This document discusses the metabolic syndrome and its relationship to cardiovascular risk. It begins with an overview of type 2 diabetes as a progressive disease driven by insulin resistance and declining beta cell function. It then discusses how insulin resistance, hyperinsulinemia, hypertension, dyslipidemia and other factors associated with the metabolic syndrome contribute to increased cardiovascular risk in those with type 2 diabetes or prediabetes. The document reviews various criteria and definitions for diagnosing the metabolic syndrome, and discusses the prevalence of the metabolic syndrome in the United States. It also summarizes several studies examining the predictive value of the metabolic syndrome for future diabetes and cardiovascular disease.
http://www.lotusholisticmedicine.com - Type 2 diabetes is mainly the result of insulin resistance. It has been scientifically proven that by eating the right food, diabetes can not only be prevented but also effectively reversed.
http://www.our-diabetic-life.com Intake of large amount of carbohydrates can spike your blood glucose level. Right amount of carbohydrate can make your glucose level under control.
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A presentation on the care of diabetes in elderly people. This presentation is chiefly based on ADA guideline 2015 and focuses on the management of diabetes in persons aged >65 years.
http://www.lotusholisticmedicine.com - Type 2 diabetes is mainly the result of insulin resistance. It has been scientifically proven that by eating the right food, diabetes can not only be prevented but also effectively reversed.
http://www.our-diabetic-life.com Intake of large amount of carbohydrates can spike your blood glucose level. Right amount of carbohydrate can make your glucose level under control.
Presentation performed for highlighting VERIFY: Galvus-met trials superiority in managing newly diagnosed DMT2 patients with preserving B cell function, evidence.
A presentation on the care of diabetes in elderly people. This presentation is chiefly based on ADA guideline 2015 and focuses on the management of diabetes in persons aged >65 years.
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La insulinoterapia es un arte y actualmente contamos con nuevas formulaciones y otras en proceso de investigación y aprobación. Ponencia presentada en las jornadas del benemérito H2M.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
1. The Metabolic Syndrome
andd
Cardiovascular Risk
Vivian Fonseca
Tulane University
Texas A & M University
Scott and White Clinic
2. Type 2 Diabetes Mellitus Is a
yp
Progressive Disease
Diagnosis
350
Postprandial
300
Glucose
Glucose
(mg/dL)
250 Fasting
200 Glucose
150
G
(
100
50
250 Insulin Resistance
200
150 Insulin Relative
100 Level
L l Insulin
50 Inadequate Resistance
β-Cell Function Decreasing β-Cell Function
0
Uncontrolled
Obesity
y IGT Diabetes
Hyperglycemia
Clinical Macrovascular Changes
Features Microvascular Changes
Years –10 –5 0 5 10 15 20 25 30
Adapted from Type 2 Diabetes BASICS. International Diabetes Center; 2000.
3. Insulin Resistance Syndrome and Risk
Factors for CVD in Type 2 Diabetes
Hypertension Hyperglycemia
Hyperinsulinemia
yp Dyslipidemia
– decreased HDL
Altered – increased
fibrinolysis, triglycerides
Inflammation, Insulin
Endothelial resistance
i t Genetics
dysfunction Aging
Obesity
Ob it
Sedentary lifestyle
4. Metabolic Syndrome: NCEP Criteria
Diagnosis requires three or more of the following features
• Waist ≥40” in males or ≥35” females
≥40 ≥35
• Triglycerides ≥150 mg/dL (or treatment)
• HDL <40 mg/dL in males and <50 mg/dL in females
(or t t
( treatment) t)
• SBP ≥130 or DBP ≥85 mmHg (or treatment)
• Fasting plasma glucose (FPG) ≥100 mg/dL (or treatment)
100
Issues
• Great
G t concept for professional and patient education:
tf f i l d ti t d ti
clustering of risk factors relate to poor lifestyle habits
• Providers do not measure waist and many lipid panels
are non-fasting
f ti
Grundy S, et al. Circulation 2005;112:2735
5. WHO and NCEP ATP III Criteria
for the Metabolic Syndrome
Criteria WHO NCEP
Glucose status or IR plus 3
or more of others: 3 or more of:
Glucose Status IGT/IFG/DM IFG/DM
HOMA IR Highest 25%
g N/A
Blood Pressure (mmHg) ≥140/90 ≥130/85
Triglycerides (mg/dL) ≥150 ≥150
HDL (mg/dL) <35 (M) <40 (M)
<39 (F)
( ) <50 (F)
( )
Obesity WHR>0.9 (M) WC>102 cm (M)
WHR>0.85 (F) WC>88 cm (F)
or BMI>30 kg/m^2
Microalbuminuria ≥30 mg/g N/A
6. Nuances in the definitions can
have huge effects
SBP>130 AND DBP>85
or
SBP>130 OR DBP>85
The latter scoops up about 60% more people
than the former
Does it matter? We don’t know.
