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- December 1, 2008 |
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Welcome to the #1 online source of information for Diabetes Specialists! An international online community of more than 10,000 Diabetes Specialists.
CME on Diabetes is a website built to transmit top-level CME conferences given by international experts in endocrinology, insulin resistance, prediabetes, metabolic syndrome and type 2 diabetes. More than 2.6 million slides have been viewed since the website launch. Thank you for your continued support and commitment!
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"Lung function and inhaled insulin in diabetes"Prof. Timothy Davis (biography)
English - 2008-02-05 - 35 minutes
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Summary :
Pulmonary involvement in diabetes was first reported about thirty years ago, and in 1989 a cross-sectional study from Denmark was published showing slightly impaired lung function among diabetic patients, which was more apparent in those taking insulin (1).
More recently, cross-sectional and prospective data from the Fremantle Diabetes Study shed further light on the topic. In this...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The effect of diabetes on the lung
- The rationale for inhaled insulin
- The status of inhaled insulin
Bibliographic references :
1. Lange P, Groth S, Kastrup J, Mortensen J, Appleyard M, Nyboe J, Jensen G, Schnohr P. Diabetes mellitus, plasma glucose and lung function in a cross-sectional population study. Eur Respir J. 1989 Jan;2(1):14-9.
2. Timothy M.E Davis, Matthew Knuiman, Peter Kendall, Hien Vu, Wendy A Davis Reduced pulmonary function and its associations in type 2 diabetes: the Fremantle Diabetes Study Diabetes Research and Clinical Practice - 1 October 2000 (Vol. 50, Issue 2, Pages 153-159)
3. Davis WA, Knuiman M, Kendall P, Grange V, Davis TM; Fremantle Diabetes Study.Glycemic Exposure Is Associated With Reduced Pulmonary Function in Type 2 Diabetes: The Fremantle Diabetes Study Diabetes Care. 2004 Mar;27(3):752-7.
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"Antipsychotics and Diabetes"Prof. John Prins (biography)
English - 2007-11-21 - 25 minutes
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Summary :
In this presentation Prof. Prins talks about the relationship between the use of therapies for major psychiatric disorders and the increase in the incidence of metabolic dysfunction.
Different types of studies have suggested a trend toward worsening metabolic dysfunction with antipsychotic therapies (1). An important effect of these therapies is weight gain, and related to the...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Metabolic dysfunction in schizophrenia
- Metabolic effects of antipsychotic therapies
- Data to suggest within-class differences in metabolic effects of antipsychotics
- Management of patients taking atypical antipsychotics
Bibliographic references :
1. Holt RIG and Peveler RC Association between antipsychotic drugs and diabetes Diabetes, Obesity and Metabolism 8 (2) , 125–135.
2. Haupt DW, Kane JM.
Metabolic risks and effects of atypical antipsychotic treatment. J Clin Psychiatry. 2007 Oct;68(10):e24.
3. STEPHEN H. SCHULTZ, MD, STEPHEN W. NORTH, MD, mph, and CLEVELAND G. SHIELDS, PhD. Schizophrenia: A Review Am Fam Physician. 2007 Jun 15;75(12):1821-9.
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"The Edmonton protocol - Where to from now?"Dr. Philip O'Connell (biography)
English - 2007-11-17 - 43 minutes
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Summary :
In patients with type 1 diabetes, increasing hypoglycaemia with improving glycaemic control is a problem in patients on intensive insulin treatment. Although the DCCT study showed intensive insulin treatment to result in less complications, the accompanying risk of severe hypoglycaemia makes it harder to maintain long-term.
Islet transplantation aims to achieve normal HbA1c using...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The rationale of the Edmonton protocol for islet transplantation
- Results from the Edmonton group and the International Multicenter Trial of Islet Transplantation Using the Edmonton Protocol in Patients with Type 1 Diabetes
- Benefits of and problems with the Edmonton protocol
- Future directions for research
Bibliographic references :
A.M. James Shapiro, M.B., B.S., Jonathan R.T. Lakey, Ph.D., Edmond A. Ryan, M.D., Gregory S. Korbutt, Ph.D., Ellen Toth, M.D., Garth L. Warnock, M.D., Norman M. Kneteman, M.D., and Ray V. Rajotte, Ph.D.Islet Transplantation in Seven Patients with Type 1 Diabetes Mellitus Using a Glucocorticoid-Free Immunosuppressive Regimen N Engl J Med. 2000 Jul 27;343(4):230-8.
2.Ryan EA, Paty BW, Senior PA, Bigam D, Alfadhli E, Kneteman NM, Lakey JR, Shapiro AM. Five-Year Follow-Up After Clinical Islet Transplantation Diabetes 54:2060-2069, 2005.
3. A.M. James Shapiro, M.D., Ph.D., Camillo Ricordi, M.D., Bernhard J. Hering, M.D., Hugh Auchincloss, M.D., Robert Lindblad, M.D., R. Paul Robertson, M.D., Antonio Secchi, M.D., Mathias D. Brendel, M.D., Thierry Berney, M.D., Daniel C. Brennan, M.D., Enrico Cagliero, M.D., Rodolfo Alejandro, M.D., Edmond A. Ryan, M.D., Barbara DiMercurio, R.N., Philippe Morel, M.D., Kenneth S. Polonsky, M.D., Jo-Anna Reems, Ph.D., Reinhard G. Bretzel, M.D., Federico Bertuzzi, M.D., Tatiana Froud, M.D., Raja Kandaswamy, M.D., David E.R. Sutherland, M.D., Ph.D., George Eisenbarth, M.D., Ph.D., Miriam Segal, Ph.D., Jutta Preiksaitis, M.D., Gregory S. Korbutt, Ph.D., Franca B. Barton, M.S., Lisa Viviano, R.N., Vicki Seyfert-Margolis, Ph.D., Jeffrey Bluestone, Ph.D., and Jonathan R.T. Lakey, Ph.D.International Trial of the Edmonton Protocol for Islet Transplantation N Engl J Med. 2006 Sep 28;355(13):1318-30.
