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- March 15, 2010 |
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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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"Pre-diabetes: Definition"Dr. Sir George Alberti (biography)
English - 2005-04-14 - 34 minutes
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Summary :
Prediabetes is an old term first used officially by WHO as a retrospective diagnosis to describe the state of a person which preceded the diagnosis of diabetes in that person. A radical new definition was introduced in the United States recently to describe collectively people found to have IGT and/or IFG. In other words it describes those with a high risk of developing diabetes in the future and...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The changing definition of "prediabetes" according to a historical perspective
- Limitations of the current definition of “prediabetes”
Bibliographic references :
JACKSON WP;That expression, "prediabetes". Diabetes. 1962 Jul-Aug;11:334.
Keen H, Jarrett RJ, McCartney P.; The ten-year follow-up of the Bedford survey (1962-1972): glucose tolerance and diabetes. Diabetologia. 1982 Feb;22(2):73-8.
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""Prediabetes" - A Global Snapshot"Prof. Paul Zimmet (biography)
English - 2005-04-14 - 28 minutes
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Summary :
The dramatic increase in the prevalence of diabetes (mainly type 2) world-wide is a matter of enormous concern to public health authorities in both developed and developing nations and international agencies such as WHO. Perhaps of even greater concern is the simultaneous dramatic increase in numbers with IFG and IGT (prediabetes). This is occurring not only in adults but, in so far poorly...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Prevalence rates of prediabetes in different populations around the world
- Gender differences in abnormal glucose tolerance
- IGT and IFG as CVD risk factors
- Progression to diabetes
Bibliographic references :
Davies MJ, Raymond NT, Day JL, Hales CN, Burden AC. Impaired glucose tolerance and fasting hyperglycaemia have different characteristics.Diabet Med. 2000 Jun;17(6):433-40.
F de Vegt, JM Dekker, CD Stehouwer, G Nijpels, LM Bouter and RJ Heine. Similar 9-year mortality risks and reproducibility for the World Health Organization and American Diabetes Association glucose tolerance categories: the Hoorn StudyDiabetes Care. 2000;23(1):40-44.
SB Harris, J Gittelsohn, A Hanley, A Barnie, TM Wolever, J Gao, A Logan and B Zinman. The prevalence of NIDDM and associated risk factors in native CanadiansDiabetes Care. 1997; 20(2):185-187.
M Tominaga, H Eguchi, H Manaka, K Igarashi, T Kato and A Sekikawa.
Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes StudyDiabetes Care. 1999; 22(6):920-924.
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"IDF Consensus on the Metabolic Syndrome: Definition and Treatment"Dr. Sir George Alberti (biography)
English - 2005-04-14 - 38 minutes
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Summary :
The modern era of the "metabolic syndrome" began with the seminal work of Reaven and his Banting Lecture in 1988. He described the association of glucose intolerance, hypertension, dyslipidaemia and obesity and termed it Syndrome X with insulin resistance suggested as the unifying underlying aetiological factor. An explosion of studies and publications followed with the syndrome given a variety...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Different names and criteria used to describe the metabolic syndrome
- Conclusions from the 2004 IDF Consensus Meeting on the Metabolic Syndrome
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"Origin and Development of the Metabolic Syndrome"Prof. Gaetano Crepaldi (biography)
English - 2005-04-14 - 32 minutes
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Summary :
The metabolic syndrome, as a conceptual entity, is a relatively young one. However, the first descriptions of the syndrome and its associated pathology reach as far back as the 17th century. Prof. Gaetano Crepaldi of the University of Padua leads us through the history of the metabolic syndrome, from the first observations of Turp and Morgagni to the accelerated understanding of this “peculiar...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The history of the metabolic syndrome
• The different definitions of the metabolic syndrome
• The new consensus on the definitions of the components of the metabolic syndrome
• Recent scientific achievements in the study of the components of the metabolic syndrome
• The results of the Italian Longitudinal Study of Aging (ILSA)
• Future challenges in the study the metabolic syndrome
Bibliographic references :
P. Avogaro, G. Crepaldi, G. Enzi, A. Tiengo. Association of hyperlipemia, diabetes mellitus and mild obesity. Acta Diabetologica Latina, Vol IV, 1967
Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) JAMA 2001; 285: 2486-2497.
Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002 Jan 16;287(3):356-9.
Superko HR. Beyond LDL cholesterol reduction. Circulation. 1996 Nov 15;94(10):2351-4.
Austin MA, Edwards KL. Small, dense low density lipoproteins, the insulin resistance syndrome and noninsulin-dependent diabetes. Curr Opin Lipidol. 1996 Jun;7(3):167-71.
Thompson SG, Kienast J, Pyke SD, Haverkate F, van de Loo JC. Hemostatic factors and the risk of myocardial infarction or sudden death in patients with angina pectoris. European Concerted Action on Thrombosis and Disabilities Angina Pectoris Study Group. N Engl J Med. 1995 Mar 9;332(10):635-41.
Faggin E, Zambon A, Puato M, Deeb SS, Bertocco S, Sartore S, Crepaldi G, Pessina AC, Pauletto P. Association between the --514 C-->T polymorphism of the hepatic lipase gene promoter and unstable carotid plaque in patients with severe carotid artery stenosis. J Am Coll Cardiol. 2002 Sep 18;40(6):1059-66.
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"Management of the Metabolic Syndrome: The Evidence Base"Prof. Philip Barter (biography)
English - 2005-04-14 - 27 minutes
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Summary :
Features of the metabolic syndrome include central adiposity, insulin resistance, dyslipidaemia and mild hypertension. Each of these features contributes to an increased CV risk. Management includes lifestyle measures to promote weight reduction, anti-hypertensive therapy and the use of statins, fibrates and niacin to treat the dyslipidaemia. Insulin sensitizers such as PPAR-gamma agonists may...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• Which factors predict benefit (reduced cardiovascular risk) from fibrate therapy (Helsinki Heart Study, BIP Study, VA-HIT study)
• Which factors predict benefit from statin therapy (Heart Protection Study)
• What the evidence for fibrate therapy tells us about the metabolic syndrome as a disease entity
Bibliographic references :
Tenkanen L, Manttari M, Manninen V. Some coronary risk factors related to the insulin resistance syndrome and treatment with gemfibrozil. Experience from the Helsinki Heart Study. Circulation. 1995 Oct 1;92(7):1779-85.
Manninen V, Tenkanen L, Koskinen P, Huttunen JK, Manttari M, Heinonen OP, Frick MH. Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study. Implications for treatment. Circulation. 1992 Jan;85(1):37-45.
BIP Study Group. Secondary prevention by raising HDL cholesterol and reducing triglycerides in patients with coronary artery disease: the Bezafibrate Infarction Prevention (BIP) study. Circulation. 2000 Jul 4;102(1):21-7.
Rubins HB, Robins SJ, Collins D, Nelson DB, Elam MB, Schaefer EJ, Faas FH, Anderson JW. Diabetes, plasma insulin, and cardiovascular disease: subgroup analysis from the Department of Veterans Affairs high-density lipoprotein intervention trial (VA-HIT). Arch Intern Med. 2002 Dec 9-23;162(22):2597-604.
Collins R, Armitage J, Parish S, Sleigh P, Peto R; Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol-lowering with simvastatin in 5963 people with diabetes: a randomised placebo-controlled trial. Lancet. 2003 Jun 14;361(9374):2005-16.
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"Australia and the Obesity Epidemic - Past and Future"Dr. Senator Guy Barnett (biography)
English - 2005-04-14 - 20 minutes
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Summary :
Australians are getting fatter, asserts Australian Senator Guy Barnett of Tasmania. What is to be done about it?
Senator Barnett presents here a synopsis of the state of the obesity epidemic in Australia, highlighting both the health and economic costs and addressing some of the societal issues that may be at the root of this growing problem.
Most interestingly,...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The state of the obesity epidemic in Australia
• The initiatives that the Australian Government has instituted in the community
• The initiatives that the Australian Government has instituted with key stakeholders
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"The Metabolic Syndrome -The Clinicians' Point of View"Prof. Gerard Slama (biography)
English - 2005-04-14 - 29 minutes
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Summary :
The concept of metabolic syndrome was suspected in the 1950's by a clinician, Jean Vague, in Marseille, France. This remarkable physician noticed that women exhibiting abdominal obesity were more frequently suffering from diabetes, hypertension, and cardiovascular complications. With the thousand of epidemiological and observational studies witch have appeared since, the clinician can only be...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The partners in the Metabolic Syndrome Polylogue
• The regulatory oriented/legalistic approach to the management of patients with the metabolic syndrome
• The academic (prudent) approach to the management of patients with the metabolic syndrome
• The activist approach to the management of patients with the metabolic syndrome
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"The Metabolic Syndrome - Payers / Insurers Perspective"Prof. Avi Porath (biography)
English - 2005-04-14 - 27 minutes
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Summary :
Payers and insurers are increasingly recognizing the importance of the metabolic syndrome as a risk factor for cardiovascular (CV) events. Due to limited resources, modern health systems must develop a managerial approach to the condition of metabolic system in the framework of their global CV management priorities. Only recently payers have expanded their management programs to include primary...
Learning objectives :
Managerial formal considerations:
- Magnitude of the problem
- Effectiveness of interventions
- Cost-effectiveness
- Affordability
- Priority setting
Additional considerations
Conclusions
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"IFG and IGT - State of the Art"Dr. Nigel Unwin (biography)
English - 2005-04-14 - 32 minutes
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Summary :
Impaired glucose tolerance (IGT) and impaired fasting glycaemia (IFG) represent higher than normal blood glucose levels, based on post glucose challenge and fasting blood measurement respectively, and are associated with a markedly increased risk of developing diabetes and an increased risk of cardiovascular disease. Interest in these categories has grown with the clear demonstration that...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Epidemiology of IFG and IGT
- Metabolic characteristics and CV risk factors associated with IFG and IGT
- Risk of diabetes and CVD mortality associated with IFG and IGT
- ADA proposal to lower the cut point for IFG
Bibliographic references :
M Coutinho, HC Gerstein, Y Wang and S Yusuf. The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 yearsDiabetes Care. 1999;22(2):233-240.
Andreas Festa, Ralph D’Agostino, Jr., Anthony J.G. Hanley, Andrew J. Karter, Mohammed F. Saad, and Steven M. Haffner. Differences in Insulin Resistance in Nondiabetic Subjects With Isolated Impaired Glucose Tolerance or Isolated Impaired Fasting Glucose Diabetes 53:1549-1555, 2004.
The DECODE Study Group Age- and Sex-Specific Prevalences of Diabetes and Impaired Glucose Regulation in 13 European CohortsDiabetes Care 26:61-69, 2003.
N. Unwin, J. Shaw, P. Zimmet and K. G. M. M. Alberti. Impaired glucose tolerance and impaired fasting glycaemia: the current status on definition and intervention Diabetic Medicine. Volume 19 Issue 9 Page 708 - September 2002.
