorvastatin seems to have greater renoprotective effects compared to rosuvastatin in diabetes patients with kidney disease and proteinuria.
1) The document summarizes the results of a large clinical trial testing the fixed-dose combination drug Preterax (perindopril and indapamide) for the treatment of type 2 diabetes patients.
2) The trial found that Preterax reduced the risk of cardiovascular mortality by 18%, total mortality by 14%, and the combined outcome of major macrovascular or microvascular events by 9% compared to placebo.
3) The beneficial effects of Preterax were consistent across patient subgroups and backgrounds in ancillary treatments.
a-comprehensive-approach-to-kidney-disease-and-hypertension by HazwanMohd Hanafi
This document discusses kidney disease and hypertension. It begins by outlining the key functions of the kidneys, including regulating blood pressure through the renin-angiotensin-aldosterone system. It then examines the causes and classifications of acute and chronic kidney disease. Chronic kidney disease is a growing problem due to its asymptomatic nature in early stages. The document reviews factors that can damage the kidneys and lead to reduced glomerular filtration rate. It also discusses how chronic kidney disease and reduced kidney function are linked to increased risk of cardiovascular disease, anemia, and bone disease like renal osteodystrophy. Hypertension is both a common cause and complication of chronic kidney disease. Tight blood pressure control is important to slow
The JUPITER trial was stopped early due to clear evidence of benefit from rosuvastatin treatment. The trial aimed to test whether rosuvastatin could reduce cardiovascular events in apparently healthy people with normal LDL cholesterol but high hsCRP. Over 17,000 participants were randomized to rosuvastatin 20mg or placebo. After almost 2 years, rosuvastatin showed a highly significant 44% reduction in the primary cardiovascular endpoint compared to placebo, demonstrating its benefit in primary prevention. This clear benefit led to the trial being stopped early.
- Statins may increase the risk of developing diabetes through pathways that reduce insulin sensitivity and insulin secretion. The JUPITER trial found a small increased risk of physician-reported diabetes with rosuvastatin use.
- Individual statins have variable effects on diabetes risk, with some studies finding atorvastatin and simvastatin association and others not finding rosuvastatin association. Higher intensity statin use was linked to greater diabetes risk than moderate-dose use.
- For patients with risk factors for both cardiovascular disease and diabetes, the cardiovascular benefits of statins often outweigh the risks of developing diabetes, but close monitoring of blood glucose is recommended. Risks and benefits should be weighed individually
This is a case of a 74-year-old woman with a history of myocardial infarction who presents for routine follow-up. Her current medications include a statin but her lipid levels are not at goal. The guidelines recommend an LDL goal of <55 mg/dL and at least a 50% reduction for very high risk patients like her. After increasing her statin and adding ezetimibe, her LDL decreased to 53 mg/dL but she had a transient ischemic attack. Additional treatment options to further lower her risk should be considered.
This document discusses several clinical studies that compare the effects of different statin drugs on cardiovascular outcomes and the progression of atherosclerosis. The STELLAR study showed that rosuvastatin more effectively lowered LDL-C and raised HDL-C than other statins. Two real-world studies found that rosuvastatin use was associated with a 28-40% lower risk of cardiovascular events compared to other statins. The METEOR study found that rosuvastatin slowed the progression of atherosclerosis whereas the ENHANCE study found that ezetimibe added to simvastatin provided no benefit.
Three cases of acute myocardial infarction are presented. All three patients had type 2 diabetes and other cardiovascular risk factors like hypertension and dyslipidemia. They presented with chest pain and ST-segment changes on electrocardiogram. All underwent emergency cardiac catheterization and had stents placed in obstructed coronary arteries. Strict control of blood sugar, blood pressure, and lipids is emphasized going forward to prevent further cardiovascular complications. The role of SGLT2 inhibitors in cardiovascular and renal protection for patients with diabetes is also discussed.
Hypertension and Diabetic Kidney Disease Progression Hypertension and Diabe...MedicineAndHealthUSA
Hypertension and diabetic kidney disease progression are linked, and reducing proteinuria is key to slowing kidney disease. The document discusses how conditions like hypertension and diabetes that cause kidney damage have increased in the US population. Landmark trials found that lowering blood pressure and proteinuria reduced kidney disease progression and cardiovascular risks. Initial therapy for kidney or diabetes patients should be an ACE inhibitor or ARB to target blood pressure under 130/80 mmHg.
This document discusses diabetic kidney disease and intensive glucose control. It begins with the author's conflicts of interest related to pharmaceutical companies. It then reviews several major studies on intensive glucose control including the DCCT, UKPDS, ADVANCE, ACCORD, and VADT trials. The studies showed reductions in microvascular complications with intensive control but mixed results for cardiovascular outcomes, with the ACCORD trial finding higher mortality in the intensive control group. Overall the document examines the evidence from major trials on benefits and risks of tight glycemic control.
The HOPE-3 trial found that combining treatment with rosuvastatin, candesartan, and hydrochlorothiazide reduced the risk of cardiovascular events by 29% compared to placebo in a population at intermediate cardiovascular risk. The combination therapy lowered LDL cholesterol by 33.7 mg/dL and systolic blood pressure by 6.2 mmHg on average over 5.6 years. It reduced the risk of the primary composite outcome of cardiovascular death, myocardial infarction, or stroke compared to placebo, with numbers needed to treat of 72 and 63 to prevent an event in the primary outcomes. Subgroup analyses suggested greater benefit for those with higher baseline blood pressure.
This document provides recommendations for evaluating and managing erectile dysfunction (ED) in patients with cardiovascular disease (CVD). It finds that ED often precedes CVD by 2-3 years and is associated with increased CVD risk and mortality. It recommends assessing all men with ED for CVD risk factors and stratifying risk. High risk patients should undergo stress testing. Lifestyle changes like weight loss and exercise can improve ED. Aggressive treatment of hypertension, diabetes and hyperlipidemia may also benefit ED patients. Managing cardiovascular health should take priority over initiating ED treatment. Phosphodiesterase 5 inhibitors are first-line ED therapy for most patients with CVD. Testosterone should be measured in all ED patients and supplementation may help ED in some
This document discusses cardiometabolic risk, which refers to the risks associated with metabolic changes that can lead to cardiovascular disease. It defines cardiometabolic risk and identifies both non-modifiable and modifiable risk factors such as obesity, dyslipidemia, hypertension, smoking, and physical inactivity. The document emphasizes the importance of early identification and management of risk factors through comprehensive patient assessment and targeted intervention to prevent diseases like cardiovascular disease and diabetes.