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"Practical diabesity intervention: Strategies borrowed from the marketing and economics world"Dr. Soji Swaraj (biography)
English - 2007-08-17 - 12 minutes
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Summary :
In this presentation Dr. Swaraj talks about how disciplines outside of medicine, such as economics and marketing, can help in understanding the diabesity epidemic and motivating diabetic patients to adhere to therapy and lifestyle change.
How can the current diabesity epidemic be explained? According to economic theory, human lifestyles have been 'optimised' to minimise energy...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Why bother with aggressive diabesity intervention?
- Failure in achieving targets: economic and marketing hypotheses
- Are standard approaches counterproductive?
- Solutions: A patient-centric 'marketing' approach
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"Is self-monitoring of blood glucose (SMBG) worthwhile in type 2 diabetes? Findings from the Fremantle Diabetes Study"Prof. Timothy Davis (biography)
English - 2007-05-31 - 37 minutes
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Summary :
Although self-monitoring of blood glucose (SMBG) is unanimously recommended for type 2 diabetic patients treated with insulin, there is no international consensus on whether SMBG is required in those on diet or oral antihyperglycaemic treatment (1).
Here Prof. Davis presents recently published data from the prospective, observational Fremantle Diabetes Study (FDS). These analyses...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The value of self-monitoring of blood glucose in type 2 diabetes
Bibliographic references :
1. Burgers JS, Bailey JV, Klazinga NS, Van Der Bij AK, Grol R, Feder G; AGREE COLLABORATION.Comparative analysis of recommendations and evidence in diabetes guidelines from 13 countries Diabetes Care 25:1933-1939, 2002.
2. Wendy A. Davis, PHD, David G. Bruce, MD and Timothy M.E. Davis, DPHILIs Self-Monitoring of Blood Glucose Appropriate for All Type 2 Diabetic Patients? Diabetes Care 29:1764-1770, 2006.
3. W. A. Davis, D. G. Bruce1 and T. M. E. Davis. Does self-monitoring of blood glucose improve outcome in type 2 diabetes? The Fremantle Diabetes Study Diabetologia 2007;50:510-515.
4. S. Martin, B. Schneider, L. Heinemann, V. Lodwig, H.-J. Kurth, H. Kolb, W. A. Scherbaum and for the ROSSO Study Group.Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological cohort study Diabetologia 2006;49:271-278.
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"Adding PS to the ABCss of Diabetes Care – An Australian Perspective"Dr. Pat Phillips (biography)
English - 2006-12-07 - 29 minutes
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Summary :
In this presentation, Dr. Phillips talks about the importance of adding psychosocial (PS) issues to the "ABCss" of diabetes care or working to achieve the targets for A1c, blood pressure, cholesterol, salicylate use and smoking cessation.
Psychosocial issues can impact on diabetes control/care and vice versa. In addition, depression has been found to be an independent risk factor...
Learning objectives :
After viewing this presentation, the participant will be able to discuss:
- Why diabetes is commonly associated with psychosocial issues.
- The importance of psychosocial issues affecting and being affected by diabetes control and care.
- The risk of diabetes complications associated with psychosocial issues, particularly depression.
- Ways to incorporate assessment and intervention into the routine cycle of diabetes care.
Bibliographic references :
1. Stephen J Bunker, David M Colquhoun, Murray D Esler, Ian B Hickie, David Hunt, V Michael Jelinek, Brian F Oldenburg, Hedley G Peach, Denise Ruth, Christopher C Tennant and Andrew M Tonkin"Stress" and coronary heart disease: psychosocial risk factors - National Heart Foundation of Australia position statement update MJA 2003 178 (6): 272-276.
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"The Progressive Nature of Type 2 Diabetes - Update on Clinical Management: Results of the ADOPT Trial"Prof. Giancarlo Viberti (biography)
English - 2006-12-04 - 43 minutes
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Summary :
Clinical management of type 2 diabetes has conventionally relied on a stepwise approach, in which therapy is intensified, from diet and exercise, through monotherapy and then on to combination therapy, in response to steadily worsening glycaemic control. As such, the stepwise approach implicitly acknowledges type 2 diabetes as an inevitably progressive disorder and principally aims to respond to...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
Newly-released results from the ADOPT trial - Effects of rosiglitazone versus metformin or glyburide as initial therapy in recently diagnosed type 2 diabetic patients:
- Primary outcome: Time to monotherapy failure - FPG > 180 mg/dl (> 10 mmol/L)
- Secondary outcomes: FPG > 140 mg/dl (> 7.8 mmol/L); Changes in FPG, HbA1c, insulin sensitivity and beta-cell function
- Adverse events
- Clinical implications
Bibliographic references :
Steven E. Kahn, Steven M. Haffner, Mark A. Heise, William H. Herman, Rury R. Holman, Nigel P. Jones, Barbara G. Kravitz, John M. Lachin, M. Colleen O'Neill, Bernard Zinman, Giancarlo Viberti, for the ADOPT Study Group Glycemic Durability of Rosiglitazone, Metformin, or Glyburide Monotherapy NEJM. 2006 Dec;(23) 355:2427-2443
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"Are We Making Progress With Slowing Disease Progression?"Prof. Peter J. Grant (biography)
English - 2006-12-04 - 17 minutes
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Summary :
Our understanding of the pathophysiological relationship between diabetes and cardiovascular disease has been markedly increased over the last 15 years. The seminal ADA lecture by Reaven in 1989, which described the existence of cardiovascular risk clustering in the presence of underlying insulin resistance, has been followed by a wave of publications linking changes in classical and novel...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Diabetes and cardiovascular disease: the "common soil" hypothesis
- Targeting of beta-cell dysfunction and increasing insulin resistance
- The DREAM trial: summary and conclusions
- The ADOPT trial: summary of glycaemic efficacy; outstanding questions
- Clinical trials across the diabetes continuum
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"Complementary Therapies - An Overview"Prof. Trisha Dunning (biography)
English - 2006-10-28 - 59 minutes
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Summary :
What are complementary therapies? According to the British Medical Association, they are therapies which can work alongside and in conjunction with orthodox medical treatment.