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"Impaired Glucose Tolerance versus Impaired Fasting Glucose: Is the Risk the Same?"Prof. Markolf Hanefeld (biography)
English - 2005-04-14 - 29 minutes
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Summary :
IGT and IFG are two risk categories for type 2 diabetes. According to the NCEPIII definition fasting hyperglycemia but not postchallenge hyperglycemia is considered as a single trait of the metabolic syndrome. As consistently shown IFG and IGT bear a similar risk for subsequent conversion to type 2 diabetes. They are, however, different in underlying pathophysiology: IFG is more related to...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Differences in demographic epidemiology between IFG and IGT
- Differences in underlying pathophysiology between IFG and IGT
- IFG- and IGT-associated risk for diabetes
- Differences in the risk of CVD with IFG or IGT
Bibliographic references :
Markolf Hanefeld, MD, PHD, Carsta Koehler, PHD, Katja Fuecker, DIPL CHEM, Elena Henkel, MD, Frank Schaper, MD and Theodora Temelkova-Kurktschiev, MD, PHD. Insulin Secretion and Insulin Sensitivity Pattern Is Different in Isolated Impaired Glucose Tolerance and Impaired Fasting Glucose - The Risk Factor in Impaired Glucose Tolerance for Atherosclerosis and Diabetes Study Diabetes Care 26:868-874, 2003.
Kohler C, Temelkova-Kurktschiev T, Schaper F, Fucker K, Hanefeld M.
[Prevalence of newly diagnosed type 2 diabetes, impaired glucose tolerance and abnormal fasting glucose in a high risk population. Data from the RIAD study using new diagnostic criteria for diabetes]Dtsch Med Wochenschr. 1999 Sep 17;124(37):1057-61.
TS Temelkova-Kurktschiev, C Koehler, E Henkel, W Leonhardt, K Fuecker and M Hanefeld. Postchallenge plasma glucose and glycemic spikes are more strongly associated with atherosclerosis than fasting glucose or HbA1c levelDiabetes Care. 2000;23(12):1830-1834.
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"Control of Adipocyte Function by Nuclear Receptors of the PPAR and REV-ERBalpha Family"Prof. Bart Staels (biography)
English - 2005-04-14 - 34 minutes
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Summary :
Lipid and carbohydrate homeostasis is controlled by integrated systems that allow higher organisms to respond to metabolic changes. Numerous signals reciprocally convey information about body fat status from the periphery to the central nervous system in an attempt to maintain body weight stable throughout life. The role of the adipocyte in energy homeostasis goes beyond its function as a simple...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Rev-erbα- and PPARγ-mediated effects in vivo
- The effects of Rev-erbα deficiency in vivo
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"Insulin Resistance and Glucose Allostasis"Prof. Michael Stumvoll (biography)
English - 2005-04-14 - 34 minutes
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Summary :
Maintance of glycemia is of vital importance. Regulation of glycemia is accomplished by the balanced interplay between insulin action and insulin secretion. It is common belief that in healthy humans plasma glucose concentration is regulated by a homeostatic system, i.e. a system designed to maintain plasma glucose concentration constant. Here we review evidence that in response to a chronic...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The variation of serum glucose levels with different degrees of insulin resistance (IR)
• The signals that may be responsible for the increase beta cell response to IR
• The definition of the Disposition Index (DI)
• The definition of the Beta Cell Demand Index (BCDI)
• The relationship of both the DI and the BCDI to serum glucose levels
Bibliographic references :
Michael Stumvoll, P. Antonio Tataranni, Norbert Stefan, Barbora Vozarova, and Clifton Bogardus Glucose Allostasis Diabetes 52:903-909, 2003
Stumvoll M, Tataranni PA, Bogardus C. The hyperbolic law--a 25-year perspective. Diabetologia. 2005 Feb;48(2):207-9.
Stumvoll M, Goldstein BJ, van Haeften TW. Type 2 diabetes: principles of pathogenesis and therapy. Lancet. 2005 Apr;365(9467):1333-46.
Weyer C, Bogardus C, Mott DM, Pratley RE. The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus. J Clin Invest. 1999 Sep;104(6):787-94.
Goran MI, Gower BA. Longitudinal study on pubertal insulin resistance. Diabetes. 2001 Nov;50(11):2444-50
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"Genetics of Type 2 Diabetes and the Metabolic Syndrome?"Prof. Leif C Groop (biography)
English - 2005-04-14 - 27 minutes
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Summary :
Whereas diabetes can be diagnosed by measuring blood glucose, there are few laboratory tests for diagnosing diabetic subgroups like type 1 and type 2 diabetes (T2D). In general, everything which is not type 1 diabetes has been considered as type 2 diabetes. Therefore, T2D has accounted between 85-99% of all cases with diabetes around the world. This certainly represents an oversimplification of...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Metabolic disturbances leading to type 2 diabetes
- Some important susceptibility genes for type 2 diabetes
Bibliographic references :
Charlotte Ling, Pernille Poulsen, Emma Carlsson, Martin Ridderstråle, Peter Almgren, Jørgen Wojtaszewski, Henning Beck-Nielsen, Leif Groop and Allan VaagMultiple environmental and genetic factors influence skeletal muscle PGC-1(alpha) and PGC-1ß gene expression in twins
J. Clin. Invest. 114:1518-1526 (2004).
Valeriya Lyssenko, Peter Almgren, Dragi Anevski, Roland Perfekt, Kaj Lahti, Michael Nissén, Bo Isomaa, Björn Forsen, Nils Homström, Carola Saloranta, Marja-Riitta Taskinen, Leif Groop, and Tiinamaija Tuomi for the Botnia Study Group Predictors of and Longitudinal Changes in Insulin Sensitivity and Secretion Preceding Onset of Type 2 Diabetes
Diabetes 54:166-174, 2005.
Vamsi K Mootha, Cecilia M Lindgren, Karl-Fredrik Eriksson, Aravind Subramanian, Smita Sihag, Joseph Lehar, Pere Puigserver, Emma Carlsson, Martin Ridderstråle, Esa Laurila, Nicholas Houstis, Mark J Daly, Nick Patterson, Jill P Mesirov, Todd R Golub, Pablo Tamayo, Bruce Spiegelman, Eric S Lander, Joel N Hirschhorn, David Altshuler & Leif C GroopPGC-1-(alpha) responsive genes involved in oxidative phosphorylation are coordinately downregulated in human diabetes
Nature Genetics 34, 267 - 273 (2003).
David Altshuler, Joel N. Hirschhorn, Mia Klannemark, Cecilia M. Lindgren, Marie-Claude Vohl, James Nemesh, Charles R. Lane, Stephen F. Schaffner, Stacey Bolk, Carl Brewer, Tiinamaija Tuomi, Daniel Gaudet, Thomas J. Hudson, Mark Daly, Leif Groop & Eric S. LanderThe common PPAR(gamma) Pro12Ala polymorphism is associated with decreased risk of type 2 diabetesNature Genetics.2000;volume 26 no. 1 pp 76 - 80.
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"Comparison of the Observed Prevalence of the Metabolic Syndrome with that Expected According to the Random Clustering of its Components. The MGSD Study in Five Mediterranean Countries"Prof. Basil Karamanos (biography)
English - 2005-04-14 - 16 minutes
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Summary :
AIM: To investigate the prevalence of the Metabolic Syndrome (MS, NCEP criteria) and the various combinations of its components in comparison to the expected frequencies of by chance clustering of these components.
SUBJECTS AND METHODS: We studied 1833 subjects, 20-74 years, in 5 Mediterranean Countries. Blood pressure, waist circumference, fasting glucose and lipids were measured....
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The goals of the Mediterranean Group for the Study of Diabetes (MGSD) Nutrition Study
• The design of the MGSD Nutrition Study
• The prevalence of the metabolic syndrome (ATP-III definition) and its components among the study population
• How this prevalence compares to the chance clustering of the components
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"Prevalence of the Metabolic Syndrome, and the Ability of 3 Definitions to Identify Incident Cases of Diabetes in Australia"Prof. Jonathan Shaw (biography)
English - 2005-04-14 - 24 minutes
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Summary :
The World Health Organisation (WHO), the (American) National Cholesterol Education Program (NCEP) and the European Group for the study of Insulin Resistance (EGIR) have recently developed independent definitions of the metabolic syndrome (MS). Data from the Australian AusDiab study (1999), and the 5 year follow-up, have been used to calculate the national prevalence of the MS and the ability of...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The prevalence of the metabolic syndrome in Australia, using 3 commonly used definitions (WHO, EGIR, ATP-III) as found in the AusDiab Study
• The capacity of the metabolic syndrome to predict incident diabetes
• The degree of insulin resistance associated with each of the 3 definitions
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"Prevalence of the Metabolic Syndrome in Spanish Population"Dr. M.T. Martinez-Larrad (biography)
English - 2005-04-14 - 19 minutes
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Summary :
The MS is a cluster of metabolic abnormalties conferring an increased risk for DM2 and high cardiovascular morbimortality. We investigate the prevalence of the MS in a sample of the Spanish population. A cross-sectional survey in 809 individuals (males 46%), aged 35 - 74 years. A OGTT was performed in all participants. MS was diagnosed according to the criteria issued by NCEP-ATPIII, 3 or more of...
Learning objectives :
- To review data from a cross-sectional population based study to estimate the prevalence of metabolic syndrome in the Spanish population.
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"Neural Control of Energy Balance"Prof. Stephen C. Woods (biography)
English - 2005-04-14 - 32 minutes
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Summary :
Knowledge of the hormones, neurotransmitters and neural pathways that regulate energy homeostasis is increasing at a rapid pace. Food intake was historically thought to occur in response to acute energy demands; however, current evidence suggests that meals occur based on habit and convenience rather than on metabolic need. Most individuals maintain stable body weights over long intervals by...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The satiety system of energy balance
• The adiposity system of energy balance
• The central integrators of energy balance
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"Genetics of Obesity"Dr. Claude Bouchard (biography)
English - 2005-04-14 - 39 minutes
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Summary :
Obesity is one of the most pressing public health problems in the industrialized world. Twin, adoption, and family studies have shown that genetic factors play a significant role in the pathogenesis of obesity. Rare mutations in humans and model organisms have provided insights into the pathways involved in body weight regulation. To date, almost 200 human obesity cases have been ascribed to...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The four adiposity phenotypes
• The five genetic hypotheses of obesity
• The evidence for single gene diseases
• The evidence for oligogenic disorders
Bibliographic references :
Pietilainen KH, Rissanen A, Kaprio J, Makimattila S, Hakkinen AM, Westerbacka J, Sutinen J, Vehkavaara S, Yki-Jarvinen H. Acquired obesity is associated with increased liver fat, intra-abdominal fat, and insulin resistance in young adult monozygotic twins. Am J Physiol Endocrinol Metab. 2005 Apr;288(4):E768-74. Epub 2004 Dec 7.
Bouchard C, Tremblay A, Despres JP, Nadeau A, Lupien PJ, Theriault G, Dussault J, Moorjani S, Pinault S, Fournier G. The response to long-term overfeeding in identical twins. N Engl J Med. 1990 May 24;322(21):1477-82.
Perusse L, Rankinen T, Zuberi A, Chagnon YC, Weisnagel SJ, Argyropoulos G, Walts B, Snyder EE, Bouchard C. The human obesity gene map: the 2004 update. Obes Res. 2005 Mar;13(3):381-490.
Human Obesity Gene Map Website
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"Societal Approach to DM Prevention in the Young"Prof. Francine Kaufman (biography)
English - 2005-04-14 - 33 minutes
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Summary :
Rather than contributing to the emerging epidemic of type 2 diabetes in the global pediatric population, schools, communities and governments must play a role in preventing this disorder. There is ample evidence that lifestyle interventions can prevent diabetes in adults, and similar evidence is emerging of the salutatory effect of lifestyle change in youth.
Breast-feeding has...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Measures that can be taken by schools, communities and governments to reduce the incidence of obesity and diabetes in youth.
