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- May 16, 2008 |
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"Use of Thiazolidinediones in Type 2 Diabetes: Advantages"Dr. David Kendall (biography)
English - 2004-06-04 - 48 minutes
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Summary :
In this presentation Dr. Kendall discusses the advantages of using thiazolidinedione therapy in type 2 diabetes, with regards to various aspects of management.
The development of type 2 diabetes is dependent on insulin resistance and beta cell dysfunction. TZDs are known to reduce insulin resistance and lower glucose, and studies done in Zucker diabetic fatty rats showed that TZDs also prevented a decline in beta cell mass (1). A small study done in humans with impaired glucose tolerance or mild diabetes showed that troglitazone improved insulin secretory rates (2).
The TRIPOD and DPP studies both looked at troglitazone in the prevention of diabetes in high risk groups, and Dr. Kendall discusses the data suggesting a role for TZD therapy in diabetes prevention. The DREAM, ACT NOW, and ADOPT trials are all investigating the role of TZD therapy in diabetes prevention or progression.
Insulin resistance has been shown to be predictive of cardiovascular disease (3), and can be significantly improved with weight loss and physical activity. Insulin resistance is associated with a number of factors that increase the risk of atherosclerosis and cardiovascular disease, and Dr. Kendall discusses the ability of glitazones to cause improvements in these risk factors. Outcome trials with glitazones looking at cardiovascular events are ongoing, and the results of these trials would determine the specific cardiovascular benefits of these drugs.
Dr. Kendall concludes his presentation with a discussion of the treatment limiting side effects of TZDs, and the cost of diabetes health care in terms of medication costs versus the costs associated with the cardiovascular complications of diabetes.
Copyright © 2004 E-MedHosting.com Inc.
Learning objectives :
After viewing this presentation the participant will be able to discuss:
- Glycemic control with TZD therapy:
---- Targeting the metabolic defects of type 2 diabetes
---- Preserving beta cell function
- The role of TZD therapy in diabetes prevention:
---- DPP and TRIPOD studies
- Insulin resistance and CVD risk:
---- Targeting insulin resistance in the metabolic syndrome
- The safety and tolerability of TZDs
- The cost of comprehensive diabetes care
Bibliographic references :
1. Diane T. Finegood, M. Dawn McArthur, David Kojwang, Marion J. Thomas, Brian G. Topp, Thomas Leonard, and Robin E. Buckingham. ß-Cell Mass Dynamics in Zucker Diabetic Fatty Rats: Rosiglitazone Prevents the Rise in Net Cell Death Diabetes 50:1021-1029, 2001.
2. Melissa K. Cavaghan, David A. Ehrmann, Maria M. Byrne, and Kenneth S. Polonsky.Treatment with the Oral Antidiabetic Agent Troglitazone Improves Cell Responses to Glucose in Subjects with Impaired Glucose Tolerance JCI.1997;100(3):530-537.
3. Jeannie Yip, Francesco S. Facchini and Gerald M. Reaven.Resistance to Insulin-Mediated Glucose Disposal as a Predictor of Cardiovascular Disease JCEM.1998;83(8):2773-2776.
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