Management of CAD in Diabetes the cardiovascular equivalent is challenging.The slides take you from the epidemiology,ADD,and CV benefit and how to manage CAD
1) LDL-C levels are a major risk factor for acute coronary syndrome (ACS) and lowering LDL-C through intensive statin therapy leads to significant reductions in recurrent events and mortality after ACS.
2) Guidelines recommend initiating high-dose statins early for ACS patients and achieving an LDL-C reduction of at least 50% from baseline and an LDL-C level below 55 mg/dL to reduce risk.
3) Studies show high-dose rosuvastatin preloading before percutaneous coronary intervention (PCI) significantly reduces major adverse cardiac events and peri-procedural myocardial injury compared to no preloading or lower statin doses.
This document discusses treatment options after metformin for type 2 diabetes, comparing sulfonylureas and gliptins. It provides the following key points:
1. Sulfonylureas are more effective at reducing HbA1c levels and achieving glycemic control targets compared to gliptins. They lower HbA1c by 1-2% on average versus 0.5-1% for gliptins.
2. Studies show sulfonylureas may better preserve beta-cell function in the long-term compared to metformin or gliptins. They have been shown to enhance insulin secretion from beta and alpha cells.
3. While older studies linked sulfonylureas
Reduciendo eventos cardiovasculares en pacientes con DM2: nuevas evidencias
23/06/16 18:00h Casa del Corazón, Madrid
http://ecvdm2.secardiologia.es
#ECVDM2
Resultados de nuevos estudios: más allá de la no inferioridad
Dr. Luis Masmiquel Comas, Endocrinólogo. Hospital Son Llàtzer (Palma de Mallorca)
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
EMPA-REG: un punto de inflexión en el tratamiento de la diabetes
18/11/15 20:00h Casa del Corazón (Madrid)
http://empareg.secardiologia.es
#EMPAREG
Resultados del estudio EMPA-REG
Dr. Domingo Marzal Martín, Complejo Hospitalario de Mérida (Badajoz)
@domingomarzal
Syndrome metabolique et maladies vasculaires s novosfa_angeiologie
This document summarizes a presentation on detecting preclinical atherosclerosis and evaluating cardiovascular risk. It discusses the metabolic syndrome and its association with future cardiovascular events. The summary is:
1) The presentation discusses preclinical atherosclerosis, metabolic syndrome, and their ability to predict future cardiovascular events over long-term follow-up of patients.
2) Metabolic syndrome was found to double the risk of cardiovascular events over 20 years of follow-up compared to healthy patients.
3) Preclinical atherosclerosis detected by carotid ultrasound also independently predicted cardiovascular outcomes, with higher rates of events in patients showing thickening of carotid arteries.
Newer Approach in management of Angina & CHF: Heart rate modulation and beyond..Arindam Pande
1) A study evaluated the addition of ivabradine to metoprolol in patients with stable angina pectoris and found that it significantly reduced mean resting heart rate, weekly angina attacks, and use of short-acting nitrates over 4 months compared to baseline.
2) The mean heart rate fell by 19.7 bpm, weekly angina attacks decreased 8-fold, and quality of life scores increased with the combination therapy.
3) Heart rate reductions and clinical benefits were greater in patients who had higher baseline heart rates of 70 bpm or more.
Atorvastatin: Statins in CVD management. Is just lipid lowering enough Dr Vivek Baliga
This document discusses the benefits of statin drugs beyond their lipid-lowering effects. It summarizes several key studies that show statins reduce cardiovascular events in patients with diabetes or chronic kidney disease, even when baseline lipid levels are normal. The document highlights that atorvastatin and simvastatin have evidence from primary prevention trials of reducing cardiovascular outcomes in diabetes, whereas other statins do not. It also notes that atorvastatin seems to have greater renoprotective effects compared to rosuvastatin in diabetes patients with kidney disease and proteinuria.
1) The document summarizes the results of a large clinical trial testing the fixed-dose combination drug Preterax (perindopril and indapamide) for the treatment of type 2 diabetes patients.
2) The trial found that Preterax reduced the risk of cardiovascular mortality by 18%, total mortality by 14%, and the combined outcome of major macrovascular or microvascular events by 9% compared to placebo.
3) The beneficial effects of Preterax were consistent across patient subgroups and backgrounds in ancillary treatments.
a-comprehensive-approach-to-kidney-disease-and-hypertension by HazwanMohd Hanafi
This document discusses kidney disease and hypertension. It begins by outlining the key functions of the kidneys, including regulating blood pressure through the renin-angiotensin-aldosterone system. It then examines the causes and classifications of acute and chronic kidney disease. Chronic kidney disease is a growing problem due to its asymptomatic nature in early stages. The document reviews factors that can damage the kidneys and lead to reduced glomerular filtration rate. It also discusses how chronic kidney disease and reduced kidney function are linked to increased risk of cardiovascular disease, anemia, and bone disease like renal osteodystrophy. Hypertension is both a common cause and complication of chronic kidney disease. Tight blood pressure control is important to slow
The JUPITER trial was stopped early due to clear evidence of benefit from rosuvastatin treatment. The trial aimed to test whether rosuvastatin could reduce cardiovascular events in apparently healthy people with normal LDL cholesterol but high hsCRP. Over 17,000 participants were randomized to rosuvastatin 20mg or placebo. After almost 2 years, rosuvastatin showed a highly significant 44% reduction in the primary cardiovascular endpoint compared to placebo, demonstrating its benefit in primary prevention. This clear benefit led to the trial being stopped early.
- Statins may increase the risk of developing diabetes through pathways that reduce insulin sensitivity and insulin secretion. The JUPITER trial found a small increased risk of physician-reported diabetes with rosuvastatin use.
