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- May 12, 2008 |
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"Diabetes in the US: The Need for Aggressive Disease Management and Getting to Goal"Dr. Richard W. Nesto (biography)
English - 2003-06-16 - 24 minutes
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Summary :
In order to prevent some of the death, disability and complications due to type 2 diabetes, it’s important to choose therapies earlier to provide long-term glycemic control, by acting on insulin resistance and beta cell failure. The UKPDS showed a steady decline in beta cell function after diagnosis (Diabetes. 1995; 44: 1249-58). This decline in beta cell function can be avoided if a treatment modality such as TZDs are used, which not only preserve beta function but improve CVD risk parameters as well. This talk will also cover what happens in patients who are still in the pre-diabetic state and are exposed to the CVD risk and other risks brought about by insulin resistance.
Learning objectives :
The participant will learn how to identify "high risk" metabolic syndrome patients:
Background components:
- Early age at onset
- Strong family history of premature CVD
- First degree relative with type 2 diabetes
- Presence of "other" inflammatory disease
- History or evidence of CVD
Metabolic Syndrome components:
"Very obese"
Fasting glucose > 110 mg/dl
Microalbuminuria (from WHO criteria)
High CRP or PAI-1
Summary:
- Micro/macro vascular disease is present when type 2 diabetes is first diagnosed
- Preceded by years of risk usually in the form of metabolic syndrome
- Natural history is due to a combination of insulin resistance and beta cell decline
- Treatment opportunities now exist that are directed at decreasing insulin resistance and preserving beta cell function.
Bibliographic references :
Hanley AJ, McKeown-Eyssen G, Harris SB, Hegele RA, Wolever TM, Kwan J, Zinman B. Association of parity with risk of type 2 diabetes and related metabolic disorders. Diabetes Care. 2002 Apr;25(4):690-5.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
Hanley AJ, Karter AJ, Festa A, D'Agostino R Jr, Wagenknecht LE, Savage P, Tracy RP, Saad MF, Haffner S; Insulin Resistance Atherosclerosis Study. Factor analysis of metabolic syndrome using directly measured insulin sensitivity: The Insulin Resistance Atherosclerosis Study. Diabetes. 2002 Aug;51(8):2642-7.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi
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