People with diabetes have been found to be more likely to use complementary therapies than non-diabetics (1). What do people with diabetes use? Among the range of therapies used are glucose-lowering and...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The philosophical basis of complementary therapies
- Frequency of complementary therapy use in diabetic patients
- Types of herbs and supplements used by diabetic patients
- Safety issues associated with complementary therapy use
- Potential interactions between herbal and conventional medicines
Bibliographic references :
1. Leonard E. Egede, MD, MS, Xiaobou Ye, MD, MS, Deyi Zheng, MB, PHD and Marc D. Silverstein, MDThe Prevalence and Pattern of Complementary and Alternative Medicine Use in Individuals With Diabetes Diabetes Care 25:324-329, 2002
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"UKPDS - Unanswered Questions?"Prof. Rury Holman (biography)
English - 2006-09-13 - 31 minutes
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Summary :
The UKPDS was a landmark 20-year trial which showed that the complications of type 2 diabetes could be reduced by more intensive management of glycaemia and blood pressure. In 5, 102 patients recruited with newly-diagnosed type 2 diabetes, the study demonstrated that maintaining improved blood glucose control with sulphonylurea or insulin monotherapy over median 10.3 years reduced the risk of the...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Additive effects of glucose and blood pressure control in T2DM
- Ongoing studies on glucose control and macrovascular risk
- Macrovascular benefits of metformin
- T2DM, metabolic syndrome and CVD mortality
- CHD case fatality with and without SU therapy in the UKPDS
- The progressive nature of T2DM
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"Pharmacotherapy for Obesity"Dr. David Lau (biography)
English - 2006-05-26 - 82 minutes
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Summary :
According to data from Statistics Canada the majority of adults in Canada are overweight or obese, and not only that but as a study reported in the Canadian Medical Association Journal in 2000 indicated, the childhood obesity rates have been climbing as well (1).
Obesity is known to be associated with a number of medical complications, and with respect to the metabolic...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
- The emerging dual epidemics of obesity and type 2 diabetes
- The role of abdominal adiposity in metabolic co-morbidities
- Current and future pharmacotherapy for obesity
- Implications of CPGs in the treatment and prevention of obesity
Bibliographic references :
1. Mark S. Tremblay and J. Douglas Willms Secular trends in the body mass index of Canadian children CMAJ. 2000 Nov 28;163(11):1429-33
2. Lau DC, Yan H, Dhillon B. Metabolic syndrome: A marker of patients at high cardiovascular risk Can J Cardiol. 2006 Feb;22 Suppl B:85B-90B.
Further reading:
Alison E. Field, ScD; Eugenie H. Coakley; Aviva Must, PhD; Jennifer L. Spadano, MA; Nan Laird, PhD; William H. Dietz, MD, PhD; Eric Rimm, ScD; Graham A. Colditz, MD, DrPH Impact of Overweight on the Risk of Developing Common Chronic Diseases During a 10-Year Period Arch Intern Med. 2001;161:1581-1586
Yong-Woo Park, MD, PhD; Shankuan Zhu, MD, PhD; Latha Palaniappan, MD; Stanley Heshka, PhD; Mercedes R. Carnethon, PhD; Steven B. Heymsfield, MD The Metabolic Syndrome: Prevalence and Associated Risk Factor Findings in the US Population From the Third National Health and Nutrition Examination Survey, 1988-1994 Arch Intern Med. 2003;163:427-436
Vincent J. Carey, Ellen E. Walters, Graham A. Colditz, Caren G. Solomon, Walter C. Willet, Bernard A. Rosner, Frank E. Speizer and JoAnn E. Manson Body Fat Distribution and Risk of Non-Insulin-dependent Diabetes Mellitus in Women: The Nurses' Health Study American Journal of Epidemiology Vol. 145, No. 7: 614-619
Lau DC, Dhillon B, Yan H, Szmitko PE, Verma S. Adipokines: molecular links between obesity and atheroslcerosis Am J Physiol Heart Circ Physiol 288: H2031-H2041, 2005
Jean-Pierre Després, professor, Isabelle Lemieux, PhD student, Denis Prud'homme, professor Treatment of obesity: need to focus on high risk abdominally obese patients BMJ 2001;322:716-720
Sjostrom L, Rissanen A, Andersen T, Boldrin M, Golay A, Koppeschaar HP, Krempf M. Randomised placebo-controlled trial of orlistat for weight loss and prevention of weight regain in obese patients Lancet. 1998 Jul 18;352(9123):167-72
Hollander PA, Elbein SC, Hirsch IB, Kelley D, McGill J, Taylor T, Weiss SR, Crockett SE, Kaplan RA, Comstock J, Lucas CP, Lodewick PA, Canovatchel W, Chung J, Hauptman J. Role of orlistat in the treatment of obese patients with type 2 diabetes. A 1-year randomized double-blind study Diabetes Care. 1998 Aug;21(8):1288-94
James WP, Astrup A, Finer N, Hilsted J, Kopelman P, Rossner S, Saris WH, Van Gaal LF. Effect of sibutramine on weight maintenance after weight loss: a randomised trial. STORM Study Group. Sibutramine Trial of Obesity Reduction and Maintenance Lancet. 2000 Dec 23-30;356(9248):2119-25
Thomas A. Wadden, Ph.D., Robert I. Berkowitz, M.D., Leslie G. Womble, Ph.D., David B. Sarwer, Ph.D., Suzanne Phelan, Ph.D., Robert K. Cato, M.D., Louise A. Hesson, M.S.N., Suzette Y. Osei, M.D., Ph.D., Rosalind Kaplan, M.D., and Albert J. Stunkard, M.D. Randomized Trial of Lifestyle Modification and Pharmacotherapy for Obesity N Engl J Med. 2005 Nov 17;353(20):2111-20
Zhaoping Li, MD, PhD; Margaret Maglione, MPP; Wenli Tu, MS; Walter Mojica, MD; David Arterburn, MD, MPH; Lisa R. Shugarman, PhD; Lara Hilton, BA; Marika Suttorp, MS; Vanessa Solomon, MA; Paul G. Shekelle, MD, PhD; and Sally C. Morton, PhD Meta-Analysis: Pharmacologic Treatment of Obesity Ann Intern Med 2005; 532-546
Diabetes Prevention Program Research Group Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin N Engl J Med. 2002 Feb 7;346(6):393-403
Steven B. Heymsfield, MD; Andrew S. Greenberg, MD; Ken Fujioka, MD; Russell M. Dixon, MD; Robert Kushner, MD; Thomas Hunt, MD; John A. Lubina, PhD; Janet Patane, MPH; Barbara Self, MPH; Pam Hunt, PhD; Mark McCamish, PhD, MD Recombinant Leptin for Weight Loss in Obese and Lean Adults : A Randomized, Controlled, Dose-Escalation Trial JAMA. 1999;282:1568-1575
David E. Cummings, M.D., David S. Weigle, M.D., R. Scott Frayo, B.S., Patricia A. Breen, B.S.N., Marina K. Ma, E. Patchen Dellinger, M.D., and Jonathan Q. Purnell, M.D. Plasma Ghrelin Levels after Diet-Induced Weight Loss or Gastric Bypass Surgery N Engl J Med. 2002 May 23;346(21):1623-30
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"Oral Hypoglycemic Agents and Cardiac Events: The Good the Bad and the Ugly"Dr. David S.H. Bell (biography)
English - 2006-04-28 - 62 minutes
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Summary :
In this presentation Dr. Bell talks about different classes of antidiabetic agents, their effects, tolerability and impact on cardiac risk.
