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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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| Presentation |
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"Prevention Trials in Diabetes: A New Era"Dr. James O' Keefe (biography)
English - 2006-11-17 - 31 minutes
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 | (37 slides) |
Summary :
The incidence of diabetes or prediabetes has been on a steeply rising trajectory that parallels the epidemic of obesity. Diabetes confers a level of cardiovascular risk similar to that associated with a history of prior myocardial infarction; thus, diabetes is considered a “risk equivalent” to established coronary disease. The converse is also true – more than 70% of people who present with coronary artery disease have abnormal glucose metabolism. Thus, the prevention of type 2 diabetes, which comprises 90% to 95% of all diabetes, is an important step for ensuring the future cardiovascular health of our patients. The first detectable abnormality of glucose metabolism is loss of the first-phase insulin release. This loss of the preemptive insulin bolus predisposes one to post-meal spikes in glucose. Epidemiologic data consistently indicate that postprandial hyperglycemia is an independent predictor of future cardiovascular events, even in individuals who do not have diabetes. The cardiovascular toxicity of postprandial hyperglycemia appears to be mediated by oxidant stress, which is directly proportional to the glucose excursion after a meal. This transient increase in free radicals acutely triggers inflammation, endothelial dysfunction, hypercoagulability, sympathetic hyperactivity, and a cascade of other atherogenic changes that contribute to the progressive nature of prediabetes, diabetes, and cardiovascular disease.
The postprandial hyperglycemia and cardiotoxicity hypothesis has been bolstered by early intervention studies, which have demonstrated that blunting the postprandial spikes in glucose immediately improves inflammation and endothelial function. More importantly, recent, randomized, controlled trials indicate that improving postprandial hyperglycemia appears to significantly reduce the incidence of type 2 diabetes and hypertension, slow the progression of atherosclerosis, and improve cardiovascular prognosis.
Diet and exercise interventions can reduce the risk of type 2 diabetes by approximately 50% to 60%. Specifically, diets rich in fresh unprocessed plants, with moderate levels of lean protein and beneficial fats (such as omega 3 and monounsaturated oils), but low levels of processed carbohydrates and saturated and trans fats, substantially improve postprandial glucose levels and risk of new diabetes. Additionally, because of the higher antioxidant content and lower glycemic indices of whole plant foods, these tend to induce less postprandial oxidative stress and inflammation. Studies of this type of anti-inflammatory diet show reductions in glucose levels and markers of inflammation almost immediately, even before any significant weight changes occur. Specific foods or beverages, when ingested chronically, have been associated with reduced risk of new diabetes. These include nuts, coffee, alcohol (in low to moderate quantities), and whole grains.
Physical inactivity and excessive abdominal weight both contribute to increased insulin resistance, which magnifies the postprandial glycemic response to dietary carbohydrates and increases the risk of diabetes and cardiovascular disease. Exercise improves insulin sensitivity, and acutely lowers both fasting and post-meal glucose levels. Maintained weight loss of as little as 5% of body weight in obese patients is associated with a substantial reduction in risk of new diabetes.
Several pharmacologic agents have demonstrated effectiveness in preventing type 2 diabetes. In randomized, controlled trials, the occurrence of new diabetes was reduced by 62% with rosiglitazone, by 31% with metformin, by 25% with acarbose, and by 36% with orlistat. Large, randomized studies have shown that rimonabant reduces the prevalence of the metabolic syndrome by 30% to 50%, and decreases the occurrence of new diabetes by 40%. Angiotensin-converting enzyme inhibitors and angiotensin inhibitors may lower the risk of new diabetes by approximately 20%. In summary, type 2 diabetes is a highly preventable disease through diet, lifestyle, and pharmacologic interventions. Normalizing glucose metabolism in the prediabetic state, particularly by controlling postprandial glucose spikes, may be an important opportunity for both improving cardiovascular health and preventing diabetes.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- The burden of prediabetes in the U.S.
- Diabetes mortality in the U.S.
- IGT as a CV risk factor
- Postprandial glucose levels and oxidative stress
- DM prevention: diet and exercise; antidiabetic drugs
- Foods and drugs that reduce postprandial glycemia
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