- Individual statins have variable effects on diabetes risk, with some studies finding atorvastatin and simvastatin association and others not finding rosuvastatin association. Higher intensity statin use was linked to greater diabetes risk than moderate-dose use.
- For patients with risk factors for both cardiovascular disease and diabetes, the cardiovascular benefits of statins often outweigh the risks of developing diabetes, but close monitoring of blood glucose is recommended. Risks and benefits should be weighed individually
This is a case of a 74-year-old woman with a history of myocardial infarction who presents for routine follow-up. Her current medications include a statin but her lipid levels are not at goal. The guidelines recommend an LDL goal of <55 mg/dL and at least a 50% reduction for very high risk patients like her. After increasing her statin and adding ezetimibe, her LDL decreased to 53 mg/dL but she had a transient ischemic attack. Additional treatment options to further lower her risk should be considered.
This document discusses several clinical studies that compare the effects of different statin drugs on cardiovascular outcomes and the progression of atherosclerosis. The STELLAR study showed that rosuvastatin more effectively lowered LDL-C and raised HDL-C than other statins. Two real-world studies found that rosuvastatin use was associated with a 28-40% lower risk of cardiovascular events compared to other statins. The METEOR study found that rosuvastatin slowed the progression of atherosclerosis whereas the ENHANCE study found that ezetimibe added to simvastatin provided no benefit.
Three cases of acute myocardial infarction are presented. All three patients had type 2 diabetes and other cardiovascular risk factors like hypertension and dyslipidemia. They presented with chest pain and ST-segment changes on electrocardiogram. All underwent emergency cardiac catheterization and had stents placed in obstructed coronary arteries. Strict control of blood sugar, blood pressure, and lipids is emphasized going forward to prevent further cardiovascular complications. The role of SGLT2 inhibitors in cardiovascular and renal protection for patients with diabetes is also discussed.
Hypertension and Diabetic Kidney Disease Progression Hypertension and Diabe...MedicineAndHealthUSA
Hypertension and diabetic kidney disease progression are linked, and reducing proteinuria is key to slowing kidney disease. The document discusses how conditions like hypertension and diabetes that cause kidney damage have increased in the US population. Landmark trials found that lowering blood pressure and proteinuria reduced kidney disease progression and cardiovascular risks. Initial therapy for kidney or diabetes patients should be an ACE inhibitor or ARB to target blood pressure under 130/80 mmHg.
This document discusses diabetic kidney disease and intensive glucose control. It begins with the author's conflicts of interest related to pharmaceutical companies. It then reviews several major studies on intensive glucose control including the DCCT, UKPDS, ADVANCE, ACCORD, and VADT trials. The studies showed reductions in microvascular complications with intensive control but mixed results for cardiovascular outcomes, with the ACCORD trial finding higher mortality in the intensive control group. Overall the document examines the evidence from major trials on benefits and risks of tight glycemic control.
The HOPE-3 trial found that combining treatment with rosuvastatin, candesartan, and hydrochlorothiazide reduced the risk of cardiovascular events by 29% compared to placebo in a population at intermediate cardiovascular risk. The combination therapy lowered LDL cholesterol by 33.7 mg/dL and systolic blood pressure by 6.2 mmHg on average over 5.6 years. It reduced the risk of the primary composite outcome of cardiovascular death, myocardial infarction, or stroke compared to placebo, with numbers needed to treat of 72 and 63 to prevent an event in the primary outcomes. Subgroup analyses suggested greater benefit for those with higher baseline blood pressure.
This document provides recommendations for evaluating and managing erectile dysfunction (ED) in patients with cardiovascular disease (CVD). It finds that ED often precedes CVD by 2-3 years and is associated with increased CVD risk and mortality. It recommends assessing all men with ED for CVD risk factors and stratifying risk. High risk patients should undergo stress testing. Lifestyle changes like weight loss and exercise can improve ED. Aggressive treatment of hypertension, diabetes and hyperlipidemia may also benefit ED patients. Managing cardiovascular health should take priority over initiating ED treatment. Phosphodiesterase 5 inhibitors are first-line ED therapy for most patients with CVD. Testosterone should be measured in all ED patients and supplementation may help ED in some
This document discusses cardiometabolic risk, which refers to the risks associated with metabolic changes that can lead to cardiovascular disease. It defines cardiometabolic risk and identifies both non-modifiable and modifiable risk factors such as obesity, dyslipidemia, hypertension, smoking, and physical inactivity. The document emphasizes the importance of early identification and management of risk factors through comprehensive patient assessment and targeted intervention to prevent diseases like cardiovascular disease and diabetes.
1) Prediabetes is a condition where blood sugar levels are higher than normal but not high enough for a diagnosis of diabetes. It affects an estimated 14% of people in India and 9.9-25% of people in other countries.
2) Lifestyle changes like diet modification, increased physical activity, weight loss and smoking cessation can help prevent or delay progression from prediabetes to diabetes. Medications like metformin have also shown effectiveness.
3) People with prediabetes have an increased risk of cardiovascular diseases like heart attack and stroke, even at blood sugar levels below the prediabetes threshold. Intensive lifestyle interventions or metformin treatment can significantly reduce risk of developing diabetes.
1) Exenatide once weekly (QW), also known as Bydureon, provides glycemic control through reductions in HbA1c of 1.3-1.9% over 24-30 weeks according to clinical trials.
2) Head-to-head trials show Exenatide QW results in similar or greater HbA1c reductions and more weight loss compared to other GLP-1 receptor agonists such as liraglutide.
3) Exenatide QW has been shown to maintain glycemic control over the long term with reductions in HbA1c of 1.5% maintained out to 6 years, along with significant and sustained weight loss from
A 52-year-old man with type 2 diabetes of 8 years was uncontrolled on insulin therapy and gaining weight. He was obese, had hypertension and dyslipidemia. Dapagliflozin was added to his insulin regimen while reducing his insulin dose by 25%. This led to reductions in his HbA1c, weight, blood pressure, and lipid levels over 6 months of follow up while preventing further increases to his insulin needs. Dapagliflozin provided glycemic control and weight loss without increasing hypoglycemia risk for this patient with multiple comorbidities.