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"The Metabolic Phenotype of Pre-diabetes in Obese Youth"Dr. Sonia Caprio (biography)
English - 2005-04-14 - 39 minutes
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Summary :
The unabated rise in the prevalence of childhood obesity has been accompanied by the appearance of a new pediatric disease: Type 2 diabetes. In adults, type 2 diabetes develops over a long period. Most, if not all, patients initially have impaired glucose tolerance (IGT), which is highly predictive of diabetes and cardiovascular disease. Little is known about IGT in pediatrics.
We...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The epidemiology of childhood obesity
• The emerging epidemic of type-2 diabetes in the world
• How the metabolic syndrome in adolescents was defined by Weiss et al (NEJM, 2004)
• Prevalence of impaired glucose tolerance and the metabolic syndrome in obese youth
• Mechanisms of insulin resistance in obese adolescents with impaired glucose tolerance
• The natural history of “pre-diabetes” in the young
Bibliographic references :
Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, Savoye M, Rieger V, Taksali S, Barbetta G, Sherwin RS, Caprio S. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med. 2002 Mar 14;346(11):802-10.
Weiss R, Dziura J, Burgert TS, Tamborlane WV, Taksali SE, Yeckel CW, Allen K, Lopes M, Savoye M, Morrison J, Sherwin RS, Caprio S. Obesity and the metabolic syndrome in children and adolescents. N Engl J Med. 2004 Jun 3;350(23):2362-74.
Weiss R, Taksali SE, Tamborlane WV, Burgert TS, Savoye M, Caprio S. Predictors of changes in glucose tolerance status in obese youth. Diabetes Care. 2005 Apr;28(4):902-9.
Weiss R, Dufour S, Taksali SE, Tamborlane WV, Petersen KF, Bonadonna RC, Boselli L, Barbetta G, Allen K, Rife F, Savoye M, Dziura J, Sherwin R, Shulman GI, Caprio S. Prediabetes in obese youth: a syndrome of impaired glucose tolerance, severe insulin resistance, and altered myocellular and abdominal fat partitioning. Lancet. 2003 Sep 20;362(9388):951-7.
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"Epidemiology of 'Prediabetes' and the MS - Global View"Prof. Jonathan Shaw (biography)
English - 2005-04-14 - 34 minutes
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Summary :
The metabolic syndrome, diabetes and pre-diabetes have become major public health problems in recent decades, and are increasing in prevalence around the world. Declining levels of physical activity, increasing caloric intake and the subsequent rises in obesity rates have been documented in populations from virtually every ethnic and cultural background. Whilst pre-diabetes is more common in most...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Prevalence of pre diabetes worldwide
- Prevalence of the metabolic syndrome in consequence of the definition used
- The need to develop a uniform method of determining obesity criteria that is ethnic specific
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"Diabetes and Metabolic Syndrome - An Asian Perspective"Prof. Juliana Chan (biography)
English - 2005-04-14 - 32 minutes
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Summary :
In this presentation Dr. Chan gives an Asian perspective on diabetes and the metabolic syndrome, focusing on studies from China.
About 60 million Chinese adults of age 35-74 years are estimated to have diabetes or impaired fasting glucose, and Dr. Chan shows data from the DECODA study on the prevalence of diagnosed and undiagnosed DM, and IFG/IGT in Chinese and Japanese men and...
Learning objectives :
After viewing this presentation the participant will be able to discuss studies from Asian (mainly Chinese) populations on the following:
- The prevalence of obesity, diabetes and metabolic syndrome
- The relationship between metabolic syndrome and CVD
- The effect of weight reduction on components of the metabolic syndrome
Bibliographic references :
Gu D, Reynolds K, Duan X, Xin X, Chen J, Wu X, Mo J, Whelton PK, He J; InterASIA Collaborative Group.Prevalence of diabetes and impaired fasting glucose in the Chinese adult population: International Collaborative Study of Cardiovascular Disease in Asia (InterASIA).Diabetologia. 2003 Sep;46(9):1190-8. Epub 2003 Jul 15.
The DECODA Study Group Age- and Sex-Specific Prevalence of Diabetes and Impaired Glucose Regulation in 11 Asian Cohorts Diabetes Care 26:1770-1780, 2003
Chee-Eng Tan, Stefan Ma, Daniel Wai, Suok-Kai Chew, and E.-Shyong TaiCan We Apply the National Cholesterol Education Program Adult Treatment Panel Definition of the Metabolic Syndrome to Asians?Diabetes Care 27: 1182-1186.
Jung-Nan Wei; Fung-Chang Sung; Chau-Ching Lin; Ruey-Shiung Lin; Chuan-Chi Chiang; Lee-Ming ChuangNational Surveillance for Type 2 Diabetes Mellitus in Taiwanese Children JAMA, Sep 2003; 290: 1345 - 1350.
Peter C. Y. Tong; Zoe S. K. Lee; Man-Mei Sea; Chun-Chung Chow; Gary T. C. Ko; Wing-Bun Chan; Wing-Yee So; Ronald C. W. Ma; Risa Ozaki; Jean Woo; Clive S. Cockram; Juliana C. N. Chan The Effect of Orlistat-Induced Weight Loss, Without Concomitant Hypocaloric Diet, on Cardiovascular Risk Factors and Insulin Sensitivity in Young Obese Chinese Subjects With or Without Type 2 Diabetes Archives of Internal Medicine, Nov 2002; 162: 2428 - 2435.
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"Epidemiology of Prediabetes and Metabolic Syndrome in Indians"Dr. A. Ramachandran (biography)
English - 2005-04-14 - 25 minutes
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Summary :
Objective: To highlight high prevalence and the peculiarities of prediabetic conditions and the metabolic syndrome in India.
Method: Epidemiological data on the prevalence and risk associations of prediabetic conditions, and occurrence and peculiarities in metabolic syndrome are described.
Results: Both IFG (8.7%) and IGT (8.1%) show high prevalence in India with an...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The prevalence of prediabetes in the Indian population based on IGT and IFG;
• The prevalence of the metabolic syndrome among the Indian population.
Bibliographic references :
Ramachandran A, Snehalatha C, Vijay V.Temporal changes in prevalence of type 2 diabetes and impaired glucose tolerance in urban southern India.Diabetes Res Clin Pract. 2002 Oct;58(1):55-60
Ramachandran A, Snehalatha C, Kapur A, Vijay V, Mohan V, Das AK, Rao PV, Yajnik CS, Prasanna Kumar KM, Nair JD; Diabetes Epidemiology Study Group in India (DESI).High prevalence of diabetes and impaired glucose tolerance in India: National Urban Diabetes Survey.Diabetologia. 2001 Sep;44(9):1094-101.
Ramachandran A, Snehalatha C, Baskar AD, Mary S, Kumar CK, Selvam S, Catherine S, Vijay V.Temporal changes in prevalence of diabetes and impaired glucose tolerance associated with lifestyle transition occurring in the rural population in India.Diabetologia. 2004 May;47(5):860-5. Epub 2004 Apr 28.
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"Genetic Prediction of the Metabolic Syndrome: The Botnia Study"Dr. Valeriya Lyssenko (biography)
English - 2005-04-14 - 13 minutes
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Summary :
Background and aims: The metabolic syndrome is a cluster of risk factors associated with cardiovascular morbidity and mortality. However, underlying genetic susceptibility to the metabolic syndrome has not been extensively studied. The aim of the study was to evaluate the role of common variants in candidate genes for their ability to predict the metabolic syndrome in a large prospective study...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The risk of developing the metabolic syndrome in the BOTNIA population
• Which mutations were associated with the development of the metabolic syndrome
• Which components of the metabolic syndrome (ATP-III) were predictable by the mutations studied
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"Polymorphism -308 G/A of the TNF-(alpha) Gene: Effect on plasma soluble TNF-receptor 2 (sTNFR2) according to Degree of Glucose Tolerance (IGT, DM2), Insulin Resistance (IR), and other Related Parameters. A Population Based Study (The Segovia Study, Spain)"Dr. Jose Luis Gonzalez- Sanchez (biography)
English - 2005-04-14 - 14 minutes
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Summary :
To investigate the relationships between the -308 G/A TNF-(alpha) polymorphism on plasma sTNFR2 levels, IR and other related parameters 436 unrelated subjects (49.1% males; 35-74 years) from a cross-sectional population-based survey in the province of Segovia (Spain) were studied.
Measurements: BMI, waist circumference (WC), sagittal abdominal diameter (SAD), systolic and...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
Data from the population based Segovia study on the relationship between the -308 G/A polymorphism of the TNF-alpha gene, and the following:
- Plasma soluble TNF-alpha receptor 2 in DM2
- Insulin resistance
- Other related parameters
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"Association of Low Testosterone and Insulin-Like Growth Factor-1 but High C-Reactive Protein with Metabolic Syndrome in Chinese Middle-Aged Men with a Family History of Type 2 Diabetes"Dr. Wing Yee So (biography)
English - 2005-04-14 - 23 minutes
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Summary :
Aim: Age-related decline in testosterone and insulin-like growth factor-1 (IGF-1) may interact with familial disposition to increase the association with metabolic syndrome (MES).
Methods: We compared clinical characteristics and prevalence of fMES using the WHO criteria with modified definitions of obesity for Asians (BMI³25kg/m2) between 179 middle aged men with family history...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The incidence of metabolic syndrome in Chinese men with and without a family history of diabetes
• The association of testosterone, IGF-1 and hs-CRP with the metabolic syndrome
• The metabolic profiles of subjects with/without metabolic syndrome, with/without a family history of diabetes.
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"The Diabetes Prevention Program"Dr. William C. Knowler (biography)
English - 2005-04-15 - 28 minutes
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Summary :
The DPP was a randomized clinical trial of type 2 diabetes prevention in high-risk persons conducted in 27 clinics in the U.S.A. From 1996-98, participants were randomly assigned to treatment with placebo, metformin, troglitazone, or intensive lifestyle intervention. Due to concern regarding its liver toxicity, use of troglitazone was discontinued in 1998. Randomization to the other three groups...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The objective of the diabetes prevention program (DPP)
• The medical and lifestyle interventions in subjects enrolled in the DPP
• The DPP study design and changes
• The results of the DPP
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"STOP NIDDM Trial"Prof. Avraham Karasik (biography)
English - 2005-04-15 - 19 minutes
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Summary :
The STOP NIDDM trial was a multicenter, international, placebo-controlled, randomized clinical trial to assess the effect of acarbose in preventing or delaying conversion of impaired glucose tolerance (IGT) to type 2 diabetes. Patients were recruited through screening of high risk population and those with both IGT and IFG (FBG > 5.6 mmol/L) were included in the study. 714 patients were allocated...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The effect of acarbose in preventing or delaying conversion of impaired glucose tolerance (IGT) to type 2 diabetes.
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"TheTRIPOD and PIPOD Studies"Prof. Thomas A. Buchanan (biography)
English - 2005-04-15 - 24 minutes
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Summary :
The Troglitazone in Prevention of Diabetes (TRIPOD) and Pioglitazone in Prevention of Diabetes (PIPOD) studies were conducted in Hispanic-American women with recent gestational diabetes. TRIPOD was a randomized, placebo-controlled trial in which 236 of 266 randomized subjects had at least one follow-up visit and 126 women completed 3.6 years of treatment and 8 months of post-drug washout. The...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The nature of pre-diabetes (type 2)
- The effects of thiazolidinediones on progression to diabetes
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"DREAM Trial"Prof. Hertzel Gerstein (biography)
English - 2005-04-15 - 31 minutes
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Summary :
The objective of the dream trial (Diabetes REduction Assessment with ramipril and rosiglitazone Medication) is to determine the efficacy of ramipril and/or rosiglitazone on prevention of diabetes in non-diabetic individuals with impaired glucose tolerance or impaired fasting glucose.