Do sulfonylureas increase the risk of cardiac events? Sulfonylureas work by closing the ATP-sensitive K+ channels in the wall of the pancreatic beta cell, leading to depolarization, an influx of calcium and an increased release of insulin....
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Ischemic preconditioning in the heart: effects of SUs and diabetes
- Studies on SU treatment and mortality in type 2 diabetes
- Decreased cardiac events associated with α-glucosidase inhibitor and metformin use
- Effects of TZDs in lowering cardiac risk factors and surrogate markers of atherosclerosis
- Evidence for possible benefit of lowering insulin resistance in heart failure
Bibliographic references :
1. Bell, DSH. Do sulfonylurea drugs increase the risk of cardiac events? CMAJ. 2006 Jan 17;174(2):185-6.
2. Garratt KN, Brady PA, Hassinger NL, Grill DE, Terzic A, Holmes DR Jr.
Sulfonylurea drugs increase early mortality in patients with diabetes mellitus after direct angioplasty for acute myocardial infarction J Am Coll Cardiol. 1999 Jan;33(1):119-24.
3. UGDP.Diabetes (1970);19:789-826.
4. Jeffrey A. Johnson, PHD, Sumit R. Majumdar, MD, MPH, FRCPC, Scot H. Simpson, PHARMD and Ellen L. Toth, MD, FRCPCDecreased Mortality Associated With the Use of Metformin Compared With Sulfonylurea Monotherapy in Type 2 Diabetes Diabetes Care 25:2244-2248, 2002.
5. Scot H. Simpson, Sumit R. Majumdar, Ross T. Tsuyuki, Dean T. Eurich and Jeffrey A. Johnson Dose–response relation between sulfonylurea drugs and mortality in type 2 diabetes mellitus: a population-based cohort study CMAJ. 2006 Jan 17;174(2):169-74.
6. Matteo Monami, Chiara Luzzi, Caterina Lamanna, Veronica Chiasserini, Filomena Addante, Carla Maria Desideri, Giulio Masotti, Niccolò Marchionni, Edoardo MannucciThree-year mortality in diabetic patients treated with different combinations of insulin secretagogues and metformin Diabetes Metab Res Rev. 2006 Apr 24.
7. Ceriello A, Hanefeld M, Leiter L, Monnier L, Moses A, Owens D, Tajima N, Tuomilehto J.Postprandial glucose regulation and diabetic complications. Arch Intern Med. 2004 Oct 25;164(19):2090-5.
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"Prevention and Treatment of Diabetic Nephropathy: Controversies Resolved?"Dr. Richard E. Gilbert (biography)
English - 2006-04-28 - 26 minutes
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Summary :
In this presentation Dr. Gilbert talks about anti-hypertensive therapy in the prevention and treatment of diabetic nephropathy, recent advances in understanding and remaining questions.
Are ACE inhibitors and ARBs equally good at slowing the progression of diabetic nephropathy? Studies such as IDNT and RENAAL have demonstrated renal benefits with ARBs in type 2 diabetic patients...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Prevalence of diabetic nephropathy and associated cardiovascular risk
- Effects of ARBs and ACE inhibitors on progression of diabetic nephropathy: current knowledge and remaining questions
- Evidence for decreased incidence of microalbuminuria with anti-hypertensive therapy in diabetic patients
- Approach to anti-hypertensive therapy in diabetes
Bibliographic references :
1. Anthony H. Barnett, M.D., Stephen C. Bain, M.D., Paul Bouter, Ph.D., Bengt Karlberg, M.D., Sten Madsbad, M.D., Jak Jervell, Ph.D., Jukka Mustonen, Ph.D., for the Diabetics Exposed to Telmisartan and Enalapril Study GroupAngiotensin-Receptor Blockade versus Converting–Enzyme Inhibition in Type 2 Diabetes and Nephropathy N Engl J Med. 2004 Nov 4;351(19):1952-61.
2. Piero Ruggenenti, M.D., Anna Fassi, M.D., Anelja Parvanova Ilieva, M.D., Simona Bruno, M.D., Ilian Petrov Iliev, M.D., Varusca Brusegan, M.D., Nadia Rubis, R.N., Giulia Gherardi, R.N., Federica Arnoldi, R.N., Maria Ganeva, Stat.Sci.D., Bogdan Ene-Iordache, Eng.D., Flavio Gaspari, Ph.D., Annalisa Perna, Stat.Sci.D., Antonio Bossi, M.D., Roberto Trevisan, M.D., Alessandro R. Dodesini, M.D., Giuseppe Remuzzi, M.D., for the Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) InvestigatorsPreventing Microalbuminuria in Type 2 Diabetes N Engl J Med. 2004 Nov 4;351(19):1941-51.
