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- May 17, 2008 |
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| Presentation |
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"Targeting Glycemia in Type 2 Diabetes"Prof. Bernard Zinman (biography)
English - 2002-11-16 - 27 minutes
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 | (29 slides) |
Summary :
The management of type 2 Diabetes Mellitus has some critical issues. We
still need to reach a consensus about adequate screening measures for type
2 diabetes, and traditional therapies reduce hyperglycemia in the short
term, but fail to maintain glycemic control. The Disposition Index shows
the relationship between insulin resistance and beta cell function, and
how staying on the "euglycemic curve" involves increasing insulin
secretion, improving insulin sensitivity, or as is often the case, using
more than one strategy. Hence it's important to have treatments which are
at least additive, and which target pathophysiology so target glycemia
levels can be obtained.
Learning objectives :
Ojectives:
Learn how to manage Type 2 Diabetes Mellitus by:
- Implementing appropriate screening
- Striving for better metabolic control (glycemic control is still poor in many patients)
- Using therapeutic interventions that target pathophysiology
- Using additive rather than substitutive therapy
Conclusions:
- We still need to reach a consensus about adequate screening measures for type 2 diabetes
- Traditional therapies reduce hyperglycemia in the short term, but fail to maintain glycemic control
- Significant reductions in macrovascular complications have only been seen with metformin in overweight patients
- The Disposition Index shows the relationship between insulin resistance and beta cell function, and how staying on the "euglycemic curve" involves increasing insulin secretion, improving insulin sensitivity, or as is often the case, using more than one strategy. Hence it's important to have treatments which are at least additive, and which target pathophysiology so target glycemia levels can be obtained
- Patients seem to prefer taking one pill containing two medications versus taking two kinds of pills, and (newly released in Canada) Avandamet (rosiglitazone maleate/metformin HCl) offers the advantage of 2 agents in one pill which not only lower blood glucose but do so by targeting pathophysiology
- The rosiglitazone and metformin in Avandamet have complementary mechanisms of action, where metformin primarily reduces hepatic glucose production, and rosiglitazone directly targets insulin resistance increasing peripheral glucose uptake
- The combination of rosiglitazone and metformin mitigates some of the weight gain seen with rosiglitazone use alone
- GI side effects with Avandamet are identical to those seen with metformin alone
- Hypoglycemia rates are very low with the combination of rosiglitazone and metformin
- Precautions and contraindications are the same for Avandamet as for metformin or Avandia alone (renal function, heart failure, liver function)
- Avandamet fixed dose combination is indicted for use as an adjunct to diet and exercise in the treatment of type 2 diabetes when diet, exercise and metformin or rosiglitazone alone do not result in adequate glycemic control
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