6 of 22
7. Associated with insulin resistance?
Then how about adding…
Adiponectin
p
C-reactive protein
Age
Others?
Oth ?
7 of 22
8. Insulin resistance in those with MS
Author Sensitivity Specificity PPV Comment
Cheal et al. 46% 93% 76% N=443, no diabetes,
Diabetes 40% overweight
53:1195,2004
3 119 2004
Liao et al. 20 - 50% 92% 56% N=74,
Diabetes Care no diabetes
27:978,2004
McLaughlin 52% 85% 78% N=258,
N=258
et al. Ann no diabetes,
Intern Med 100% overweight
,
139:802,2003 or obese
Sierra-Johnson
42% 94% 72% N=256,
et al.
no HBP,
Diabetes C
Di b t Care
no diabetes
29:668,2006
8 of 22
9. Likelihood of IR* in
overweight / obese people
Marker Positive Predictive Value
Overweight / Obese alone 50%
Triglyceride > 130 mg/dl 70%
Triglyceride / HDL ratio >3.0 67%
ATP III Criteria 78%
*Insulin resistance = highest tertile
McLaughlin T et al. Ann Intern Med 139:802,2003 9 of 22
10. Prevalence of Metabolic Syndrome
One in four Americans have metabolic syndrome by
NCEP criteria
Approximately 80% of adults over the age of 20 have
one or more of th components of metabolic syndrome
f the t f t b li d
In addition to 21 million people with diabetes, there are
approximately 50 million people with pre-diabetes or
metabolic syndrome
Ford et al. JAMA 2002;287:356
http://www.diabetes.org/diabetes-statistics/prevalence.jsp
11. CHD Associated with High Insulin
Levels in Nondiabetic Subjects
1.00
0.95
Proportion Q1
0.90
0 90 Increasing
Without
Major CHD insulin
0.85 Q2
Event levels
0.80
Log rank: associated
Overall P=.001 Q3
with insulin
Q5 vs. Q1 P <.001 Q4 resistance
0.75
Q5
0
0 5 10 15 20 25
Years
Pyörälä M et al. Circulation 1998;98:398
12. Cardiovascular Disease Mortality
and the Metabolic Syndrome
15
Metabolic
RR=3.55
Syndrome
10 (95% CI, 1.96-6.43)
Cumulative
Hazard Ratio
5
Controls
0
0 2 4 6 8 10 12
Follow-up (Years)
Metabolic Yes 866 852 834 292
Syndrome? No 288 279 234 100
Lakka HM et al. JAMA 2002;288:2709
13. Dysglycemia in Patients with Acute MI
y gy
Consecutive patients presenting with acute MI, n = 181
Oral Glucose
Tolerance Test
20% 25%
80% 40% 35%
Diabetic
DM by OGTT
No DM (by History)
IGT by OGTT
Normal OGTT
Norhammar A et al. Lancet. 2002;359:2140
14. Metabolic Syndrome and the risk
of di b t
f diabetes
(San Antonio Heart Study)
Sens. Spec. PPV
ATP III 53 85 31
WHO 43 87 30
FPG ≥ 97 mg/dl 43 92 39
Lorenzo C, et al. Diabetes Care. 26:3153, 2003.
