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- May 12, 2008 |
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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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"Identifying Metabolic Syndrome as a Risk Factor for Type 2 Diabetes: Implications for Cardiologists"Dr. Barry Goldstein (biography)
English - 2004-11-08 - 44 minutes
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Summary :
Diabetes is known to increase the risk of cardiovascular disease, and it is important for cardiologists to know how to optimally manage diabetic patients in order to reduce their risk of adverse cardiovascular outcomes.
Hyperglycaemia is a key risk factor for cardiovascular disease. HbA1c values were correlated with the risk of myocardial infarction in the UKPD study (1), however even minor elevations in blood glucose levels have been associated with increased risk of cardiovascular mortality. The EPIC-Norfolk study for example, showed that HbA1c predicted CV mortality in men not known to have type 2 diabetes (2), and the DECODE study found that fasting plasma glucose and postprandial glucose levels predicted mortality in persons not known to have type 2 diabetes (3).
In the metabolic syndrome, visceral adiposity is associated with a number of atherogenic changes and correlates negatively with insulin sensitivity (4). Insulin resistance is a core defect in type 2 diabetes, characterized by overproduction of glucose by the liver and impaired glucose uptake by skeletal muscle. In analyses from the San Antonio Heart Study, Haffner et al. found that converters to diabetes had both insulin resistance and low insulin secretion in a majority of cases, and also that insulin resistant prediabetic subjects had more atherogenic risk factors than insulin-sensitive prediabetic subjects (5), suggesting that strategies to prevent diabetes based on insulin-sensitizing interventions would lower cardiovascular risk.
In the Diabetes Prevention Program it was shown that metformin reduced the risk of diabetes by 31 percent, and lifestyle intervention reduced the risk of diabetes by 58 percent, in subjects with impaired glucose tolerance (6). In other studies from Tom Buchanan's group, the thiazolidinedione (TZD) troglitazone reduced the risk of diabetes (7) and subclinical atherosclerosis progression (8) in high risk women.
Dr. Goldstein concludes his presentation with a discussion of the effects of oral diabetes medications on cardiovascular risk factors, and the potential benefits of combination therapy with agents such as metformin and TZDs, having complementary modes of action.
Copyright © 2005 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The contribution of hyperglycemia towards the risk of cardiovascular disease
- Identifying patients at risk for conversion to type 2 diabetes
- Studies on diabetes prevention using lifestyle intervention and/or insulin-sensitizing oral agents (DPP, TRIPOD)
- Treatment strategies for improving cardiovascular risk factors in type 2 diabetes
Bibliographic references :
1. Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR.Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study BMJ 2000;321:405-412.
2. Khaw KT, Wareham N, Luben R, Bingham S, Oakes S, Welch A, Day N. Glycated haemoglobin, diabetes, and mortality in men in Norfolk cohort of European Prospective Investigation of Cancer and Nutrition (EPIC-Norfolk)BMJ 2001;322:15.
3. The DECODE study group on behalf of the European Diabetes Epidemiology 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.
4. Barry J. Goldstein MD, PhDInsulin resistance as the core defect in type 2 diabetes mellitus The American Journal of Cardiology. Volume 90, Issue 5, Supplement 1 , 5 September 2002, Pages 3-10.
5. Steven M. Haffner, MD; Leena Mykkänen, MD; Andreas Festa, MD; James P. Burke, PhD; Michael P. Stern, MD Insulin-Resistant Prediabetic Subjects Have More Atherogenic Risk Factors Than Insulin-Sensitive Prediabetic Subjects: Implications for Preventing Coronary Heart Disease During the Prediabetic State Circulation. 2000;101:975.
6.Diabetes Prevention Program Research Group Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or MetforminNEJM. 2002; Volume 346:393-403.
7. 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.
8. Anny H. Xiang, Ruth K. Peters, Siri L. Kjos, Cesar Ochoa, Aura Marroquin, Jose Goico, Sylvia Tan, Chengwei Wang, Stanley P. Azen, Chao-ran Liu, Ci-hua Liu, Howard N. Hodis, and Thomas A. Buchanan. Effect of Thiazolidinedione Treatment on Progression of Subclinical Atherosclerosis in Premenopausal Women at High Risk for Type 2 Diabetes Journal of Clinical Endocrinology & Metabolism 2004. Dec 28; [Epub ahead of print].
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