Prof Gerstein presents the design of the DREAM trial in detail and reviews the key questions which...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
- The objectives of the DREAM trial;
- The study design of the DREAM trial.
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"The Diabetes Prevention Program: A Randomized Clinical Trial to Prevent Type 2 Diabetes in Persons at High Risk"Prof. Elizabeth Barrett-Connor (biography)
English - 2005-04-15 - 38 minutes
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Summary :
The DPP randomized controlled clinical trial included 3234 participants with impaired glucose tolerance (IGT) who were randomized to ILS, MET, or usual advice. Both ILS and MET significantly reduced the risk of diabetes. A further major benefit of these interventions may be reduction of cardiovascular disease (CVD) risk. Because persons with IGT have a high prevalence of CVD risk factors,...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The objective, design and outcomes of the Diabetes Prevention Program (DPP);
- Adverse events in the DPP;
- Treatment effect of the DPP on hypertension, dyslipidemia, and the metabolic syndrome;
- The effect of age, sex, ethnicity, and body mass index on the incidence of diabetes.
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"Primary Prevention of Type 2 Diabetes - A Matter of Maintaining the New Lifestyle"Dr. Bernt Lindahl (biography)
English - 2005-04-15 - 16 minutes
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Summary :
Object: To study short- and long-term effects of an intensive lifestyle change programme.
Method: Subjects with IGT and obesity (BMI>27) were randomised to two different intervention programmes based on low-fat, high-fibre diet and regular physical exercise. The intensive group (n=100) participated in a one month learning and training session using behavioural modification...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
- Compliance-oriented and empowerment-oriented approaches to behaviour modification
- The design of the GT-VIP Study
- The short-term effects of an intensive behavioural intervention in the GT-VIP
- The long-term effects of an intensive behavioural intervention in the GT-VIP
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"Lessons from the UKPDS"Prof. Alastair Gray (biography)
English - 2005-04-15 - 33 minutes
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Summary :
In this presentation Prof. Gray descibes results from UKPDS 61 and 68, which looked at fasting plasma glucose (FPG) levels at diagnosis of diabetes in relation to clinical outcomes, and the UKPDS Outcomes Model, respectively.
UKPDS 61 found that those with lower FPG levels at diagnosis of diabetes had fewer complications but similar rates of deterioration in glycemic control...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The relationship between FPG level at diagnosis of diabetes and clinical outcomes
- The UKPDS Outcomes Model
Bibliographic references :
Stephen Colagiuri, FRACP, Carole A. Cull, PHD and Rury R. Holman, FRCP For the UKPDS Group. Are Lower Fasting Plasma Glucose Levels at Diagnosis of Type 2 Diabetes Associated With Improved Outcomes? - U.K. Prospective Diabetes Study 61 Diabetes Care 25:1410-1417, 2002.
P. M. Clarke, A. M. Gray, A. Briggs, A. J. Farmer, P. Fenn, R. J. Stevens, D. R. Matthews, I. M. Stratton, R. R. Holman and on behalf of the UK Prospective Diabetes Study (UKPDS) Group. A model to estimate the lifetime health outcomes of patients with Type 2 diabetes: the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68)Diabetologia. 2004; 47(10):1747 - 1759.
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"Does the Metabolic Syndrome Predict Death in Type 2 Diabetes? The Fremantle Diabetes Study"Prof. Timothy Davis (biography)
English - 2005-04-15 - 20 minutes
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Summary :
The Fremantle Diabetes Study (FDS) was a prospective, observational study of a representative patient cohort recruited from 1993 to 1996 and followed for at least 5 years. The FDS cohort comprised 1426 patients (63% of all diabetic individuals identified in a catchment area of 120,000 people), and 1294 (91%) had type 2 diabetes. Prospective outcome data were obtained through the Western Australia...
Learning objectives :
After viewing this presentation the participant will be able to discuss results from the Fremantle Diabetes Study relating to:
- Prevalence of metabolic syndrome in type 2 diabetic patients
- Metabolic syndrome as a predictor of all-cause and CHD mortality in type 2 diabetic patients
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"Television Viewing Time and Blood Glucose Levels in Australian Adults"Dr. David Dunstan (biography)
English - 2005-04-15 - 24 minutes
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Summary :
Objective:
Sedentary behaviours, as well as physical activity, are important determinants of glycaemic control. We examined the associations of television (TV) time with fasting blood glucose (FBG) and 2-hour blood glucose levels (2-hr BG) in Australian adults.
Materials and Methods:
A population-based cross-sectional study (AusDiab) included 9,966 adults aged...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The sedentary death syndrome
• The different types of sedentary behaviours
• The association between television viewing time and fasting and 2-hour blood glucose levels
Bibliographic references :
David W. Dunstan, PHD, Jo Salmon, PHD, Neville Owen, PHD, Timothy Armstrong, PHD, Paul Z. Zimmet, MD, Timothy A. Welborn, PHD, Adrian J. Cameron, MPH, Terence Dwyer, PHD, Damien Jolley, MSC and Jonathan E. Shaw, MD on behalf of the AusDiab Steering Committee Physical Activity and Television Viewing in Relation to Risk of Undiagnosed Abnormal Glucose Metabolism in Adults Diabetes Care. 2004 Nov;27(11):2603-9.
David W. Dunstan, Paul Z. Zimmet, Timothy A. Welborn, Maximilian P. de Courten, Adrian J. Cameron, Richard A. Sicree, Terry Dwyer, Stephen Colagiuri, Damien Jolley, Matthew Knuiman, Robert Atkins, and Jonathan E. Shaw The Rising Prevalence of Diabetes and Impaired Glucose Tolerance: The Australian Diabetes, Obesity and Lifestyle Study Diabetes Care 25: 829-834.
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"Prevalence of the Metabolic Syndrome in the City of Beijing and Developing a Prediction System for Diabetes in Large Population"Dr. Tiemei Zhang (biography)
English - 2005-04-15 - 24 minutes
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Summary :
The prevalence of the metabolic syndrome in the city of Beijing was defined by the NCEP-ATPIII(2002) among 15387 adults over 20 years old. The unadjusted prevalence of metabolic syndrome was 9.9% and the age-adjusted prevalence of metabolic syndrome was 7.55% respectively. Using 2000 census data, about 90 million Chinese residents had the metabolic syndrome. The syndrome was more common in the...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The prevalence of metabolic syndrome in the city of Beijing
- A prediction system for diabetes based on survey data
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"New drugs for 'Prediabetes', Metabolic Syndrome and their CVD consequences: GLP-1"Prof. Michael A. Nauck (biography)
English - 2005-04-15 - 23 minutes
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Summary :
Glucagon-like Peptide 1 (GLP-1) is a gut hormone with incretin and "ileal brake" activity. There are many facets of its action that add up to antidiabetic effects: (a) glucose-dependent stimulation of insulin secretion, (b) a glucagonostatic activity, (c) a deceleration of gastric emptying, (d) a suppression of appetite (and reduction in food intake), and effects on islet B cells demonstrated in...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Antidiabetic effects of GLP-1
- Incretin mimetics: GLP-1 receptor antagonists with prolonged pharmacokinetic profiles
- Efficacy of GLP-1 in subjects with IGT
- Antiapoptotic effect of GLP-1
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"The Endocannabinoid System: A New Therapeutic Target in Metabolic Disorders"Prof. Uberto Pagotto (biography)
English - 2005-04-15 - 25 minutes
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Summary :
Endocannabinoids and in particular anandamide and 2-arachidonoylglycerol are endogenous lipids capable of activating, the two cannabinoid (CB) receptors CB1 and CB2. These receptors belong to the G-protein-coupled family receptors and they were discovered in 1990s while investigating the molecular mode of action of the principal psychoactive component of Cannabis, r9-tetrahydrocannabinol, to...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The function and sites of action of the endocannabinoids
• Role of cannabanoid receptor type 1 (CB1) in the metabolic syndrome
• The potential benefit of CB1 blockade with agents such as rimonabant
• The mechanism of action of CB1 antagonists
Bibliographic references :
De Petrocellis L, Melck D, Bisogno T, Milone A, Di Marzo V. Finding of the endocannabinoid signalling system in Hydra, a very primitive organism: possible role in the feeding response. Neuroscience. 1999;92(1):377-87.
Kirkham TC, Williams CM, Fezza F, Di Marzo V. Endocannabinoid levels in rat limbic forebrain and hypothalamus in relation to fasting, feeding and satiation: stimulation of eating by 2-arachidonoyl glycerol. Br J Pharmacol. 2002 Jun;136(4):550-7.
Jamshidi N, Taylor DA. Anandamide administration into the ventromedial hypothalamus stimulates appetite in rats. Br J Pharmacol. 2001 Nov;134(6):1151-4.
Di Marzo V, Goparaju SK, Wang L, Liu J, Batkai S, Jarai Z, Fezza F, Miura GI, Palmiter RD, Sugiura T, Kunos G. Nature. 2001 Apr 12;410(6830):822-5. Nature. 2001 Apr 12;410(6830):822-5.
Cota D, Marsicano G, Tschop M, Grubler Y, Flachskamm C, Schubert M, Auer D, Yassouridis A, Thone-Reineke C, Ortmann S, Tomassoni F, Cervino C, Nisoli E, Linthorst AC, Pasquali R, Lutz B, Stalla GK, Pagotto U. The endogenous cannabinoid system affects energy balance via central orexigenic drive and peripheral lipogenesis. J Clin Invest. 2003 Aug;112(3):423-31.
Ravinet Trillou C, Delgorge C, Menet C, Arnone M, Soubrie P. CB1 cannabinoid receptor knockout in mice leads to leanness, resistance to diet-induced obesity and enhanced leptin sensitivity. Int J Obes Relat Metab Disord. 2004 Apr;28(4):640-8.
Colombo G, Agabio R, Diaz G, Lobina C, Reali R, Gessa GL. Appetite suppression and weight loss after the cannabinoid antagonist SR 141716. Life Sci. 1998;63(8):PL113-7.
Bensaid M, Gary-Bobo M, Esclangon A, Maffrand JP, Le Fur G, Oury-Donat F, Soubrie P. The cannabinoid CB1 receptor antagonist SR141716 increases Acrp30 mRNA expression in adipose tissue of obese fa/fa rats and in cultured adipocyte cells. Mol Pharmacol. 2003 Apr;63(4):908-14.
Liu YL, Connoley IP, Wilson CA, Stock MJ. Effects of the cannabinoid CB1 receptor antagonist SR141716 on oxygen consumption and soleus muscle glucose uptake in Lep(ob)/Lep(ob) mice. Int J Obes Relat Metab Disord. 2005 Feb;29(2):183-7.
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"Pharmacological Intervention in CVD Risk Factors - Components of the Metabolic Syndrome: Hypertension"Prof. Stefano Del Prato (biography)
English - 2005-04-15 - 33 minutes
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Summary :
Insulin resistance occurs in many hypertensive patients. Moreover, increased blood pressure levels have been included in the ATP III diagnostic criteria for the Metabolic Syndrome, a condition that is believed to recognize insulin resistance as the background pathogenetic factor. Based on these assumptions, it has been suggested that 1. treatment of hypertension should not aggravate insulin...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The importance of hypertension in the definition of the metabolic syndrome
• Improving insulin sensitivity to reduce blood pressure
• Treating hypertension without worsening insulin resistance
Bibliographic references :
Pedrinelli, Roberto; Dell'Omo, Giulia; Penno, Giuseppe; Di Bello, Vitantonio; Giorgi, Davide; Pellegrini, Giovanni; Del Prato, Stefano; Mariani, MarioMicroalbuminuria, a parameter independent of metabolic influences in hypertensive men. Journal of Hypertension. 21(6):1163-1169, June 2003.