14 of 22
15. Metabolic Syndrome and the risk of diabetes
(Insulin Resistance Atherosclerosis Study*)
Variable OR** (95% CI)
ATPIII 4.14 (2.79 6.16)
4 14 (2 79 – 6 16)
3.84 (2.59 – 5.69)
AHA/NHLBI
3.40 (2.28 – 5.06)
IDF
IGT alone 5.42 (3.60 – 8.17)
* Incident of diabetes in 822 subjects followed for a mean of 5.2 years
j y
** Adjusted for age, sex and ethnicity
Hanley et al., Circulation 112:3713-3721,2005 15 of 22
16. Does the Metabolic Syndrome Predict
CVD?
(Data from San Antonio Heart Study*)
Variable Odds Ratio**(CI) P-Value
ATP III definition 1.56 .028
Adjusted for diabetes
Adj t d f di b t 1.11
1 11 .658
658
Diabetes 2.63
2 63 <0.0001
<0 0001
* CVD mortality i 5 158 people f ll
t lit in 5,158 l followed f 7 8 years
d for 7-8
** Adjusted for age and gender
Stern MP et al. Atheroscler Suppl. 6:3-6, 2005. 16 of 22
18. Relation of Waist:Hip Ratio to MI
and Mortality in Women
dM li i W
20
15 Mortality
MI
Incidence 10
(%)
5
0
0-20 21-40 41-60 61-80 81-90 91-95 96-100
Centiles of waist-to-hip ratio
Lapidus L et al. BMJ. 1984;289:1257-1261.
18 of 22
20. The Adipocyte as an Endocrine Cell
FFA adiponectin PAI-1
leptin
RPB-4
resistin omentin
apelin
li adipsin
di i
SAA
TNF-α
IL-6 visfatin MCP-1
21. Metabolic Syndrome: ADA/EASD View
Adults with any major CVD risk factor should be evaluated
for the presence of other CVD risk factors
Lifestyle modification should be advised for patients with
CVD risk factors above the “normal” cut-point
p
Pharmacological treatment should be administered if the
CVD risk factor is indicative of frank disease
All CVD risk factors should be treated individually
Until randomized controlled trials have been completed,
there is no indication for the pharmacological
treatment for the metabolic syndrome
Kahn R et al. ADA/EASD. Diabetes Care 2005;28:2289
22. Prevention of Type 2 Diabetes:
Results f Recent R d i d T i l
R l of R Randomized Trials
Relative Risk
Study Subjects Intervention Reduction NNT
Behavioral
Finnish DPS IGT Lifestyle 58%
4-8
US DPP IGT y
Lifestyle 58%
%
US DPP IGT Metformin 31% 14
STOP-NIDDM IGT Acarbose 32% 11
edication
TRIPOD Troglitazone
Prior 56% 6
GDM
Orlistat 45%
XENDOS
Me
10
IGT
Ramipril /
DREAM Rosiglitazone NS / 62% 7
IGT
Nathan DM et al. Diabetes Care 2007 30:753
23. Steps to Obesity Management
p y g
Recognition
BMI, waist circumference obesity-related complications
BMI circumference, obesity-
Commitment
Patient, and nutrition team (MD, NP-PA, RD, PhD)
NP-
Realistic expectations
Reduction in health risks, 5% to10% initial weight loss
A multi-disciplined treatment approach
multi-
Behavior modification
Physical activity
y y
Diet
Pharmacotherapy
24. What is Known about
Weight Management?
• Modest weight loss is beneficial especially in the prevention
o chronic diseases c ud g
of c o c d seases including type 2 d abetes a d for
diabetes and o
lowering blood pressure
• At ~6 months individuals can lose 5% to 10% of their
6
starting weight
• Regardless of the intervention, plateaus and regain of
weight loss are expected; compensatory mechanisms
protect against weight loss
• If treatment is discontinued, weight gain occurs
• With support modest weight loss can be maintained
support,
Franz M et al. J Am Diet Assoc 2007:107:1736
25. Being Fit Reduces the Hazards
of Obesity in Males
25,389 males followed for 8 years
Physical fitness, regardless of body mass index (BMI)
fitness (BMI),
decreases risk of mortality from all chronic diseases
3
RR Of All-Cause Mortality including CVD
2.5
Relative
2
Risk
Fit
1.5
Unfit
1
0.5
0
Lean Normal Obese
Lee CD et al. Am J Clin Nutr 1999;69:373; Sui X et al. JAMA 2007;298:2507
26. Comparison of Popular Weight Loss
Diets
• Subjects (n=160) utilized one of the following diets
– Atkins (carbohydrate restricted)
– Zone (macronutrient balanced)
– Weight Watchers (calorie restriction)
– O i h (fat restriction)
Ornish (f t t i ti )
• Weight loss and completers at 1 year
– Atkins 2.1 kg (4.6 lb) [53%]
– Zone 3.2 kg (7.0 lb) [65%]
– Weight Watchers 3 0 kg (6 6 lb) [65%]
3.0 (6.6
– Ornish 3.3 kg (7.3 lb) [50%]
• Each popular diet modestly reduced body weight
weight.