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"Treating Obesity in Type 2 DM: What's New?"Dr. Jeannette Goguen (biography)
English - 2006-04-28 - 30 minutes
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Summary :
Diabetes and obesity are intimately linked, says Dr. Goguen. Not only does visceral obesity lead to insulin resistance and diabetes but some antidiabetic agents also cause weight gain. Would stopping weight gain or promoting weight loss reduce the risk of cardiovascular disease in these patients?
Of the several components of weight loss programs, Dr. Goguen focuses on...
Learning objectives :
1. To know the benefits and risks for the use of each of the following medications to treat obesity in diabetes:
a. Sibutramine
b. Orlistat
c. Rimonabant
2. To understand limitations of drug studies in obesity
Bibliographic references :
J. Bruce Redmon, MD, Kristell P. Reck, RD, Susan K. Raatz, PHD, Joyce E. Swanson, RD, Christine A. Kwong, RD, Hong Ji, MS, William Thomas, PHD and John P. Bantle, MDTwo-Year Outcome of a Combination of Weight Loss Therapies for Type 2 Diabetes Diabetes Care 28:1311-1315, 2005.
NEW DRUG TREATS MULTIPLE PROBLEMS OF PEOPLE WITH TYPE 2 DIABETES: Rimonabant Lowers Blood Glucose and Reduces Weight, Waist Size, and Lipid Problems American Diabetes Association.
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"Thiazolidinediones and the Heart: A Tale of Two Organs?"Dr. Robin Buckingham (biography)
English - 2006-03-27 - 58 minutes
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Summary :
In this presentation Dr. Buckingham talks about congestive heart failure (CHF) and diabetes in general and in the context of thiazolidinedione treatment.
Are the perceived cardiovascular benefits of thiazolidinediones negated by an increased incidence of CHF? First looking at some background data, in a 6-year cohort study from Kaiser Permanente, risk factors for incident CHF were...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Risk factors for incident CHF
- Thiazolidinediones and other treatments in relation to CHF incidence
- Effects of thiazolidinediones on cardiac energy metabolism in type 2 diabetes
- Risk factors for heart failure in patients treated with thiazolidinediones
- Clinical practice recommendations
Bibliographic references :
1. Gregory A. Nichols, PHD, Christina M. Gullion, PHD, Carol E. Koro, PHD, Sara A. Ephross, PHD and Jonathan B. Brown, PHD, MPP The Incidence of Congestive Heart Failure in Type 2 Diabetes: An update Diabetes Care 27:1879-1884, 2004.
2. Ingelsson E, Sundstrom J, Arnlov J, Zethelius B, Lind L.Insulin resistance and risk of congestive heart failure. JAMA. 2005 Jul 20;294(3):334-41.
3. Varela-Roman A, Grigorian Shamagian L, Barge Caballero E, Mazon Ramos P, Rigueiro Veloso P, Gonzalez-Juanatey JR.Influence of diabetes on the survival of patients hospitalized with heart failure: A 12-year study Eur J Heart Fail. 2005 Aug;7(5):859-64.
4. Dormandy JA, Charbonnel B, Eckland DJ, Erdmann E, Massi-Benedetti M, Moules IK, Skene AM, Tan MH, Lefebvre PJ, Murray GD, Standl E, Wilcox RG, Wilhelmsen L, Betteridge J, Birkeland K, Golay A, Heine RJ, Koranyi L, Laakso M, Mokan M, Norkus A, Pirags V, Podar T, Scheen A, Scherbaum W, Schernthaner G, Schmitz O, Skrha J, Smith U, Taton J; PROactive investigators.Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study (PROspective pioglitAzone Clinical Trial In macroVascular Events): a randomised controlled trial Lancet. 2005 Oct 8;366(9493):1279-89.
5. Delea TE, Edelsberg JS, Hagiwara M, Oster G, Phillips LS.Use of Thiazolidinediones and Risk of Heart Failure in People With Type 2 Diabetes Diabetes Care 26:2983-2989, 2003.
6. Rajagopalan R, Rosenson RS, Fernandes AW, Khan M, Murray FT.Association between congestive heart failure and hospitalization in patients with type 2 diabetes mellitus receiving treatment with insulin or pioglitazone: a retrospective data analysis Clin Ther. 2004 Sep;26(9):1400-10.
7. A. J. Karter, A. T. Ahmed, J. Liu, H. H. Moffet and M. M. ParkerPioglitazone initiation and subsequent hospitalization for congestive heart failure Diabet Med. 2005 Aug;22(8):986-93.
8. Frederick A. Masoudi, MD, MSPH; Silvio E. Inzucchi, MD; Yongfei Wang, MS; Edward P. Havranek, MD; JoAnne M. Foody, MD; Harlan M. Krumholz, MDThiazolidinediones, Metformin, and Outcomes in Older Patients With Diabetes and Heart Failure: An Observational Study Circulation. 2005;111:583-590.
9. Inzucchi SE, Masoudi FA, Wang Y, Kosiborod M, Foody JM, Setaro JF, Havranek EP, Krumholz HM.Insulin-Sensitizing Antihyperglycemic Drugs and Mortality After Acute Myocardial Infarction: Insights from the National Heart Care Project Diabetes Care 28:1680-1689, 2005.
10. Lautamaki R, Airaksinen KE, Seppanen M, Toikka J, Luotolahti M, Ball E, Borra R, Harkonen R, Iozzo P, Stewart M, Knuuti J, Nuutila P.Rosiglitazone Improves Myocardial Glucose Uptake in Patients With Type 2 Diabetes and Coronary Artery Disease Diabetes 54:2787-2794, 2005.