Giuseppe Schillaci, Matteo Pirro, Gaetano Vaudo, Fabio Gemelli, Simona Marchesi, Carlo Porcellati and Elmo MannarinoPrognostic value of the metabolic syndrome in essential hypertension Journal of the American College of Cardiology Volume 43, Issue 10 , 19 May 2004, Pages 1817-1822
Jaakko Tuomilehto, M.D., Ph.D., Jaana Lindstrom, M.S., Johan G. Eriksson, M.D., Ph.D., Timo T. Valle, M.D., Helena Hamalainen, M.D., Ph.D., Pirjo Ilanne-Parikka, M.D., Sirkka Keinanen-Kiukaanniemi, M.D., Ph.D., Mauri Laakso, M.D., Anne Louheranta, M.S., Merja Rastas, M.S., Virpi Salminen, M.S., Sirkka Aunola, Ph.D., Zygimantas Cepaitis, Dipl.Eng., Vladislav Moltchanov, Ph.D., Martti Hakumaki, M.D., Ph.D., Marjo Mannelin, M.S., Vesa Martikkala, M.S., Jouko Sundvall, M.S., Matti Uusitupa, M.D., Ph.D., for the Finnish Diabetes Prevention Study Group Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance NEJM Volume 344:1343-1350
Andrea Natali, Stephanie Baldeweg, Elena Toschi, Brunella Capaldo, Daniele Barbaro, Amalia Gastaldelli, John S. Yudkin, and Ele FerranniniVascular Effects of Improving Metabolic Control With Metformin or Rosiglitazone in Type 2 DiabetesDiabetes Care 27: 1349-1357
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"Nutrition"Prof. Andreas Pfeiffer (biography)
English - 2005-04-15 - 31 minutes
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Summary :
The effect of diet on cardiovascular risk has been known for some time. However, what is the effect of nutrition on the risk of diabetes and on the components of the metabolic syndrome?
Prof. Pfeiffer reviews the results of the EPIC-Potsdam Study and other studies, as he reveals the components of our diet that appear to both positively and negatively affect the components of the...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The benefit of diet in mediating cardiovascular risk
• The benefit of diet in mediating diabetes risk
• The beneficial effect of dietary modifications on fat metabolism
• The results of the EPIC-Potsdam Study
Bibliographic references :
Hu FB. Plant-based foods and prevention of cardiovascular disease: an overview. Am J Clin Nutr. 2003 Sep;78(3 Suppl):544S-551S.
Effect of an Indo-Mediterranean diet on progression of coronary artery disease in high risk patients (Indo-Mediterranean Diet Heart Study): a randomised single-blind trial. Singh RB, Dubnov G, Niaz MA, Ghosh S, Singh R, Rastogi SS, Manor O, Pella D, Berry EM. Lancet. 2002 Nov 9;360(9344):1455-61.
Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, Willett WC. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001 Sep 13;345(11):790-7.
Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M; Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001 May 3;344(18):1343-50.
Spranger J, Kroke A, Mohlig M, Hoffmann K, Bergmann MM, Ristow M, Boeing H, Pfeiffer AF. Inflammatory cytokines and the risk to develop type 2 diabetes: results of the prospective population-based European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study. Diabetes. 2003 Mar;52(3):812-7.
Hofmann et al., Diabetologia 2005, in press.
Rochlitz H, Akpulat S, Bobbert T, Mai K, Mohlig M, Osterhoff M, Weickert MO, Pfeiffer AF, Spranger J. [Changes of biomarkers during weight reduction in metabolic syndrome.] Dtsch Med Wochenschr. 2005 Apr 29;130(17):1061-6. [Article in German]
Esposito K, Marfella R, Ciotola M, Di Palo C, Giugliano F, Giugliano G, D'Armiento M, D'Andrea F, Giugliano D. Effect of a mediterranean-style diet on endothelial dysfunction and markers of vascular inflammation in the metabolic syndrome: a randomized trial. JAMA. 2004 Sep 22;292(12):1440-6.
McKeown NM, Meigs JB, Liu S, Saltzman E, Wilson PW, Jacques PF. Carbohydrate nutrition, insulin resistance, and the prevalence of the metabolic syndrome in the Framingham Offspring Cohort. Diabetes Care. 2004 Feb;27(2):538-46.
Gannon MC, Nuttall FQ, Saeed A, Jordan K, Hoover H. An increase in dietary protein improves the blood glucose response in persons with type 2 diabetes. Am J Clin Nutr. 2003 Oct;78(4):734-41.
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"The Acute Effect of Various Glycemic Index Dietary Carbohydrates"Dr. Talya Lavi (biography)
English - 2005-04-15 - 24 minutes
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Summary :
Postprandial hyperglycemia is as an important risk factor for cardiovascular disease. The current study was designed to explore the acute effect of various glycemic index dietary carbohydrates on endothelial function.
Methods: We prospectively assessed endothelium-dependent flow-mediated vasodilation (FMD) brachial artery vasoreactivity non-invasively in 34 consecutive healthy...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The effect of oral glucose loading on endothelial function
- The effect of different glycemic index foods on endothelial function
Bibliographic references :
Hiroaki Kawano MD, Takeshi Motoyama MD, Osamu Hirashima MD, Nobutaka Hirai MD, Yuji Miyao MD, Tomohiro Sakamoto MD, Kiyotaka Kugiyama MD, Hisao Ogawa MD and Hirofumi Yasue MDHyperglycemia rapidly suppresses flow-mediated endothelium- dependent vasodilation of brachial arteryJournal of the American College of Cardiology
Volume 34, Issue 1 , July 1999, Pages 146-154.
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"Effect of Fructose Overfeeding and Fish Oil Administration on De Novo Lipogenesis and Insulin Sensitivity in Healthy Males"Dr. David Faeh (biography)
English - 2005-04-15 - 23 minutes
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Summary :
High fructose diets (Hfr) may stimulate hepatic de novo lipogenesis (DNL), and cause hypertriglyceridemia and insulin resistance in rodents. It can therefore be hypothesized that fructose-induced insulin resistance is secondary to alterations of hepatic and extra-hepatic lipid metabolism. Since fish oil supplementation (FO) is known to suppress lipogenic enzymes and to decrease TG, it may improve...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Animal and human studies relating to the metabolic effects of fructose overfeeding and fish oil supplementation
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"The Influence of Meal and Increment of Postprandial Glycaemia on Superoxide Production by Polymorphonuclear Neutrophils in Patients with Metabolic Syndrome"Dr. Dorota Zozulinska (biography)
English - 2005-04-15 - 21 minutes
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Summary :
Inflammatory process plays a crucial role in the development of late diabetic complications and is associated with disturbances between endothelial and inflammatory cells. The peripheral polymorphonuclear neutrophils (PMNs) are one of the main inflammatory cells and seem to significantly influence the damage of endothelium. Mechanisms of injurious effect of activated neutrophils on endothelium...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The role of inflammatory processes in the development on metabolic syndrome and diabetes;
• The influence of meal and increment of postprandial glycemia on reactive oxygen species production.
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"Disturbances of Phosphate Metabolism in Patients with Metabolic Syndrome"Dr. Vasilis Tsimihodimos (biography)
English - 2005-04-15 - 24 minutes
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Summary :
Despite the recent advances in the understanding of the consequences of the metabolic syndrome, its pathophysiology remains unclear. It has been proposed that disturbances of phosphate metabolism may contribute to the development of this constellation of cardiovascular risk factors. However, so far there is only little clinical data supporting this hypothesis. The aim of our study was to confirm...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The electrolyte abnormalities of the metabolic syndrome
• The possible explanations for these abnormalities
• The potential pathophysiologic role of these electrolyte disturbances
Bibliographic references :
Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA. 2002 Jan 16;287(3):356-9.
Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, Salonen JT. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA. 2002 Dec 4;288(21):2709-16.
Haglin L. Hypophosphataemia: cause of the disturbed metabolism in the metabolic syndrome. Med Hypotheses. 2001 Jun;56(6):657-63.
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"CVD in 'Prediabetes': The Hoorn Study Experience"Prof. Robert J. Heine (biography)
English - 2005-04-15 - 23 minutes
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Summary :
Various definitions of the metabolic syndrome are applied. Their value to assess cardiovascular disease (CVD) risk is unclear. We compared the definitions proposed by the Adult Treatment Panel III (ATP3), World Health Organisation (WHO), European Group for the study of Insulin Resistance (EGIR), and American College of Endocrinology (ACE) with respect to the prevalence of the metabolic syndrome...
Learning objectives :
After viewing this presentation the participant will be able to discuss results from the Hoorn Study:
- Metabolic syndrome (different definitions) and CVD risk
- Metabolic syndrome and incident diabetes
- The predictive value of the metabolic syndrome compared to the sum of its components
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"CVD Risk in the Metabolic Syndrome"Dr. Richard W. Nesto (biography)
English - 2005-04-15 - 34 minutes
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Summary :
In this presentation Dr. Nesto gives a general overview of CVD risk in the metabolic syndrome, and discusses specific features of the metabolic syndrome that are strongly associated with risk.
In the U.S. National Health and Nutrition Examination Survey III (NHANES III), metabolic syndrome was associated with history of myocardial infarction and stroke (1), and in NHANES II it was...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Increased risk of CHD, CVD and total mortality with the metabolic syndrome
- The importance of high TG and low HDL as determinants of CV risk in the metabolic syndrome
- Hypertension as a more powerful predictor of CV risk in the setting of insulin resistance
- C-reactive protein, metabolic syndrome and CV risk
- Features of high-risk metabolic syndrome patients
Bibliographic references :
1. John K. Ninomiya, MSc; Gilbert L’Italien, PhD; Michael H. Criqui, MD, MPH; Joanna L. Whyte, MS, RD, MSPH; Anthony Gamst, PhD; Roland S. Chen, MD. Association of the Metabolic Syndrome With History of Myocardial Infarction and Stroke in the Third National Health and Nutrition Examination Survey Circulation. 2004;109:42-46.
2. Shaista Malik, MD, MPH; Nathan D. Wong, PhD, MPH; Stanley S. Franklin, MD; Tripthi V. Kamath, PhD; Gilbert J. L’Italien, PhD; Jose R. Pio, BS; G. Rhys Williams, ScD. Impact of the Metabolic Syndrome on Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in United States Adults Circulation. 2004;110:1245-1250.
3. Jørgen Jeppesen, MD; Hans Ole Hein, MD; Poul Suadicani, DD; Finn Gyntelberg, MD. Low Triglycerides–High High-Density Lipoprotein Cholesterol and Risk of Ischemic Heart Disease Arch Intern Med. 2001;161:361-366.
4. Giuseppe Schillaci, Matteo Pirro, Gaetano Vaudo, Fabio Gemelli, Simona Marchesi, Carlo Porcellati and Elmo Mannarino Prognostic value of the metabolic syndrome in essential hypertensionJACC. 19 May 2004, Volume 43, Issue 10 Pages 1817-1822.