Ueda 2016 2-pathophysiology ,classification & diagnosis of diabetes - kha...ueda2015
This document outlines an agenda and presentation on the pathophysiology, screening, diagnosis and classification of diabetes given at a mini-course in Aswan, Egypt in February 2016. The presentation covers:
1. The normal physiology and definition of diabetes and its chronic hyperglycemia-related complications.
2. The clinical classes of diabetes including type 1, type 2, gestational diabetes and other specific types.
3. The pathophysiology, risk factors, screening and diagnosis of type 1, type 2 and gestational diabetes are discussed in further detail.
4. The goals of the course are to help participants in advance of an upcoming conference on diabetes.
weight loss Overview, causes and risk pdfYutchayxx
The document discusses four weight loss medications - phentermine, orlistat, lorcaserin, and liraglutide. It provides information on the mechanism of action, indications, dosing, warnings, contraindications, adverse effects, and clinical efficacy for each medication based on data from prescribing information and clinical trials. The summaries highlight that phentermine is a sympathomimetic amine used short-term to enhance weight loss from diet and exercise, orlistat is a gastrointestinal lipase inhibitor that works by blocking fat absorption, and lorcaserin is a serotonin receptor agonist shown to promote weight loss and reduce cardiometabolic risk factors and diabetes incidence over 1-2 years of treatment
The Role of SGLT 2 Inhibitors and GLP 1 Receptor Agonists and DPP 4 InhibitorsPHAM HUU THAI
This document discusses the role of SGLT-2 inhibitors, GLP-1 receptor agonists, and DPP-4 inhibitors in managing type 2 diabetes. It provides background on the pathophysiology and progression of type 2 diabetes and limitations of older drug classes. It then describes the mechanisms and roles of the newer drug classes like SGLT-2 inhibitors in promoting urinary glucose excretion and GLP-1 agonists and DPP-4 inhibitors in augmenting the body's own incretin response. It also discusses ongoing cardiovascular outcome trials and FDA approvals of these newer agents.
Materi Workshop Diabetes Melitus untuk Dokter Umum - Practical Management of ...Dayu Agung Dewi Sawitri
Materi Workshop Diabetes Melitus untuk Dokter Umum - Practical Management of Diabetes and Its Complication for General Practitioner.
Diselenggarakan oleh Perkeni, Kementerian Kesehatan RI dan STENO Diabetes Center
Early Treatment to Manage Hyperglycemia: Do We Have Enough Option Dr olly tr...Suharti Wairagya
This document discusses early treatment options for managing hyperglycemia in type 2 diabetes. It begins by outlining the symptoms, signs, and diagnostic criteria for diabetes. It then discusses the pathophysiology of type 2 diabetes, focusing on pancreatic beta cell dysfunction and insulin resistance over time. The document examines various oral medications for managing blood glucose levels, including their mechanisms of action, efficacy, safety profiles, and rationale for combination therapy. It emphasizes that the ideal treatment would address all key aspects of disease progression like glucose control, weight, cardiovascular risk, and beta cell function while minimizing hypoglycemia.
This document summarizes findings from several studies related to cardiovascular protection in type 2 diabetes patients. It begins by noting that atherosclerosis and diabetes often have common antecedents. A framingham offspring study found that 2/3 of diabetes patients have subclinical cardiovascular disease, which increases their cardiovascular risk 4-fold. Another study found that 66-74% of asymptomatic South Asian type 2 diabetes patients have coronary artery disease. The document then notes that subclinical cardiovascular disease affects over 2/3 of diabetes patients, and that cardiovascular complications form a progressive continuum in type 2 diabetes, with heart failure developing early. It reviews findings on cardiovascular risk prior to diabetes diagnosis and the cardiovascular risk continuum in dysglycemia. The document discusses challenges with long
This document discusses treatment of type 1 diabetes (T1D). The goals of T1D management are near-normal blood glucose and A1C levels while preventing complications. Routine care recommendations include regular checkups, testing, and screenings. Intensive insulin therapy aimed at an A1C below 7% has been shown to significantly reduce risks of complications, though it carries a higher risk of hypoglycemia. New insulin analogues, insulin pumps, home glucose monitoring, and continuous glucose monitoring have advanced T1D treatment. The basal-bolus insulin regimen uses a basal insulin to maintain blood glucose levels between meals combined with bolus insulins before meals.
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2) Modifiable risk factors associated with metabolic syndrome like abdominal obesity, elevated blood pressure, high blood glucose, high triglycerides and low HDL cholesterol can be addressed through lifestyle modifications to reduce the risk of chronic diseases.
3) Simple lifestyle changes like following a healthy diet low in salt and high in potassium, engaging in regular physical activity, avoiding smoking and excessive alcohol, and managing stress can help control chronic conditions and may have similar benefits as medications.
This document discusses the use of SGLT2 inhibitors (SGLT2i) in managing diabetes. It presents three case studies of patients with diabetes and cardiovascular complications who may benefit from SGLT2i treatment. It summarizes clinical trial data showing that empagliflozin lowers HbA1c, fasting plasma glucose, body weight, and blood pressure compared to other antidiabetic drugs. Empagliflozin also reduces visceral and subcutaneous fat. The document concludes that SGLT2i like empagliflozin provide glycemic control and cardiovascular benefits and can be considered as an addition to metformin for treating diabetes.
This document summarizes a teleconference on diabetes and metabolic syndrome in patients hospitalized with cardiovascular disease. It discusses screening for diabetes and metabolic syndrome in hospitalized CVD patients, defines metabolic syndrome, reviews the prevalence and risk factors associated with it, and how metabolic syndrome predicts diabetes and increased cardiovascular risk. It also reviews inpatient management of hyperglycemia and metabolic syndrome.