11. Scheuermann-Freestone et al, Circulation 108 Suppl IV: IV-60, abstract 277, 2003.
12. Richard W. Nesto, MD; David Bell, MD; Robert O. Bonow, MD; Vivian Fonseca, MD; Scott M. Grundy, MD, PhD; Edward S. Horton, MD; Martin Le Winter, MD; Daniel Porte, MD; Clay F. Semenkovich, MD; Sidney Smith, MD; Lawrence H. Young, MD; Richard Kahn, PhD. Thiazolidinedione Use, Fluid Retention, and Congestive Heart Failure Circulation. 2003;108:2941.
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"Diabetes In Canada Evaluation (The DICE Study): Impact on Family Practice"Dr. Stewart Harris (biography)
English - 2006-03-08 - 60 minutes
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| (36 slides) |
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Summary :
In this presentation Dr. Harris talks about the Canadian diabetes epidemic and clinical practice guidelines, and findings from the Diabetes In Canada Evaluation (DICE) study on the management of type 2 diabetes in the family practice setting.
Along with the growing burden of type 2 diabetes in Canada a major challenge remains the translation of clinical practice guidelines into...
Learning objectives :
Overview:
- Epidemiology of diabetes
- Revisiting the CDA guidelines
- How are FPs doing?
- Review of the DICE study findings
- Conclusions
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"The FIELD Study"Prof. Timothy Davis (biography)
English - 2005-12-07 - 34 minutes
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| (43 slides) |
Summary :
The results of the FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) study were presented at the AHA meeting held in Dallas in November 2005. This was a randomised trial of the effects of fenofibrate on coronary morbidity and mortality in people with diabetes, and in this talk Prof. Davis presents the data and discusses its implications.
Fenofibrate reduces...
Learning objectives :
After viewing this presentation the participant will be able to discuss randomised evidence from the prospective FIELD study:
- Effects of fenofibrate on the risk of major coronary disease events in patients with type 2 diabetes
- Secondary and tertiary outcomes including total CVD events, stroke, progression of renal disease and others
- Safety
- Implications of the data
Bibliographic references :
The FIELD study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial Lancet. 2005 Nov 26;366(9500):1849-61.
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"Dual PPAR alpha/gamma Agonists - Promise and Problems"Prof. John Prins (biography)
English - 2005-12-07 - 22 minutes
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| (22 slides) |
Summary :
In this presentation Prof. Prins talks about a newer class of compounds, the dual PPAR alpha/gamma agonists, collectively known as the glitazars.
The Peroxisome Proliferator-Activated Receptors (PPARs) are ligand-activated transcription factors belonging to the nuclear hormone receptor superfamily. PPAR α ligands include the fibrate drugs which are used in patients with...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- PPAR isoforms, their effects and ligands
- Dual PPAR alpha/gamma agonists (glitazars): development and recent clinical data
- Safety issues related to glitazar treatment in type 2 diabetic patients
Bibliographic references :
1. Buse JB, Rubin CJ, Frederich R, Viraswami-Appanna K, Lin KC, Montoro R, Shockey G, Davidson JA.Muraglitazar, a dual (α/γ) PPAR activator: A randomized, double-blind, placebo-controlled, 24-week monotherapy trial in adult patients with type 2 diabetes Clin Ther. 2005 Aug;27(8):1181-95.
2. Nissen SE, Wolski K, Topol EJ.Effect of muraglitazar on death and major adverse cardiovascular events in patients with type 2 diabetes mellitus. JAMA. 2005 Nov 23;294(20):2581-6.
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"Update on Dietary and Drug Management of Atherogenic Dyslipidemia of the Insulin Resistance Syndrome"Dr. Ronald M. Krauss (biography)
English - 2005-11-13 - 61 minutes
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| (38 slides) |
Summary :
In this presentation Dr. Krauss talks about treatment options that are available for the management of the atherogenic dyslipidemia associated with insulin resistance.
This atherogenic dyslipidemia is characterised by high triglycerides, low HDL cholesterol and an increase in small dense LDL particles. Although pharmacological treatments are available to address these...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The nature of atherogenic dyslipidemia associated with insulin resistance
- Effects of diet and exercise on dyslipidemia
- Effects on triglycerides, HDL cholesterol and LDL particle size due to treatment with statins, niacin, fibrates and glitazones
Bibliographic references :
1. Michael L. Dansinger, MD; Joi Augustin Gleason, MS, RD; John L. Griffith, PhD; Harry P. Selker, MD, MSPH; Ernst J. Schaefer, MD. Comparison of the Atkins, Ornish, Weight Watchers, and Zone Diets for Weight Loss and Heart Disease Risk Reduction: A Randomized Trial JAMA. 2005;293:43-53.
2. Orchard TJ, Temprosa M, Goldberg R, Haffner S, Ratner R, Marcovina S, Fowler S; Diabetes Prevention Program Research Group. The effect of metformin and intensive lifestyle intervention on the metabolic syndrome: the Diabetes Prevention Program randomized trial. Ann Intern Med. 2005 Apr 19;142(8):611-9.
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"Differential Effects of Rosiglitazone and Metformin on Inflammation and Subclinical Atherosclerosis in Patients with Type 2 Diabetes - The CHD Study"Prof. Allen J. Taylor (biography)
English - 2005-11-13 - 22 minutes
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| (21 slides) |
Summary :
In this talk Prof. Taylor presents the results of the CHD (Coronary Health in Diabetics) study, a randomized clinical trial on rosiglitazone vs. metformin in type 2 diabetic patients.
The insulin-sensitising antidiabetic agent metformin was shown to reduce cardiovascular outcomes in the UKPD Study, and it remains to be seen what are the effects on cardiovascular risk of the...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Effects of rosiglitazone vs. metformin in type 2 diabetic patients:
- -> Glycemic control
- -> Changes in CRP
- -> Changes in CIMT
- Implications of the CHD study
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"The VICTORY Study: Assessing the efficacy of rosiglitazone in inhibiting the progression of atherosclerosis in CABG surgery" (biography)
English - 2005-10-25 - 29 minutes
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| (23 slides) |
Summary :
In this talk Dr. Bertrand gives an overview of the design and objectives of the VICTORY (VeIn-Coronary ATherOsclerosis and Rosiglitazone after Bypass surgerY) trial.