5. Frank B. Hu, MD, Meir J. Stampfer, MD, Steven M. Haffner, MD, Caren G. Solomon, MD, Walter C. Willett, MD and JoAnn E. Manson. Impact of the Metabolic Syndrome on Mortality From Coronary Heart Disease, Cardiovascular Disease, and All Causes in United States Adults Diabetes Care 25:1129-1134, 2002.
6. Cuspidi, Cesare; Meani, Stefano; Fusi, Veronica; Severgnini, Barbara; Valerio, Cristiana; Catini, Eleonora; Leonetti, Gastone; Magrini, Fabio; Zanchetti, Alberto. Metabolic syndrome and target organ damage in untreated essential hypertensives.Journal of Hypertension. 22(10):1991-1998, October 2004.
7. Martin K. Rutter, MD; James B. Meigs, MD, MPH; Lisa M. Sullivan, PhD; Ralph B. D’Agostino, Sr, PhD; Peter W.F. Wilson, MD. C-Reactive Protein, the Metabolic Syndrome, and Prediction of Cardiovascular Events in the Framingham Offspring Study Circulation. 2004;110:380-385.
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"Postprandial Hyperglycemia and Hypertension Synergistically Predict Multivessel CAD in Patients Undergoing Elective Coronary Angiography"Dr. Thomas C. Wascher (biography)
English - 2005-04-15 - 17 minutes
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Summary :
Background and aims: In patients with coronary artery disease (CAD) undiagnosed disturbances of glucose metabolism mainly represent impaired glucose tolerance and postprandial diabetes (Wascher et al., Atherosclerosis 2004). Hypertension is an additional risk factor that is observed frequently in those patients. We aimed to investigate the impact of hypertension and postprandial...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The relationship between postprandial hyperglycemia, hypertension and CAD in patients with angina undergoing elective coronary angiography.
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"Oxidative Stress: A Common Atherogenic Factor in IR, DM and CVD"Prof. Antonio Ceriello (biography)
English - 2005-04-15 - 30 minutes
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Summary :
Type 2 diabetes is a worldwide increasing disease, resulting from the interaction between a subject's genetic makeup and lifestyle. In genetically predisposed subjects the combination of excess caloric intake and reduced physical activity induces a state of insulin resistance. When beta-cells are no more able to compensate for insulin resistance by adequately increasing insulin production,...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
- The role of Glucose and fatty acid concentration on oxidative stress;
- Oxidative stress in smooth muscle, endothelial, and beta cells;
- The role of oxidative stress on post prandial hyperglycemia, diabetes, metabolic syndrome, and cardiovascular disease.
Bibliographic references :
T Inoguchi, P Li, F Umeda, HY Yu, M Kakimoto, M Imamura, T Aoki, T Etoh, T Hashimoto, M Naruse, H Sano, H Utsumi, and H Nawata High glucose level and free fatty acid stimulate reactive oxygen species production through protein kinase C--dependent activation of NAD(P)H oxidase in cultured vascular cells Diabetes 2000(49): 1939-1945.
Joseph L. Evans, Ira D. Goldfine, Betty A. Maddux, and Gerold M. Grodsky Are Oxidative Stress-Activated Signaling Pathways Mediators of Insulin Resistance and ß-Cell Dysfunction? Diabetes 2003 (52): 1-8.
Betty A. Maddux, Wendy See, John C. Lawrence, Jr., Amy L. Goldfine, Ira D. Goldfine, and Joseph L. Evans Protection Against Oxidative Stress—Induced Insulin Resistance in Rat L6 Muscle Cells by Micromolar Concentrations of -Lipoic Acid Diabetes 2001 (50): 404-410.
R. Marfella, G. Verrazzo, R. Acampora, C. La Marca, R. Giunta, C. Lucarelli, G. Paolisso, A. Ceriello, and D. Giugliano Glutathione reverses systemic hemodynamic changes induced by acute hyperglycemia in healthy subjects Am J Physiol Endocrinol Metab, Jun 1995; 268: 1167 - 1173
Johannes Pleiner, Georg Schaller, Friedrich Mittermayer, Michaela Bayerle-Eder, Michael Roden, and Michael Wolzt FFA-Induced Endothelial Dysfunction Can Be Corrected by Vitamin C J. Clin. Endocrinol. Metab., Jun 2002; 87: 2913 - 2917.
Krauss S, Zhang CY, Scorrano L, Dalgaard LT, St-Pierre J, Grey ST, Lowell BB. Superoxide-mediated activation of uncoupling protein 2 causes pancreatic beta cell dysfunction J Clin Invest. 2003 Dec;112(12):1831-42.
Antonio Ceriello and Enrico Motz Is Oxidative Stress the Pathogenic Mechanism Underlying Insulin Resistance, Diabetes, and Cardiovascular Disease? The Common Soil Hypothesis Revisited Arterioscler Thromb Vasc Biol 2004 24: 816 - 823
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"Oxidative Stress and HDL Dysfunction in Metabolic Syndrome"Prof. John Chapman (biography)
English - 2005-04-15 - 31 minutes
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Summary :
An atherogenic disequilibrium of lipid metabolism is one of the key features of both the metabolic syndrome (MetS) and type 2 diabetes (DM2). Prof. John Chapman reviews here the disturbed lipid metabolism of the MetS and DM2 and discusses the mechanisms of lipid-induced vascular inflammation.
In particular, the antioxidative properties of HDL cholesterol are discussed along with...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The three intra-plaque processes involved in plaque rupture
• The five disequilibria that favour the progression of atherosclerosis
• The atherogenic lipid disequilibrium of the metabolic syndrome and type 2 diabetes
• The role of bioactive oxidized lipids in the induction of vascular wall inflammation
• The anti-atherogenic actions of HDL cholesterol
• The components of HDL that are implicated in its intrinsic antioxidative activity
• The usefulness of 8-isoprostanes as a global marker of systemic oxidative stress in the metabolic syndrome.
Bibliographic references :
Kontush A, Chantepie S, Chapman MJ. Small, dense HDL particles exert potent protection of atherogenic LDL against oxidative stress. Arterioscler Thromb Vasc Biol. 2003 Oct 1;23(10):1881-8.
Kontush A, de Faria EC, Chantepie S, Chapman MJ. Antioxidative activity of HDL particle subspecies is impaired in hyperalphalipoproteinemia: relevance of enzymatic and physicochemical properties. Arterioscler Thromb Vasc Biol. 2004 Mar;24(3):526-33.
Chapman MJ. Fibrates in 2003: therapeutic action in atherogenic dyslipidaemia and future perspectives. Atherosclerosis. 2003 Nov;171(1):1-13.
Hansel B, Giral P, Nobecourt E, Chantepie S, Bruckert E, Chapman MJ, Kontush A. Metabolic syndrome is associated with elevated oxidative stress and dysfunctional dense high-density lipoprotein particles displaying impaired antioxidative activity. J Clin Endocrinol Metab. 2004 Oct;89(10):4963-71.
Nobecourt E, Jacqueminet S, Hansel B, Chantepie S, Grimaldi A, Chapman MJ, Kontush A. Defective antioxidative activity of small dense HDL3 particles in type 2 diabetes: relationship to elevated oxidative stress and hyperglycaemia. Diabetologia. 2005 Mar;48(3):529-38
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"A Simple Tool to Predict the Risk of Cardiovascular Events in Patients with Diabetes Mellitus based on the Acarbose Meta-Analysis (MERIA)"Prof. Jaakko Tuomilehto (biography)
English - 2005-04-15 - 23 minutes
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Summary :
OBJECTIVES: Different tools for the estimation of individual risk of cardiovascular diseases (CVD) in patients with diabetes mellitus (DM) exist. Our aim was to develop a risk score to predict the risk of CVD in patients with DM. In addition the score can estimate the risk reduction following acarbose treatment.
METHODS: The MERIA study showed that treatment with acarbose can...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
- Data from the Acarbose meta analysis study (MERIA);
- Development of a multivariable Cox regression model to determine onset of cardiovascular disease;
- Data from the DECODE study (Diabetes Epidemiology : Collaborative analysis Of Diagnostic criteria in Europe)
Bibliographic references :
M. Hanefeld, M. Cagatay, T. Petrowitsch, D. Neuser, D. Petzinna, and M. Rupp Acarbose reduces the risk for myocardial infarction in type 2 diabetic patients: meta-analysis of seven long-term studies Eur. Heart J., January 2004; 25: 10 - 16.
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"Finnish Prevention Study"Prof. Jaakko Tuomilehto (biography)
English - 2005-04-15 - 33 minutes
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Summary :
In this presentation Prof. Tuomilehto talks about the results of the Finnish Diabetes Prevention Study, which investigated the role of lifestyle guidance in the prevention or delay of type 2 diabetes in overweight, middle-aged subjects with impaired glucose tolerance.
Patients in the intervention group underwent dietary counseling sessions, and followed an individually tailored...
Learning objectives :
After viewing this presentation the participant will be able to discuss the Finnish Diabetes Prevention Study:
- Study design and baseline characteristics of participants
- Detailed description of the lifestyle intervention used
- Results in terms of reduction in the incidence of diabetes and changes in anthropometric and metabolic parameters
- The potential role of genes in the prevention of type 2 diabetes
Bibliographic references :
Jaakko Tuomilehto, M.D., Ph.D., Jaana Lindstrom, M.S., Johan G. Eriksson, M.D., Ph.D., Timo T. Valle, M.D., Helena Hamalainen, M.D., Ph.D., Pirjo Ilanne-Parikka, M.D., Sirkka Keinanen-Kiukaanniemi, M.D., Ph.D., Mauri Laakso, M.D., Anne Louheranta, M.S., Merja Rastas, M.S., Virpi Salminen, M.S., Sirkka Aunola, Ph.D., Zygimantas Cepaitis, Dipl.Eng., Vladislav Moltchanov, Ph.D., Martti Hakumaki, M.D., Ph.D., Marjo Mannelin, M.S., Vesa Martikkala, M.S., Jouko Sundvall, M.S., Matti Uusitupa, M.D., Ph.D., for the Finnish Diabetes Prevention Study Group. Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance NEJM. 2001;344:1343-1350.
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"Comparative Effects of Telmisartan and Losartan on Glucose Metabolism in Hypertensive Patients with Metabolic Syndrome"Dr. Guiseppe Rosano (biography)
English - 2005-04-15 - 24 minutes
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Summary :
Angiotensin II receptor blockers (ARBs) are effective antihypertensives that reduce renal and cardiovascular complications in hypertensive diabetic patients and delay the onset of diabetes in non-diabetic hypertensives. Recent data have suggested that the ARB telmisartan may display PPAR gamma agonism and may improve glucose tolerance in animals. This 3-month study compared telmisartan (80...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The benefits of angiotension receptor blockers in diabetes;
- A study comparing telmisartan and losartan on glucose metabolism and blood pressure in hypertensive patients with features of the metabolic syndrome.
Bibliographic references :
Stephen C. Benson, Harrihar A. Pershadsingh, Christopher I. Ho, Amar Chittiboyina, Prashant Desai, Michal Pravenec, Nianning Qi, Jiaming Wang, Mitchell A. Avery, and Theodore W. Kurtz Identification of Telmisartan as a Unique Angiotensin II Receptor Antagonist With Selective PPAR –Modulating Activity Hypertension, May 2004; 43: 993 - 1002.