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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- 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
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1. CÁC GIẢI PHÁP KIỂM SOÁT ĐƯỜNG HUYẾT TRÊN
NGƯỜI TIỀN ĐÁI THÁO ĐƯỜNG
QUA CÁC NGHIÊN CỨU
TS LÂM VĂN HOÀNG BVCR
2. NỘI DUNG
• DỊCH TỄ TIỀN ĐÁI THÁO ĐƯỜNG
• ĐINH NGHĨA TIỀN ĐÁI THÁO ĐƯỜNG
• HẬU QUẢ CỦA RỐI LOẠN ĐƯỜNG HUYẾT
• CÁC NGHIÊN CỨU TRONG KIỂM SOÁT ĐƯỜNG
HUYẾT TIỀN ĐÁI THÁO ĐƯỜNG
• KẾT LUẬN
3.
4.
5. Adapted from:
American Diabetes Association. Diabetes Care. 2014;37 Suppl 1:S81-90.
Normal
Diabetes Mellitus
Prediabetes
Impaired Glucose
Tolerance
Fasting Plasma
Glucose
126 mg/dL
2-hour Plasma
Glucose On OGTT
200 mg/dL
140 mg/dL
Any abnormality must be repeated and confirmed on a separate day
The diagnosis of diabetes can also be made based on unequivocal symptoms and a random glucose >200 mg/dL
100 mg/dL
Prediabetes
Impaired Fasting
Glucose
TIỀN ĐÁI THÁO ĐƯỜNG LÀ GÌ ?
Normal
Diabetes Mellitus
Hemoglobin A1C
6.5%
5.7%
Prediabetes
Normal
Diabetes Mellitus
6. Prevalence of Prediabetes in
Children/Adolescents in the U.S.
Li C, et al. Diabetes Care. 2009;32:342-347.
8. TẦM SOÁT ĐỐI TƯỢNG NGUY CƠ
• Xem xét test ở người lớn với BMI* ≥25
kg/m2 và có yếu tố nguy cơ
– Nếu không có yếu tố nguy cơ, xem
xét tầm soát sau tuổi 45
• Kết quả nệu bình thương, làm lai sau 2-3
năm
– Thương xuyên hơn phụ thuộc vào
kết quả test lần đầu và yếu tố nguy
cơ
– Xét nghiên lại hàng năm nếu tiền đái
tháo đường
Yếu tố nguy cơ
●Ít hoạt động thể lực
●Có bà con trực hệ bì đái tháo
đường
● chủng tộc sắc tộc c1 nguy cơ cao
● phụ nữ sinh con > 4kg , hay đái
tháo đường thai kỳ
● cao huyết áp hay đang điều trị
●HDL-C <35 mg/dL and/or a
TG >250 mg/dL
●A1C ≥5.7%, IGT, or IFG on
previous testing
● các tình trạng lâm sàng khác kết
hợp tăng đề kháng insulin như :
obesity, acanthosis nigricans, PCOS
● tiền căn bệnh lý tim mạch
Adapted from:
American Diabetes Association. Testing for Diabetes in Asymptomatic Patients.
Diabetes Care. 2014;37(suppl 1):S17; Table 4
*At-risk BMI may be lower in some ethnic groups
9. CÁC YẾU TỐ NGUY CƠ CỦA TIỀN ĐÁI THÁO ĐƯỜNG
VÀ ĐÁI THÁO ĐƯỜNG VỚI BỆNH LÝ TIM MẠCH
American Diabetes Association. Diabetes Care. 2014:37:S14-80.
KHÔNG CAN THIỆP ĐƯỢC
Age
Race/Ethnicity
Gender
Family history
CÓ THỂ CAN THIỆP ĐƯỢC
Physical inactivity
Overweight/Obesity
Hypertension
Smoking
Abnormal lipid metabolism
High plasma glucose levels
10. CÁC NGHIÊN CỨU CAN THIỆP
THAY ĐỔI LỐI SỐNG PHÒNG NGỪA ĐÁI
THÁO ĐƯỜNG
10
11. Study Country N
Baseline
BMI
(kg/m2)
Intervention
period
(years)
RRR
(%) NNT
Diabetes
Prevention
Program
USA 3234 34.0 2.8 58 21
Diabetes
Prevention
Study
Finland 523 31 4 39 22
Da Qing China 577 25.8 6 51 30
NNT, number needed to treat; RRR, relative risk reduction; T2D, type 2 diabetes.
DPP Research Group. N Engl J Med. 2002;346:393-403. Eriksson J, et al. Diabetologia. 1999;42:793-801.
Li G, et al. Lancet. 2008;371:1783-1789. Lindstrom J, et al. Lancet. 2006;368:1673-1679.
CÁC NGHIÊN CỨU THAY ĐỔI LÔI
SỐNG
11
12. 4.8
7.8
11
0
2
4
6
8
10
12
CAN THỆP TÍCH CỰC THAY ĐỔI LỐI SỐNG
NGĂN NGỪA TIẾN TTRIỂN TỬ IGT ĐẾN T2D
12
Intensive lifestyle
intervention*
(n=1079)
DiabetesIncidence
per100Person-Years
Placebo
(n=1082)
Metformin
850mg BID
(n=1073)
Diabetes Prevention Program
(N=3234)
58%
31%
*Goal: 7% reduction in baseline body weight through low-calorie, low-fat diet and ≥150 min/week moderate intensity exercise .
IGT, impaired glucose tolerance; T2D, type 2 diabetes.
DPP Research Group. N Engl J Med. 2002;346:393-403.
13. 11.6
10.8 10.8
6.7
7.6
9.6
6.2
4.7
3.1
0
2
4
6
8
10
12
14
25-44 45-59 ≥60
Placebo
Metformin
Lifestyle
CAN THIỆP LỐI SỐNG HIỆU QUẢ TRONG
CÁC NHÓM DÂN SỐ
DiabetesIncidence
per100Person-Years
Diabetes Prevention Program
(N=3234)
Age (years)
*Goal: 7% reduction in baseline body weight through low-calorie, low-fat diet and ≥150 min/week moderate intensity exercise .
DPP Research Group. N Engl J Med. 2002;346:393-403.