Research conducted at the Montreal Heart Institute on bypass patients has shown that the majority of vein grafts show atherosclerotic changes after 10 years. The overall objectives of VICTORY are to assess the efficacy...
Learning objectives :
Key learning points:
1. Presentation of the VICTORY trial protocol, the first cardio-metabolic trial in type 2 diabetes patients to assess atherosclerosis progression and its detailed interrelations with metabolic abnormalities.
2. Understand the combinations of intravascular ultrasound, angiography, DEXA, abdominal CT-scan, exercise test, holter monitoring and biological markers to assess cardio-metabolic abnormalities in type 2 diabetes patients.
3. Understand the use of saphenous vein graft as a clinical model of accelerated atherosclerosis.
4. Understand the use of DEXA and abdominal CT-scan to assess morphology abnormalities in type 2 diabetes patients.
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"TZDs and Atherosclerosis: Can They Make a Difference?"Dr. Lawrence A. Leiter (biography)
English - 2005-10-25 - 36 minutes
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| (65 slides) |
Summary :
Vascular disease is a leading cause of death in diabetes, and cardiovascular risk is increased even before the diagnosis of diabetes, as seen in the Nurses' Health Study (1). How well is glycemia being controlled in type 2 diabetic patients in Canada? The cross-sectional DICE (Diabetes in Canada Evaluation) study showed that half of the patients are not at target. Although physicians seem to be...
Learning objectives :
Key learning points:
1. TZDs can decrease multiple traditional and non-traditional CV risk factors.
2. There are now a number of trials using surrogate endpoints suggesting decreased CV risk in TZD-treated patients.
3. The results of the PROACTIVE study, although not definitive, are consistent with the anti-atherosclerotic effects of TZDs.
4. Ongoing clinical trials will hopefully definitively reveal if TZDs reduce CV risk.
Bibliographic references :
1. Haffner SJ, Cassells H. Hyperglycemia as a cardiovascular risk factor. The American Journal of Medicine. 115(8), 6-11.
2. Hanley AJ, Williams K, Stern MP, Haffner SM. Homeostasis Model Assessment of Insulin Resistance in Relation to the Incidence of Cardiovascular Disease. Diabetes Care. 2002 Vol. 25, 1177-1184.
3. Enzo Bonora, Gianni Formentini, Francesco Calcaterra, Simonetta Lombardi, Franco Marini, Luciano Zenari, Francesca Saggiani, Maurizio Poli, Sandro Perbellini, Andrea Raffaelli, Vittorio Cacciatori, Lorenza Santi, Giovanni Targher, Riccardo Bonadonna, and Michele Muggeo. HOMA-Estimated Insulin Resistance Is an Independent Predictor of Cardiovascular Disease in Type 2 Diabetic Subjects - Prospective data from the Verona Diabetes Complications Study. Diabetes Care. 2002 Vol. 25, 1135-1141.
4. Jagdip S. Sidhu; Zoltan Kaposzta; Hugh S. Markus; Juan Carlos Kaski. Effect of Rosiglitazone on Common Carotid Intima-Media Thickness Progression in Coronary Artery Disease Patients Without Diabetes Mellitus. Arteriosclerosis, Thrombosis, and Vascular Biology. May 2004; 24 930 – 934.
5. Hiroyuki Koshiyama, Dai Shimono, Naomitsu Kuwamura, Jun Minamikawa, and Yoshio Nakamura. RAPID COMMUNICATION: Inhibitory Effect of Pioglitazone on Carotid Arterial Wall Thickness in Type 2 Diabetes. The Journal of Clinical Endocrinology and Metabolism. July 2001; 86, 3452-6.
6. Choi SH et al. Diabetes. 2003;52 (suppl 1):A18. Oral presentation 82-0R.
7. Masoudi F.A. et al. Diabetes 2004; 53(Suppl.2);A29.
8. The official PROactive results website
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"The Link Between Diet, Exercise, and Insulin Resistance Reduction"Dr. Stuart A Ross (biography)
English - 2005-10-21 - 36 minutes
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| (20 slides) |
Summary :
In this presentation Dr. Ross talks about the importance of understanding the pathophysiology of type 2 diabetes, identifying the needs of the individual patient and tailoring their treatment accordingly to achieve optimal diabetes management.
Type 2 diabetes is characterised by impaired insulin secretion, as well as insulin resistance which can promote the development of...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The pathophysiology of type 2 diabetes
- The progressive nature of type 2 diabetes
- Recent treatment guidelines from the Canadian Diabetes Association
- The state of glycaemic control in type 2 diabetic patients in Canada
- Action points for the management of diabetic patients
Bibliographic references :
1. UK Prospective Diabetes Study (UKPDS) GroupIntensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)Lancet. 1998 Sep 12;352(9131):837-53.
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"The PROACTIVE Study: What are Its Implications for the Management of Diabetes in Canada?"Dr. Lawrence A. Leiter (biography)
English - 2005-09-14 - 35 minutes
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| (50 slides) |
Summary :
In this presentation Dr. Leiter reviews the major results of the PROactive (PROspective PioglitAzone Clinical Trial In MacroVascular Events) study presented at the recent European Association for the Study of Diabetes (EASD) meeting in Athens.
Taking into account findings from the UK Prospective Diabetes Study (UKPDS), the 2003 Canadian Diabetes Association clinical practice...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Current Canadian treatment guidelines for overweight type 2 diabetic patients with mild to moderate hyperglycemia
- Findings from the PROactive study presented at the 2005 EASD meeting
Bibliographic references :
1. CDA Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Canadian Journal of Diabetes. Dec,2003;27(Suppl 2): S39.
2. proactive-results.com The official PROactive results website
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"Anti-atherogenic Effects of PPAR gamma Activators – From Bench to Bedside"Prof. Nikolaus Marx (biography)
English - 2005-09-14 - 32 minutes
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| (47 slides) |
Summary :
During this presentation Prof. Marx talks about the role of peroxisome proliferator-activated receptor gamma (PPARγ) activators in vascular disease.