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"Clofibrate Reduces Human Platelet Aggregation: A Possible PPAR-α Mediated Effect"Dr. Manish Khanolkar (biography)
English - 2005-04-15 - 24 minutes
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Summary :
Fibrates are PPARα agonists, increasingly used to treat a dyslipidemia characterized by elevated triglycerides and a low HDL-Cholesterol as is known to occur in individuals with the metabolic syndrome. Fibrates also appear to influence a number of emerging risk factors, including hemostatic and inflammatory markers, which may contribute to their cardioprotective effects. Platelet...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Platelet aggregation in atherothrombosis and type 2 diabetes;
- The expression of PPAR-alpha and PPAR-gamma in platelets;
- The effects of clofibrate and conjugated linoleic acid (CLA) on platelet aggregation;
- The role of PPAR-alpha in platelet aggregation;
Bibliographic references :
P. Ferroni, S. Basili, A. Falco and G. Davì Platelet activation in type 2 diabetes mellitus Journal of Thrombosis and Haemostasis Volume 2, Issue 8, Page 1282-1291, August 2004
Filiz Akbiyik, Denise M. Ray, Kelly F. Gettings, Neil Blumberg, Charles W. Francis, and Richard P. Phipps Human bone marrow megakaryocytes and platelets express PPAR , and PPAR agonists blunt platelet release of CD40 ligand and thromboxanes Blood, Sep 2004; 104: 1361 - 1368.
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"GLP-1 Treatment for the Prevention of Diabetes Occurring After Organ Transplantation"Dr. Riccardo Perfetti (biography)
English - 2005-04-15 - 23 minutes
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Summary :
BACKGROUND: Glucose intolerance is often observed after pancreatic islet cell transplantation. The administration of immunosuppressive agents (ISD), necessary to avoid tissue rejection, is in part responsible for hyperglycemia.
OBJECTIVES: To investigate whether mouse insulinoma (MIN6) cells transfected with the GLP-1 fragment of the proglucagon gene (RIP/GLP-1 MIN6 cells) are...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The effect of immunosuppressive agents on glucose control
- The effects of GLP-1 on insulin secreting cells exposed to immunosuppressive agents
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"Acarbose in the Prevention of Cardiovascular Disease in Subjects with IGT and type 2 diabetes"Prof. Jean-Louis Chiasson (biography)
English - 2005-04-16 - 28 minutes
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Summary :
The STOP-NIDDM Trial investigated the effect of acarbose on the incidence of type 2 diabetes and cardiovascular disease (CVD) in high risk subjects with IGT. Subjects with IGT (n = 1,429) were randomized to either placebo (n = 715) or acarbose (n = 714) 100 mg 3 times a day for a mean follow up time of 3.3 years. The study demonstrated that acarbose treatment resulted in a reduction of diabetes...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The rationale for the STOP-NIDDM Trial
• The goals of the STOP-NIDDM Trial
• The effect of acarbose treatment on the risk of progression to diabetes mellitus in patients with IGT
• The effect of acarbose treatment on the risk of cardiovascular events in patients with IGT
• The effect of acarbose treatment on the progression of carotid artery intima-media thickness in patients with IGT
• The effect of acarbose treatment on the risk of cardiovascular events in patients with type 2 diabetes mellitus
Bibliographic references :
The DECODE study group. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The DECODE study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe. Lancet. 1999 Aug 21;354(9179):617-21.
Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M; STOP-NIDDM Trail Research Group. Acarbose for prevention of type 2 diabetes mellitus: the STOP-NIDDM randomised trial. Lancet. 2002 Jun 15;359(9323):2072-7.
Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M; STOP-NIDDM Trial Research Group. Acarbose Treatment and the Risk of Cardiovascular Disease and Hypertension in Patients With Impaired Glucose Tolerance: The STOP-NIDDM Trial JAMA 290:486-494. 2003.
Hanefeld M, Chiasson JL, Koehler C, Henkel E, Schaper F, Temelkova-Kurktschiev T. Acarbose slows progression of intima-media thickness of the carotid arteries in subjects with impaired glucose tolerance. Stroke. 2004 May;35(5):1073-8.
Hanefeld M, Cagatay M, Petrowitsch T, Neuser D, Petzinna D, Rupp M.Acarbose reduces the risk for myocardial infarction in type 2 diabetic patients: meta-analysis of seven long-term studies. Eur Heart J. 2004 Jan;25(1):10-6.
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"PROactive"Prof. Markolf Hanefeld (biography)
English - 2005-04-16 - 33 minutes
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Summary :
Prof. Hanefeld presents the pleiotropic effects of pioglitazone such as on insulin sensitivity, glucose tolerance, lipid levels, HbA1c, etc. Of interest is the effect of pioglitazone on vascular function. Prof. Hanefeld discusses data supporting the positive effect of pioglitazone on coronary blood flow, atherosclerosis, plaque formation, smooth muscle cells, and left ventricular hypertrophy.
Learning objectives :
After viewing this presentation, participants will be able to discuss:
- The pleiotropic effects of pioglitazone;
- The PROactive study;
- Further secondary objectives of the proactive study.
Bibliographic references :
Bo Isomaa, Peter Almgren, Tiinamaija Tuomi, Björn Forsén, Kaj Lahti, Michael Nissén, Marja-Riitta Taskinen, and Leif Groop Cardiovascular Morbidity and Mortality Associated With the Metabolic Syndrome Diabetes Care 24: 683-689
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"The ORIGIN Study"Prof. Hertzel Gerstein (biography)
English - 2005-04-16 - 27 minutes
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Summary :
In this presentation Prof. Gerstein describes the rationale and design of the ORIGIN (Outcome Reduction with an Initial Glargine INtervention) trial.
ORIGIN is a large, international, multicentre trial investigating in high risk people with IFG, IGT or early diabetes, whether insulin replacement therapy targeting fasting normoglycaemia with insulin glargine reduces the risk of CV...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The rationale and design of the ORIGIN trial
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"Postprandial Hyperglycemia and Cardiovascular Disease"Prof. Antonio Ceriello (biography)
English - 2005-04-16 - 31 minutes
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Summary :
Increasing evidence suggests that the postprandial state is a contributing factor to the development of atherosclerosis. In diabetes, the postprandial phase is characterized by a rapid and large increase in blood glucose levels, and the possibility that the post-prandial hyperglycemic spikes may be relevant to the onset of cardiovascular complications has received recently much attention....
Learning objectives :
After viewing this presentation, participants will be able to discuss:
- The relevance of postprandial hyperglycemia and hypertriglyceridemia on oxidative stress generation and endothelial dysfunction.
- The relationship of postprandial and fasting glucose levels with HbA1c levels
Bibliographic references :
The DECODE study group on behalf of the Europe an Diabetes Epidemiology GroupGlucose tolerance and mortality: comparison of WHO and American Diabetic Association diagnostic criteria Lancet Volume 354, Issue 9179 , 21 August 1999, Pages 617-621
M Tominaga, H Eguchi, H Manaka, K Igarashi, T Kato, and A SekikawaImpaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes StudyDiabetes Care 22: 920-924.
B Balkau, M Shipley, RJ Jarrett, K Pyorala, M Pyorala, A Forhan, and E EschwegeHigh blood glucose concentration is a risk factor for mortality in middle-aged nondiabetic men. 20-year follow-up in the Whitehall Study, the Paris Prospective Study, and the Helsinki Policemen StudyDiabetes Care 21: 360-367
E Barrett-Connor and A FerraraIsolated postchallenge hyperglycemia and the risk of fatal cardiovascular disease in older women and men. The Rancho Bernardo StudyDiabetes Care 21: 1236-1239
Markolf Hanefeld, Jean Louis Chiasson, Carsta Koehler, Elena Henkel, Frank Schaper, and Theodora Temelkova-Kurktschiev Acarbose Slows Progression of Intima-Media Thickness of the Carotid Arteries in Subjects With Impaired Glucose Tolerance Stroke 2004 35: 1073 - 1078
M. Hanefeld, M. Cagatay, T. Petrowitsch, D. Neuser, D. Petzinna, and M. RuppAcarbose reduces the risk for myocardial infarction in type 2 diabetic patients: meta-analysis of seven long-term studiesEur. Heart J., January 2004; 25: 10 - 16.
Katherine Esposito, Dario Giugliano, Francesco Nappo, Raffaele Marfella for the Campanian Postprandial Hyperglycemia Study Group Regression of Carotid Atherosclerosis by Control of Postprandial Hyperglycemia in Type 2 Diabetes Mellitus Circulation 2004 110: 214 - 219
Francesco Perticone, Roberto Ceravolo, Arturo Pujia, Giorgio Ventura, Saverio Iacopino, Angela Scozzafava, Alessandro Ferraro, Massimo Chello, Pasquale Mastroroberto, Paolo Verdecchia, and Giuseppe SchillaciPrognostic Significance of Endothelial Dysfunction in Hypertensive PatientsCirculation, Jul 2001; 104: 191 - 196.
Antonio CerielloNew Insights on Oxidative Stress and Diabetic Complications May Lead to a "Causal" Antioxidant TherapyDiabetes Care 26: 1589-1596
Irene M Stratton, Amanda I Adler, H Andrew W Neil, David R Matthews, Susan E Manley, Carole A Cull, David Hadden, Robert C Turner, and Rury R HolmanAssociation of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational studyBMJ, Aug 2000; 321: 405 - 412.
Louis Monnier, Hélène Lapinski, and Claude ColetteContributions of Fasting and Postprandial Plasma Glucose Increments to the Overall Diurnal Hyperglycemia of Type 2 Diabetic Patients: Variations with increasing levels of HbA1c Diabetes Care 26: 881-885
Curt L. Rohlfing, Hsiao-Mei Wiedmeyer, Randie R. Little, Jack D. England, Alethea Tennill, and David E. GoldsteinDefining the Relationship Between Plasma Glucose and HbA1c: Analysis of glucose profiles and HbA1c in the Diabetes Control and Complications Trial Diabetes Care 25: 275-278.
EJ Bastyr, CA Stuart, RG Brodows, S Schwartz, CJ Graf, A Zagar, and KE RobertsonTherapy focused on lowering postprandial glucose, not fasting glucose, may be superior for lowering HbA1c. IOEZ Study GroupDiabetes Care 23: 1236-1241
Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research GroupSustained Effect of Intensive Treatment of Type 1 Diabetes Mellitus on Development and Progression of Diabetic Nephropathy: The Epidemiology of Diabetes Interventions and Complications (EDIC) StudyJAMA. 2003;290:2159-2167
The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group Intensive Diabetes Therapy and Carotid Intima–Media Thickness in Type 1 Diabetes MellitusNEJM 2003 (348):2294
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"Increased Risk of Coronary Events in Dysglycemic Patients: Mechanisms, and Reasons for Poor Outcomes"Dr. Richard W. Nesto (biography)
English - 2005-04-16 - 32 minutes
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Summary :
In recent years the early in-hospital mortality of diabetic patients after MI has been substantially reduced due to improvements in the medical management of these patients within the first 24 hours (1), however diabetes and hyperglycaemia itself still confer an increased risk of long-term mortality after MI which can be explained by a higher risk of congestive heart failure (2).
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Studies relating admission blood glucose levels to in-hospital and long-term mortality after MI in diabetic and non-diabetic patients
- Mechanisms whereby hyperglycaemia in AMI leads to poor outcomes
- The role of metabolic modulators in AMI: GIK infusion therapy
- Remaining questions
Bibliographic references :
1. Oliver Schnell, MD, Oliver Schäfer, Sonja Kleybrink, Wittich Doering, MD, Eberhard Standl, MD and Wolfgang Otter, MDIntensification of Therapeutic Approaches Reduces Mortality in Diabetic Patients With Acute Myocardial Infarction: The Munich registryDiabetes Care 27:455-460, 2004.