48%
59%
71%
13
14. 9 8.9
14.3
8.8
7.6
7.0
3.3 3.7
7.3
0
2
4
6
8
10
12
14
16
22 to <30 30 to <35 ≥35
Placebo
Metformin
Lifestyle
HIỆU QUẢ CAN THIỆP LỐI SỐNG
TRÊN CÂN NẶNG
DiabetesIncidence
per100Person-Years
Diabetes Prevention Program
(N=3234)
65%
BMI (kg/m2)
51%
61%
*Goal: 7% reduction in baseline body weight through low-calorie, low-fat diet and ≥150 min/week moderate intensity exercise .
DPP Research Group. N Engl J Med. 2002;346:393-403. 14
15. DUY TRI ỔN ĐỊNH GIẢM CÂN
DPP, Diabetes Prevention Program; T2D, type 2 diabetes.
DPP Research Group. Lancet. 2009;374:1677-1686.
10 32 54 76 8 109
Years
15
DPP Outcomes Study
(N=2766)
16. 10 32 54 76 8 109
Placebo
Metformin
Lifestyle
Years
KẾT QUẢ SAU 10-NĂM TẦN SUẤT T2D
16
DPP, Diabetes Prevention Program; T2D, type 2 diabetes.
DPP Research Group. Lancet. 2009;374:1677-1686.
DPP Outcomes Study
(N=2766)
17. KẾT QUẢ SAU 10-NĂM TẦN SUẤT T2D
17
DPP, Diabetes Prevention Program; DPPOS, Diabetes Prevention Program Outcomes Study; T2D, type 2 diabetes.
DPP Research Group. Lancet. 2009;374:1677-1686.
DPP Outcomes Study
18. HIỆU QUẢ CỦA THAY ĐỔI LỐI SỐNG TRÊN
CÂN NẶNG VÀ HUYẾT ÁP
DBP, diastolic blood pressure; SBP, systolic blood pressure.
Tuomilehto J, et al. N Engl J Med. 2001;344:1343-1350.
Changefrombaseline
P<0.001 P<0.001
P=0.007 P=0.02
18
-6
-5
-4
-3
-2
-1
0
Weight (kg) Waist (cm) SBP (mm Hg) DBP (mm Hg)
Control (n=250) Diet intervention (n=256)
The Finnish Diabetes Prevention Study
19. Effect of Lifestyle Modification on
Glucose in Patients with IGT
IGT, impaired glucose tolerance.
Tuomilehto J, et al. N Engl J Med. 2001;344:1343-1350. 19
Changefrombaseline
P<0.001
P=0.003
P=0.001
(mg/dL) (mg/dL) (mg/mL) (g/mL)
-40
-30
-20
-10
0
10
FPG 2-h PG Fasting insulin 2-h insulin
Control (n=250) Diet intervention (n=256)
The Finnish Diabetes Prevention Study
20. 78
32
0
20
40
60
80
Control (n=250) Diet intervention (n=256)
TẦN SUẤT ĐÁI THÁO ĐƯỜNG TRÊN 4 NĂM
20
Incidenceofdiabetes
(cases/1000person-years)
DBP, diastolic blood pressure; SBP, systolic blood pressure.
Tuomilehto J, et al. N Engl J Med. 2001;344:1343-1350.
58%
The Finnish Diabetes Prevention Study
21. NGHIẾN CỨU TRÊN NHÓM CHÂU Á VỚI IGTPatientswithT2DatYear6(%)
IGT, impaired glucose tolerance; T2D, type 2 diabetes.
Pan XR, et al. Diabetes Care. 1997;20:537-544.
65.9
47.1 44.2 44.6
60
38.2
26.3
34.8
72.3
48
51.2 52.5
0
10
20
30
40
50
60
70
80
90
100
Control Diet Exercise Diet + Exercise
Total Lean Overweight
Da Qing Diabetes Prevention Study
(N=577)
21
22. TẦN SUẤT SAU 20 NĂM Ở NHÓM DÂN
CHÂU Á VỚI IGT
22
Da Qing Diabetes Prevention Study
IGT, impaired glucose tolerance; T2D, type 2 diabetes.
Li G, et al. Lancet. 2008;371:1783-1789.
23. TỬ VONG DO MỌI NGUYÊN NHÂN SAU 23
NĂM TRONG NHÓM NGHIÊN CỨU
Da Qing Diabetes Prevention Study
IGT, impaired glucose tolerance.
Li G, et al. Lancet Diabetes Endocrinol. 2014;2:474-478. 23
24. 23-Year Cardiovascular Mortality
in Asian Patients with IGT
IGT, impaired glucose tolerance.
Li G, et al. Lancet Diabetes Endocrinol. 2014;2:474-478.
Da Qing Diabetes Prevention Study
24
25. TẦN SUẤT ĐÁI THÁO ĐƯỜNG SAU 23 NĂM
IGT, impaired glucose tolerance; T2D, type 2 diabetes.
Li G, et al. Lancet Diabetes Endocrinol. 2014;2:474-478.
Da Qing Diabetes Prevention Study
25
27. CÁC NGHIÊN CỨU CAN THIỆP THUỐC VÀ
NGOẠI KHOA
Intervention Follow-up Period
Reduction in Risk of T2D
(P value vs placebo)
Antihyperglycemic agents
Metformin1 2.8 years 31% (P<0.001)
Acarbose2 3.3 years 25% (P=0.0015)
Pioglitazone3 2.4 years 72% (P<0.001)
Rosiglitazone4 3.0 years 60% (P<0.0001)
Weight loss interventions
Orlistat5 4 years 37% (P=0.0032)
Phentermine/topiramate6 2 years 79% (P<0.05)
Bariatric surgery7 10 years 75% (P<0.001)
27
T2D, type 2 diabetes.
1. DPP Research Group. N Engl J Med. 2002;346:393-403. 2. STOP-NIDDM Trial Research Group. Lancet. 2002;359:2072-2077.
3. Defronzo RA, et al. N Engl J Med. 2011;364:1104-15. 4. DREAM Trial Investigators. Lancet. 2006;368:1096-1105.
5. Torgerson JS, et al. Diabetes Care. 2004;27:155-161. 6. Garvey WT, et al. Diabetes Care. 2014;37:912-921.
7. Sjostrom L, et al. N Engl J Med. 2004;351:2683-2693.
28. HIỆU QUẢ CỦA METFORMIN TRÊN TIẾN
TRIỂN CỦA IGT THÀNH T2D
28
IncidenceofDiabetes(%/yr)
Control Metformin
The Chinese Prevention Study
(N=321)
IGT, impaired glucose tolerance; RRR, relative risk reduction.