PPARγ activators are regulators of gene expression in adipocytes and in muscle, increasing insulin sensitivity and modulating glucose homeostasis (1). PPARγ which is activated by thiazolidinediones (TZDs/glitazones), has...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
PPARγ activators – background
PPARγ activators – anti-atherogenic effects
-- in vitro
-- in vivo
Bibliographic references :
1. Nikolaus Marx, Hélène Duez, Jean-Charles Fruchart, Bart Staels Peroxisome Proliferator-Activated Receptors and Atherogenesis: Regulators of Gene Expression in Vascular Cells Circulation Research. 2004;94:1168.
2. Nikolaus Marx, Galina Sukhova, Curran Murphy, Peter Libby and Jorge Plutzky Macrophages in Human Atheroma Contain PPAR{gamma}: Differentiation-Dependent Peroxisomal Proliferator-ActivatedReceptor {gamma} (PPAR{gamma}) Expression and Reduction of MMP-9 Activity through PPAR{gamma} Activation in Mononuclear Phagocytes inVitro American Journal of Pathology. 1998;153:17-23.
3. Nikolaus Marx; Todd Bourcier; Galina K. Sukhova; Peter Libby; Jorge PlutzkyPPAR{gamma} Activation in Human Endothelial Cells Increases Plasminogen Activator Inhibitor Type-1 Expression: PPAR{gamma} as a Potential Mediator in Vascular Disease Arteriosclerosis, Thrombosis, and Vascular Biology. 1999;19:546-551.
4. Nikolaus Marx, Bettina Kehrle, Klaus Kohlhammer, Miriam Grüb, Wolfgang Koenig, Vinzenz Hombach, Peter Libby, Jorge Plutzky PPAR Activators as Antiinflammatory Mediators in Human T Lymphocytes: Implications for Atherosclerosis and Transplantation-Associated Arteriosclerosis Circulation Research. 2002;90:703.
5. Nikolaus Marx, Daniel Walcher, Nina Ivanova, Kirstin Rautzenberg, Annelie Jung, Reinhard Friedl, Vinzenz Hombach, Raffaele de Caterina, Giuseppina Basta, Marie-Paule Wautier, and Jean-Luc Wautiers Thiazolidinediones Reduce Endothelial Expression of Receptors for Advanced Glycation End Products Diabetes 53:2662-2668, 2004.
6. Nikolaus Marx, Uwe Schönbeck, Mitchell A. Lazar, Peter Libby, , Jorge PlutzkyPeroxisome Proliferator-Activated Receptor Gamma Activators Inhibit Gene Expression and Migration in Human Vascular Smooth Muscle Cells Circulation Research. 1998;83:1097-1103.
7. Pfutzner A, Marx N, Lubben G, Langenfeld M, Walcher D, Konrad T, Forst T.Improvement of Cardiovascular Risk Markers by Pioglitazone Is Independent From Glycemic Control: Results From the Pioneer Study Journal of the American College of Cardiology.Volume 45, Issue 12 , 21 June 2005, Pages 1925-1931.
8. Nikolaus Marx; Johannes Froehlich; Laila Siam; Jochen Ittner; Gerhard Wierse; Arnold Schmidt; Hubert Scharnagl; Vinzenz Hombach; Wolfgang KoenigAntidiabetic PPAR{gamma}-Activator Rosiglitazone Reduces MMP-9 Serum Levels in Type 2 Diabetic Patients With Coronary Artery Disease Arteriosclerosis, Thrombosis, and Vascular Biology. 2003;23:283.
9. Nikolaus Marx, MD; Armin Imhof, MD; Johannes Froehlich, MS; Laila Siam, MS; Jochen Ittner, MD; Gerhard Wierse, MD; Arnold Schmidt, MD; Winfried Maerz, MD; Vinzenz Hombach, MD; Wolfgang Koenig, MDEffect of Rosiglitazone Treatment on Soluble CD40L in Patients With Type 2 Diabetes and Coronary Artery Disease Circulation. 2003;107:1954.
10. Dandona P. Diabetologia 2001; 44 (Suppl 1): A36, Abs 136.
11. Donghoon Choi, MD, PHD, Soo-Kyung Kim, MD, Sung-Hee Choi, MD, Young-Guk Ko, MD, Chul-Woo Ahn, MD, PHD, Yangsoo Jang, MD, PHD, Sung-Kil Lim, MD, PHD, Hyun-Chul Lee, MD, PHD1, and Bong-Soo Cha, MD, PHD. Preventative Effects of Rosiglitazone on Restenosis After Coronary Stent Implantation in Patients With Type 2 Diabetes Diabetes Care 27:2654-2660, 2004.
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"Effect of Troglitazone on Pre-Clinical Carotid Atherosclerosis in Women with Recent Gestational Diabetes"Prof. Thomas A. Buchanan (biography)
English - 2005-06-10 - 26 minutes
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| (18 slides) |
Summary :
In this presentation Prof. Buchanan discusses data from the TRIPOD (Troglitazone in the Prevention of Diabetes) study on the impact of troglitazone treatment on the progression of pre-clinical atherosclerosis in high-risk Hispanic women with recent gestational diabetes, and mechanisms by which troglitazone may slow this progression.
Carotid intima media thickness (IMT) serves as a...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Data from the IMT analysis of the TRIPOD Study, showing the effect of troglitazone on IMT progression in Hispanic women at high risk for type 2 diabetes.
Bibliographic references :
Anny H. Xiang, Ruth K. Peters, Siri L. Kjos, Cesar Ochoa, Aura Marroquin, Jose Goico, Sylvia Tan, Chengwei Wang, Stanley P. Azen, Chao-ran Liu, Ci-hua Liu, Howard N. Hodis and Thomas A. Buchanan. Effect of Thiazolidinedione Treatment on Progression of Subclinical Atherosclerosis in Premenopausal Women at High Risk for Type 2 Diabetes J Clin Endocrinol Metab. 2005 Apr;90(4):1986-91.
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