2. Ischa Stranders, MD; Michaela Diamant, MD, PhD; Rogier E. van Gelder, MD; Hugo J. Spruijt, MSEE; Jos W. R. Twisk, PhD; Robert J. Heine, MD, PhD, FRCP; Frans C. Visser, MD, PhD. Admission Blood Glucose Level as Risk Indicator of Death After Myocardial Infarction in Patients With and Without Diabetes Mellitus Arch Intern Med. 2004;164:982-988.
3. Nazneem N. Wahab MD, Elizabeth A. Cowden MD, Neil J. Pearce MD, Martin J. Gardner MD, Heather Merry MSc, Jafna L. Cox MD and ICONS Investigators. Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era? JACC.20 November 2002, Volume 40, Issue 10 Pages 1748-1754.
4. John A. Colwell, MD, PHD and Richard W. Nesto, MD.The Platelet in Diabetes: Focus on prevention of ischemic eventskjhkhkhDiabetes Care 26:2181-2188, 2003.
5. Jorik R. Timmer, Jan Paul Ottervanger, Menko-Jan de Boer, Jan-Henk E. Dambrink, Jan C.A. Hoorntje, A.T. Marcel Gosselink, Harry Suryapranata, Felix Zijlstra, Arnoud W.J. van't HofHyperglycemia is an important predictor of impaired coronary flow before reperfusion therapy in ST-segment elevation myocardial infarctionJACC.5 April 2005, Volume 45, Issue 7 Pages 999-1002.
6. Katsuomi Iwakura MD, Hiroshi Ito MD, FACC, Masashi Ikushima MD, Shigeo Kawano MD, Atsushi Okamura MD, Katsuaki Asano MD, Tadashi Kuroda MD, Koji Tanaka MD, Tohru Masuyama MD, Masatsugu Hori MD and Kenshi Fujii MDAssociation between hyperglycemia and the no-reflow phenomenon inpatients with acute myocardial infarctionJACC.1 January 2003, Volume 41, Issue 1 Pages 1-7.
7. Raffaele Marfella, MD, PHD, Mario Siniscalchi, MD, PHD, Katherine Esposito, MD, Ausilia Sellitto, MD, Umberto de Fanis, MD, Ciro Romano, MD, PHD, Michele Portoghese, MD, Silvio Siciliano, MD, Francesco Nappo, MD, PHD, Ferdinando Carlo Sasso, MD, PHD, Nicola Mininni, MD, Federico Cacciapuoti, MD, Giacomo Lucivero, MD, PHD, Riccardo Giunta, MD, Mario Verza, MD and Dario Giugliano, MD, PHDEffects of Stress Hyperglycemia on Acute Myocardial Infarction: Role of inflammatory immune process in functional cardiac outcome Diabetes Care 26:3129-3135, 2003.
8. Oliver MF, Opie LH. Effects of glucose and fatty acids on myocardial ischaemia and arrhythmiasLancet. 1994 Jan 15;343(8890):155-8.
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"Dysglycemia in Acute Coronary Syndrome Patients"Dr. Jacob Ilany (biography)
English - 2005-04-15 - 32 minutes
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Summary :
In order to assess the frequency, characteristics and pathogenesis of glucose metabolism abnormalities in patients with acute coronary event, we performed OGTT to patients that were admitted to our intensive coronary unit. We included all patients with suspected coronary event without prior diagnosis of diabetes mellitus at age 20 to 80 years. Glucose, insulin and c-peptide level before and 120...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
- The pathogenesis of dysglycemia
- Prevalence of dysglycemia
- The pathogenesis of the prediabetes condition
- The contribution of acute stress to dysglycemia
Bibliographic references :
Anna Norhammar, Åke Tenerz, Göran Nilsson, Anders Hamsten, Suad Efendíc, Lars Rydén and Klas MalmbergGlucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study The Lancet, Volume 359, Issue 9324, 22 June 2002, Pages 2140-2144
Frank B. Hu, Meir J. Stampfer, Steven M. Haffner, Caren G. Solomon, Walter C. Willett, and JoAnn E. MansonElevated Risk of Cardiovascular Disease Prior to Clinical Diagnosis of Type 2 Diabetes Diabetes Care 25: 1129-1134.
K. M. Choi, K. W. Lee, S. G. Kim, N. H. Kim, C. G. Park, H. S. Seo, D. J. Oh, D. S. Choi, and S. H. BaikInflammation, Insulin Resistance, and Glucose Intolerance in Acute Myocardial Infarction Patients without a Previous Diagnosis of Diabetes MellitusJ. Clin. Endocrinol. Metab., Jan 2005; 90: 175 - 180.
Åke Tenerz, Anna Norhammar, Angela Silveira, Anders Hamsten, Göran Nilsson, Lars Rydén, and Klas MalmbergDiabetes, Insulin Resistance, and the Metabolic Syndrome in Patients With Acute Myocardial Infarction Without Previously Known DiabetesDiabetes Care 26: 2770-2776.
M Tominaga, H Eguchi, H Manaka, K Igarashi, T Kato, and A SekikawaImpaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes StudyDiabetes Care 22: 920-924
J. Kuhl, A. Hilding, C. G. Östenson, V. Grill, S. Efendic and P. BåvenholmCharacterisation of subjects with early abnormalities of glucose tolerance in the Stockholm Diabetes Prevention Programme: the impact of sex and type 2 diabetes heredity Diabetologia: Volume 48, Number 1 pg 35-40
Markolf Hanefeld, Carsta Koehler, Katja Fuecker, Elena Henkel, Frank Schaper, and Theodora Temelkova-KurktschievInsulin Secretion and Insulin Sensitivity Pattern Is Different in Isolated Impaired Glucose Tolerance and Impaired Fasting Glucose: The Risk Factor in Impaired Glucose Tolerance for Atherosclerosis and Diabetes Study Diabetes Care 26: 868-874.
Andreas Festa, Ralph D’Agostino, Jr., Anthony J.G. Hanley, Andrew J. Karter, Mohammed F. Saad, and Steven M. HaffnerDifferences in Insulin Resistance in Nondiabetic Subjects With Isolated Impaired Glucose Tolerance or Isolated Impaired Fasting GlucoseDiabetes 53: 1549-1555.
Malgorzata Bartnik, Lars Rydén, Roberto Ferrari, Klas Malmberg, Kalevi Pyörälä, Maarten Simoons, Eberhard Standl, Jordi Soler-Soler, John Öhrvik on behalf of the Euro Heart Survey InvestigatorsThe prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe: The Euro Heart Survey on diabetes and the heartEur. Heart J., November 2004; 25: 1880 - 1890.
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"Statistical Models for Immediate Classification of Gluco-Metabolic State in Patients with Coronary Artery Disease"Prof. John Öhrvik (biography)
English - 2005-04-16 - 26 minutes
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Summary :
OBJECTIVES: Abnormal glucose regulation (AbnGR) has serious prognostic implications in patients with coronary artery disease (CAD). This study tried to develop classification criteria, based on easily available clinical data, useful in acute CAD and to limit the number of oral glucose tolerance tests (OGTT) needed for accurate characterization.
METHODS: CAD patients were enrolled...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
- Characterization of glucose metabolic state using ordinal logistic regression;
- Characterization of glucose metabolic state using single hidden layer back propagation neural network;
- The clinical implications of the proposed statistical model;
- The need for an OGTT immediately after a cardiovascular event.
Bibliographic references :
Malgorzata Bartnik, Lars Rydén, Roberto Ferrari, Klas Malmberg, Kalevi Pyörälä, Maarten Simoons, Eberhard Standl, Jordi Soler-Soler, John Öhrvik on behalf of the Euro Heart Survey Investigators The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe: The Euro Heart Survey on diabetes and the heart Eur. Heart J., November 2004; 25: 1880 - 1890
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"Usefulness of Brachial Artery Distensibility in the Prediction of Coronary Risk Among Asymptomatic Individuals With and Without Metabolic Syndrome"Dr. Meng Cheng Chiang (biography)
English - 2005-04-16 - 21 minutes
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Summary :
Objective: Previous studies have shown that brachial arterial distensibility (BD) is a measure of arterial stiffness and may be used in risk assessment for cardiovascular disease (CVD). The aim of this study is to explore the predictive value of BD for CVD risk level in asymptomatic individuals with and without Metabolic Syndrome and to seek cardiovascular risk factors influencing BD.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The relationship between brachial artery distensibility and cardiovascular risk
- CV risk factors influencing brachial artery distensibility
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"Obesity and Early Changes of Endothelial Dysfunction Determined By Pulse Wave Velocity in Female Caucasian South Africans"Dr. Helen Marcoyannopoulou Fojas (biography)
English - 2005-04-16 - 18 minutes
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Summary :
PURPOSE: To show that abnormal time of Pulse Wave Velocity associated with increased Body Mass Index (BMI) is an early indication of atherosclerosis.
METHOD: Pulse Wave Velocity was determined indirectly with the use of infrared sensors which picked up and recorded the left external carotid and left dorsalis pedis arteries simultaneously with a single lead ECG. The time delay...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
Data from a study of 115 Caucasian South African women on:
- The relationship between arterial wall elasticity and BMI
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"Are We Ready to Treat the Metabolic Syndrome?"Dr. Sir George Alberti (biography)
English - 2005-04-16 - 28 minutes
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Summary :
It is helpful to (a) know what it is and (b) know what causes it. A working definition is close which will fulfil criterion (a). There is less agreement about criterion (b) with two main schools: those who consider that insulin resistance is undoubtedly causative and those who are more sceptical and consider that the cause is uncertain with some underlying pathophysiological mechanism, such as...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The purpose of and prerequisites for treating the metabolic syndrome
- The importance of lifestyle management and the role of pharmacological treatment of components of the metabolic syndrome
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"Where do we go from here?"Prof. Pierre Lefebvre (biography)
English - 2005-04-16 - 33 minutes
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Summary :
Where do we go from here? Prof. Pierre Lefebvre begins his discourse of the future of “prediabetes”, diabetes, and metabolic syndrome research and action by reviewing exactly where here is and the International Diabetes Federation (IDF) and World Health Organization (WHO) projections for the next 20 to 25 years.
Do international organizations adequately recognize the scale of the...
Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The status of the diabetes epidemic in 2005
• The IDF/IDI and WHO projections for diabetes prevalence in the future
• Whether international organizations and the private sector adequately recognize the scale and scope of the problem
• The reactions of the IDF in response to the growing diabetes epidemic, including the World Diabetes Atlas and the Diabetes Action Now projects
Bibliographic references :
World Diabetes Atlas
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004 May;27(5):1047-53.
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"What Should Governments do to Prevent Diabetes/CVD?"Dr. Peter H. Bennett (biography)
English - 2005-04-16 - 32 minutes
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Summary :
The extent and magnitude of the present and future burden of diabetes and related cardiovascular diseases is now well recognized by the medical community. While effective treatments exist, their use only benefits those who have developed these diseases. The fundamental problem relates to prevention of these diseases. For type 2 diabetes, there is unequivocal evidence that the most important risk...
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The global burden of diabetes and excess deaths due to diabetes;
- The Medical and Public Health models of prevention;
- Evidence for factors driving the diabetes epidemic: obesity and physical inactivity;
- Interventions targeted at children, adolescents and adults;
- Implementation of interventions at the international, national and local levels.
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