Yang W, et al. Chin J Endocrinol Metab. 2001;17:131-136.
11.6
4.1
0
2
4
6
8
10
12
14
65%
29. HIỆU QUẢ CỦA CAN THIỆP LỐI SỐNG VÀ
METFORMIN TRÊN TẦN SUẤT MẮC T2D
29
3-yCumulativeIncidence(%)
Control
(n=136)
DPP, Diabetes Prevention Program; LSM, lifestyle modification; MET, metformin; RRR, relative risk reduction.
Ramachandran A, et al. Diabetologia. 2006;49:289-297.
The Indian DPP
(N=531)
55.0
39.3 40.5 39.5
0
10
20
30
40
50
60
Lifestyle
Modification
(n=133)
Metformin
(n=133)
Lifestyle
Modification
+ Metformin
(n=129)
29%
P=0.02
26%
P=0.03
28%
P=0.02
30. Effect of Acarbose on
Reversion of IGT to NGT
30.9
35.3
0
5
10
15
20
25
30
35
40
P<0.0001
Placebo
(n=715)
Acarbose
(n=714)
Patients(%)
IGT, impaired glucose tolerance; NGT, normal glucose tolerance; STOP-NIDDM, Study to Prevent Non-Insulin Dependent Diabetes Mellitus.
Chiasson JL, et al. Lancet. 2002;359:2072-2077.
STOP-NIDDM
30
31. HIỆU QUẢ CỦA Rosiglitazone TRÊN
ĐÁI THÁO ĐƯỜNG MỚI
DREAM, Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication.
DREAM Trial Investigators. Lancet. 2006;368:1096-1105.
No. at risk
Placebo
Rosiglitazone
2634
2635
2470
2538
2150
2414
1148
1310
177
217
0.6
0.5
0 1 2 3 4
Follow-up (years)
0.4
0.3
0.2
0.1
0.0
Placebo
Cumulative
hazardrate
Rosiglitazone
60%
31
DREAM
32. HIỆU QUẢ Pioglitazone KIỂM SOÁT
DIỄN TIẾN T2D VỚI IGT
ACT NOW, Actos Now for the Prevention of Diabetes; IGT, impaired glucose tolerance; T2D, type 2 diabetes.
Defronzo RA, et al. N Engl J Med. 2011;364:1104-1115.
ACT NOW
32
Kaplan-Meier plot of Hazard Ratios for Time
to Development of T2D
33. HIỆU QUẢ Exenatide VÀ CAN THIỆP LỐI SỐNG
TRÊN BỆNH NHÂN THỪA CÂN CÓ HAY KHÔNG CÓ
TIỀN ĐÁI THÁO ĐƯỜNG
• NGHIÊN CỨU TRÊN
– N=152, weight 108.6 +/- 23.0 kg, BMI 39.6 +/- 7.0 kg/m2 (IGT
or IFG 25%)
• THIẾT KẾ
– 24-week randomized controlled trial: exenatide or placebo
plus lifestyle intervention
• KẾT QUẢ :
– Exenatide-treated patients lost 5.1 kg from baseline vs 1.6 kg with
placebo (P<0.001)
– Both groups reduced their daily caloric intake
– IGT or IFG normalized at end point in 77% and 56% of exenatide
and placebo subjects, respectively
BMI, body mass index; IFG, impaired fasting glucose; IGT, impaired glucose tolerance.
Rosenstock J, et al. Diabetes Care. 2010;33:1173-1175. 33
34. Effect of Lorcaserin on Body Weight
in Obese Adults Over 2 Years
Smith SR, et al. N Engl J Med. 2010;363:245-256.
BLOOM Study
34
35. Effect of Lorcaserin on Progression
to T2D
0
1
2
3
4
5
Placebo Lorcaserin
P=0.003
PatientswithA1C≥6.5%(%)
Proportion of BLOOM and BLOSSOM Patients
With Newly Diagnosed Diabetes After 52 Weeks of Treatment
T2D, type 2 diabetes.
Lorcaserin hydrochloride briefing document for FDA Advisory Committee. Woodcliff Lake, NJ: Eisai Inc.; 2012. Available at:
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/Drugs/EndocrinologicandMetabolicDrugsAdvisoryC
ommittee/UCM303200.pdf. 35
36. Effect of Lorcaserin on
Cardiometabolic Risk Markers
Risk Factors
(Mean % Weight Loss)
Lorcaserin 10
mg
(5.8%) P value*
Systolic BP, mmHg -1.4 0.04
Diastolic BP, mmHg -1.1 0.01
Triglycerides, % -6.15 <0.001
Total cholesterol, % -0.90 0.001
LDL-C, % 2.87 0.049
HDL-C, % 0.05 NS
hsCRP, mg/L -1.19 <0.001
Fibrinogen, mg/dL -21.5 0.001
*P values represent comparisons to placebo.
Intent to treat, last observation carried forward analysis for total study population.
Smith SR, et al. N Engl J Med. 2010;363:245-256.
BLOOM Study
36
37. SEQUEL ExtensionCONQUER Trial
Effect of Phentermine/Topiramate ER on
Weight Loss in Obese Adults Over 2
Years
Data are shown with mean (95% CI).
Phen/TPM ER, phentermine/topiramate extended release.
Garvey WT, et al. Am J Clin Nutr. 2012;95:297-308.
SEQUEL Study
(Completer Analysis)
Placebo Phen/TPM ER 7.5/46 Phen/TPM ER 15/92
LSmeanweightloss(%)
-2
-4
-6
-8
-10
-12
-14
-16
0 12 20 92
0
Weeks
28 36 44 52 60 68 76 84 100 108 LOCF
Placebo n: 227 227 227 208 197 227
Phen/TPM 7.5/46 n: 153 152 153 137 129 153
Phen/TPM 15/92 n: 295 295 295 268 248 295
37
38. Effects of Phentermine/Topiramate ER on
Glucose, Insulin, and Progression to T2D
Glucose and Insulin
*P≤0.005 vs placebo.