Amount of weight lost was associated with self-
Dansinger M et al. JAMA 2005;293:43 diet but not with diet type
reported adherence to
27. Predictors of Successful Weight Loss
Maintenance in National Weight Control
Registry
• Continue to eat lower energy diets (average energy intake
~1400 kcal/day); eat a low-fat, moderate-carbohydrate
diet (24% of energy from fat)
•F
Frequently self-monitor weight and f d i t k
tl lf it i ht d food intake
• Participant in a minimum of 60 to 90 minutes of physical
activity nearly every d of th week
ti it l day f the k
(2800 kcal/week; 28 miles of walking/week)
• Eat breakfast every day (contrary to the typical eating
pattern for dieters)
Wing RR, Hill JO. Ann Rev Nutr 2001;21:323. Wyatt H et al. Obes Res 2002;2:78
28. What is the Effect of Weight Loss and
Weight Loss Medications on A1C in Type
2 Diabetes?
12-mo
12 mo Weight 12-mo
12 mo Weight
Change (Type 2 12-mo A1C Change (Without
Interventions Diabetes) Change Diabetes)
Weight Loss Diet
g – 2.6 kg (
g (5.7 lb)
) – 0.4% –4.6-7.6 kg (
g (10-17 lb)
)
(n=532)
Orlistat 120 mg tid – 5.0 kg (11 lb) – 0.8% –8.2 kg (18 lb)
(n=574) (Alli)
Sibutramine 15-20 – 7.2 kg (15.8 lb) – 0.4% –8.2 (18 lb)
mg (n=152)
Franz M. On the Cutting Edge. Diabetes Care and Education 2006;6:27
29. Strategies for Changing Behavior
• Self-monitoring (recording behaviors): always rated by
participants as most helpful
• Individuals who recorded food intake frequently lost more than
twice as much weight as those who did so infrequently1
• Realistic goals: 8% to 10% weight loss improves risk f
% % factors
• Stimulus control: environmental restructuring for modification of
eating cues
• Cognitive restructuring: moving from self-rejection to
self-acceptance
p
• Contingency management: rewards by self or professionals
(rated as least helpful)
• Stress management: #1 predictor of relapse
Foreyt JP, Pendleton VR. Primary Care Reports 2000;6:19
1Wadden TA et al. N Eng J Med 2005;353:2111
30. Strategies for Maintenance
of Behavior Change
• Physical activity: major p
y y j predictor of maintenance
• Social support: family “set p , peer support,
pp y point,” p pp ,
self-help or work-site groups
• Relapse prevention: relapse is expected; coping
strategies are needed
– Stress management
– Social situations
– Continuing support from health professionals
Foreyt JP, Pendleton VR. Primary Care Reports 2000;6:19
31. Bariatric Surgery and Diabetes
Swedish Obese Subjects Study (SOS)
• Weight loss at: 10 Years Post Bariatric Surgery
• 1 year: 38%
• 2 years: 23% Post
g y
Surgery
Control
• 10 years: 16%
• All studied risk factors Resolution 36% 13%
improved, except of DM
hypercholesterolemia and
cardiovascular risk Newly 7% 24%
Developed
• Decreased overall mortality DM
Sjostrom L et al. N Engl J Med 2004;351:2683; Sjostrom L et al. N Engl J Med 2007;357:741
32. The STOP-NIDDM Study: Reduction
in Risk of Cardiovascular Disease
0.06
0.05
Probability 0.04 Hazards Ratio RRR
of Any Placebo 0.51 49%
0.03
Cardiovascular
Event 0.02
Acarbose
0.01
0 01
P=0.04 (log-rank test)
0 P=0.03 (Cox proportional model)
Days After Randomization
Patients at risk
Acarbose 686 675 667 658 643 638 633 627 615 611 604 519 424 332 232
Placebo 682 659 635 622 608 601 596 590 577 567 558 473 376 286 203
Chiasson JL, et al. JAMA. 2003;290(4):486-494.
