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- May 12, 2008 |
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Welcome to the #1 online source of information for Diabetes Specialists! An international online community of more than 10,000 Diabetes Specialists.
CME on Diabetes is a website built to transmit top-level CME conferences given by international experts in endocrinology, insulin resistance, prediabetes, metabolic syndrome and type 2 diabetes. More than 2.6 million slides have been viewed since the website launch. Thank you for your continued support and commitment!
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"Can Glitazones Delay Progression from Dysglycemia to Type 2 Diabetes? The Evidence"Prof. Hertzel Gerstein (biography)
English - 2005-09-11 - 40 minutes
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Summary :
Diabetes is a complex metabolic disorder that is a risk factor for eye, nerve, kidney, cardiovascular and other serious health consequences and that is rapidly rising in prevalence throughout the developing and the developed world. Thus, diabetes represents a significant, expensive and growing public health problem.
Large clinical trials have reported that lifestyle interventions (i.e. activity and weight loss) and the drugs metformin, acarbose and orlistat can reduce the incidence of diabetes. Whether or not preventing diabetes also prevents the chronic consequences of diabetes remains unknown. However, one report has suggested that acarbose may reduce the risk of cardiovascular disease in people with impaired glucose tolerance (IGT). Cleary, interventions that prevent both diabetes and its sequelae are the most attractive.
Thiazolidinediones (glitazones) are a class of agents that bind to peroxisome proliferators-activated gamma (PPAR gamma) receptors in fat cells and, to a lesser extent in liver and muscle. Rosiglitazone and pioglitazone are currently used to treat diabetes. They enhance hepatic and peripheral insulin sensitivity, lower glucose levels in dysglycaemic individuals, increase hepatic insulin clearance, reduce hepatic fat and inflammatory cytokines, increase adiponectin and promote preadipocyte differentiation into adipocytes. They may also prevent damage to beta cells and preserve insulin secretion. Two clinical trials with the parent glitazone troglitazone (no longer clinically available) also suggested that they reduce the incidence of diabetes by up to 75%, and emerging data suggests they may slow atherosclerosis.
The DREAM study (Diabetes Reduction Assessment with Ramipril and Rosiglitazone Medication) is a large international multicentre trial which is designed to determine whether or not the use of rosiglitazone and/or ramipril reduces the risk of type 2 diabetes in high risk individuals with impaired fasting glucose (IFG) or IGT. 5269 people with IFG and/or IGT are being followed for at least 3 years time, with glucose tolerance tests carried out periodically during the study to determine the rate of both progression to diabetes and regression to normoglycaemia. Atherosclerosis is being assessed by carotid ultrasound in the STARR substudy of >1200 individuals. The study is due to end in 2006.
We have clearly entered the era of diabetes prevention and the era of metabolic health. The emergence of new therapies will challenge both patients and physicians to truly practice preventive medicine in high-risk individuals while deepening our understanding of diabetes.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
(Outline):
- What is diabetes (DM) & why prevent or delay it?
- What therapies are proven to prevent type 2 DM?
- Why might glitazones prevent diabetes?
- What is known about glitazones and DM prevention?
- What is the DREAM study testing?
- Is there more to it than DM prevention?
Bibliographic references :
The Diabetes Prevention Program Research GroupPrevention of Type 2 Diabetes With Troglitazone in the Diabetes Prevention Program Diabetes 54:1150-1156, 2005
Thomas A. Buchanan, Anny H. Xiang, Ruth K. Peters, Siri L. Kjos, Aura Marroquin, Jose Goico, Cesar Ochoa, Sylvia Tan, Kathleen Berkowitz, Howard N. Hodis, and Stanley P. AzenPreservation of Pancreatic ß-Cell Function and Prevention of Type 2 Diabetes by Pharmacological Treatment of Insulin Resistance in High-Risk Hispanic Women Diabetes 51:2796-2803, 2002
The DREAM Trial InvestigatorsRationale, design and recruitment characteristics of a large, simple international trial of diabetes prevention: the DREAM trial Diabetologia, Volume 47, Issue 9, Sep 2004, Pages 1519 - 1527.
Giancarlo Viberti, MD, Steven E. Kahn, MB, CHB, Douglas A. Greene, MD, William H. Herman, MD, Bernard Zinman, MD, Rury R. Holman, MD, Steven M. Haffner, MD, Daniel Levy, MD, John M. Lachin, SCD, Rhona A. Berry, BSC, Mark A. Heise, PHD, Nigel P. Jones, MA and Martin I. Freed, MDA Diabetes Outcome Progression Trial (ADOPT): An international multicenter study of the comparative efficacy of rosiglitazone, glyburide, and metformin in recently diagnosed type 2 diabetes Diabetes Care 25:1737-1743, 2002.
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