NS, not significant; Phen/TPM ER, phentermine/topiramate extended release; T2D, type 2 diabetes.
Garvey WT, et al. Am J Clin Nutr. 2012;95:297-308.
*
*
*
*
*
Placebo Phen/TPM ER 7.5/46 mg Phen/TPM ER 15/92 mg
SEQUEL Study
(N=675)
3.7
1.7
0.9
0
0.5
1
1.5
2
2.5
3
3.5
4
Placebo Phen/TPM CR
7.5/46 mg
Phen/TPM CR
15/92 mg
Progressorsperyear(%)
Annualized Incidence of T2D
76%
54%
P=0.008
P=NS
0
-7.2
-3.6
-10.8
-5.4
-18
-25
-15
-5
5
Fasting 2-h OGTT
Glucose
(mg/dL)
-18
-157
-39
-264
-37
-327-400
-300
-200
-100
0
Insulin
(pmol/L)
38
39. Effects of Phentermine/Topiramate ER in
Patients at High Risk of Developing T2D
*All groups had lifestyle intervention.
NS, not significant; Phen/TPM ER, phentermine/topiramate extended release; T2D, type 2 diabetes.
Garvey WT, et al. Diabetes Care. 2014;37:912-921.
SEQUEL Prediabetes/Metabolic Syndrome Cohort
(N=475)
3.5
6.4
1.8
1.5
0.4
1.3
0
1
2
3
4
5
6
7
89%
49%
Annualizedincidence
rateofT2D
Prediabetes
(n=316)
Metabolic syndrome
(n=451)
80%77%
P=0.013
P=NS
P<0.001P=0.009
Placebo* Phen/TPM ER 7.5/46 mg* Phen/TPM ER 15/92 mg*
39
40. Relationship Between Weight Loss and
Prevention of Type 2 Diabetes
ITT, intent to treat; LOCF, last observation carried forward.
Garvey WT, et al. Diabetes Care. 2014;37:912-921.
SEQUEL Prediabetes/Metabolic Syndrome Cohort
(N=475)
40
0
1
2
3
4
5
6
7
8
<5 ≥5 to <10 ≥10 to <15 ≥15
Magnitude of Weight Loss (%)
Annualizedincidence
rateofT2D
ITT-LOCF Analysis
41. Effect of Phentermine/Topiramate
ER on Cardiometabolic Risk Markers
Risk Factors
(Mean % Weight
Loss)
Phentermine/
Topiramate ER
7.5/46 mg
(8.4%) P value*
Phentermine/
Topiramate ER
15/92 mg
(10.4%) P value*
Systolic BP, mmHg -4.7 0.0008 -5.6 <0.0001
Diastolic BP, mmHg -3.4 NS -3.8 0.0031
Triglycerides, % -8.6 <0.0001 -10.6 <0.0001
Total cholesterol, % -4.9 0.0345 -6.3 <0.0001
LDL-C, % -3.7 NS -6.9 0.0069
HDL-C, % 5.2 <0.0001 6.8 <0.0001
hsCRP, mg/L -2.49 <0.0001 -2.49 <0.0001
Adiponectin, g/mL 1.40 <0.0001 2.08 <0.0001
*P values represent comparisons to placebo.
Intent to treat, last observation carried forward analysis for total study population.
Gadde KM, et al. Lancet. 2011;377:1341-1352.
CONQUER Study
41
42. Effects of Liraglutide and Orlistat on
Body Weight Over 2 Years
Astrup A, et al. Int J Obes (Lond). 2012;36:843-854
Weight(kg)
42
43. Effects of Liraglutide in Obese Patients
with Prediabetes
*P<0.001 vs placebo.
Pi-Sunyer X, et al. N Engl J Med. 2015;373:11-22.
Liraglutide 3 mg Placebo
SCALE Obesity and Prediabetes
(N=3731)
7.2
30.8
20.7
67.3
0
10
20
30
40
50
60
70
80
Weight(kg)
Normoglycemia
at screening
Patients with Prediabetes After
56 Weeks
Patients(%)
Prediabetes at
screening
-8.4
-2.8
-10
-8
-6
-4
-2
0
Weight Change After 56 Weeks
*
*
*
43
44. Effect of Bariatric Surgery on
Incidence of Type 2 Diabetes
44Carlsson LM, et al. N Engl J Med. 2012;367:695-704.
Swedish Obesity Study
45. Effect of Different Bariatric Surgeries on
Weight-Related Comorbidities at 1 Year
*Small numbers of patients with 1 year of follow-up for all comorbidities (n≤38).
†P<0.05 vs LAGB; ‡P<0.05 vs LRYGB.
ACS, American College of Surgeons; BMI, body mass index; GERD, gastroesophageal reflux disease; LAGB, laparoscopic adjustable
gastric band; LSG, laparoscopic sleeve gastrectomy; LRYGB, laparoscopic Roux-en-Y gastric bypass.
Hutter MM, et al. Ann Surg. 2011;254:410-420.
44 44
33
38
64
55
68
35
62
50
83
79
66 66
70
0
10
20
30
40
50
60
70
80
90
Diabetes Hypertension Hyperlipidemia Sleep apnea GERD
LAGB LSG* LRYGB
ACS Bariatric Surgery Center Network
Prospective Observational Study
(N=28,616)
Patientswithresolutionor
improvementofcondition(%)
‡
†
‡
†
‡
45
46. TÓM LẠI
46
• TIỀN ĐÁI THÁO ĐƯỜNG TỶ LỆ CAO, CẦN PHÁTHIỆN SỚM
• CAN THIỆP LỐI SỐNG CHỨNG MINH HIỆU QUẢ
• CÁC NGHIÊN CỨU THUỐC CÓ VAI TRÒ CHẬM DIỄN TIÊN
MẮC BỆNH ĐÁI THÁO ĐƯỞNG