33. NAVIGATOR
2 x 2 Factorial Design
Valsartan comparison
Valsartan/Nateglinide Placebo/Nateglinide
(n = 2,288) (n = 2,288)
Nateglinide
comparison
Valsartan/Placebo Placebo/Placebo
(n = 2,288) (n = 2,288)
Dosages
Nateglinide 60 mg PO ac
Valsartan 160 mg PO qd
All subjects will receive a lifestyle advice program
34. Exenatide + Oral Agents
Summary of Weight Changes
Placebo
“THE 3 AMIGOS TRIALS”
TRIALS” Exenatide 5 μg
30-
30-Week, Randomized, Placebo-Controlled
Placebo- Exenatide 10 μg
0.0
-0.5 -0.3
-0.6
-1.0 -0.9
ght
-0.9
g)
Δ weig
(kg
-1.5
-1.6 -1.6 -1.6 -1.6
-2.0 * * * *
-2 5
2.5
-3.0 -2.8
*
*P<0 05 vs placebo
<0.05 Exenatide + SU Exenatide + Met Exenatide + SU + Met
(n=377) (n=336) (n=733)
Buse JB, et al. Diabetes Care. 2004;27:2628-2635.
Defronzo RA, et al. Diabetes Care. 2005;28:1092-1100. Kendall DM, et al. Diabetes Care. 2005;28:1083-1091.
35. Rimonabant:Changes From Baseline for
Body Weight for Year 1
0
Change from baseline, kg
,
-2
-4
b
-6
es
-8 Placebo
5 mg Rim.
20 mg Rim.
-10
0 12 24 36 52
No. at Risk Weeks
Placebo 590 496 413 347 309
5 mg Rim. 1191 1104 833 711 619
20 mg Rim. 1189 1017 863 750 672
Pi-Sunyer, F. et al., JAMA 2006; 295:761-75.
40. TINSAL T2D – Targeting Inflammation with Salsalate in Type 2 Diabetes
Salsalate is a covalent, head-to-tail dimer between two salicylic acid moieties.
Salsalate is insoluble at acidic pH so it doesn’t irritate the stomach
pH, stomach.
OH CH 3 CO 2 OH CO 2 H
CO 2 H CO 2 H CO 2
Salicylic Aspirin Salsalate
Acid (Disalcid)
42. Salsalate Improves Glycemia During Oral
Glucose Tolerance Testing in Ob it
Gl T l T ti i Obesity
Salsalate Placebo
* p<0 01
p<0.01
10
** **
9 9
Percent Change
e
5
**
mol/L)
8 8 0
lucose (mm
7 7 5
-5
-10
6 6
-15
15
Gl
5 5 Baseline
Post Therapy -20
0 60 120 0 60 120 Salsalate
Placebo
Time (minutes)
Fleischman et al Diabetes Care 2008; 31:289
43. Free Fatty Acids and Inflammatory Mediators
Improve With Salsalate in Obesity
**
0.6
20
6
* p<0.05
*
Salsalate
*
0.3
10
3
** p<0.01
14% 34% 56%
FFA CRP Adiponectin
0.6
20
6
Placebo
0.3
3
10
3
Baseline
Salsalate
FFA CRP Adiponectin
(mEq/L) (mg/L) (mg/L)
Fleischman et al Diabetes Care 2008; 31:289
44. TINSAL-
TINSAL-T2D Stage 1:
HbA1c (primary endpoint)
0.2
hange fro baseline)
Placebo
0
om
-0.2
*P vs placebo
vs.
ercent HbA1c (ch
3.5 g *0.02
-0.4 3.0 g *0.02
4.0 g *0.001
Pe
-0.6 *Holm’s procedure
0 4 8 14
Trial week