- July 31, 2010 Welcome to the #1 online source of information for Diabetes Specialists! An international online community of more than 10,000 Diabetes Specialists. 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!   Topic   Treatment therapies Diabetes is a chronic disease that weakens the capacity of the body to produce or use insulin adequately. Type 2 diabetes leads to hyperglycemia (excessive levels of sugar in the blood) and can cause complications such as kidney or heart disease, stroke, blindness and impotence. To fight the deterioration of the quality of life of diabetic patients, many possibilities are available to help them live with the disease. Pharmacological treatment is an aspect that is studied, as well as alternative methods such as nutrition, the use of natural products... Presentations listing Medication Matters - Dr. Pat Phillips Therapeutic Inertia - Dr. Pat Phillips Hypoglycaemia - Dr. Pat Phillips Starting insulin in Type 2 Diabetes - Dr. Pat Phillips Post Prandial BGL – As simple as 1, 2, 3 - Dr. Pat Phillips Glycemic intervention studies in type 2 DM: implications... - Dr. Lawrence A. Leiter Lung function and inhaled insulin in diabetes - Prof. Timothy Davis Pros and cons of newer diabetes strategies - DPP-4... - Prof. John Prins Pros and cons of newer diabetes strategies - DPP-4... - Prof. John Prins Lifestyle modification: What does it achieve? - Prof. John Prins Oral anti-diabetic action on the beta cell - Dr. Sof Andrikopoulos Lowering blood glucose - Walking the tightrope between good... - Prof. Richard O'Brien Lifestyle modification - What does it achieve? - Prof. John Prins The importance of achieving glycemic control - Prof. Stephan Matthaei Medico-legal aspects of prescribing guidance - Dr. Paul Nisselle Lowering blood glucose - Walking the tightrope between good... - Prof. Richard O'Brien Managing chronic renal failure and diabetes - Dr. Nicole Isbel Oral anti-diabetic action on the beta cell - Dr. Sof Andrikopoulos Insulin Pump Therapy in Children and Adolescents - A.Prof. Timothy W. Jones Antipsychotics and Diabetes - Prof. John Prins The Edmonton protocol - Where to from now? - Dr. Philip O'Connell Management of Type 2 Diabetes: A GP's Perspective - Dr. Nestor Fuertes Glycaemic Efficacy of TZDs - Prof. Don Chisholm Thiazolidinediones and bone biology - Prof. John Prins Where Do Glitazones Fit In in clinical practice? - Dr. Soji Swaraj Practical diabesity intervention: Strategies borrowed from... - Dr. Soji Swaraj Is self-monitoring of blood glucose (SMBG) worthwhile in... - Prof. Timothy Davis Treat to target - Prof. Richard O'Brien Introduction - Dr. Matthew Cohen Current treatments in type 2 diabetes - Dr. Neale Cohen Summary and Close - Dr. Matthew Cohen Case Study Presentation - Dr. Andrew Marangou ‘Algorithm(s)’ for Glycaemic Control - Preceding ADOPT - Dr. Stephen Twigg Effects of Thiazolidinediones on Insulin Secretion in... - Prof. Kenneth Polonsky A (brief) review of the UKPDS - Prof. Timothy Davis Adding PS to the ABCss of Diabetes Care – An Australian... - Dr. Pat Phillips The Progressive Nature of Type 2 Diabetes - Update on... - Prof. Giancarlo Viberti Are We Making Progress With Slowing Disease Progression? - Prof. Peter J. Grant Complementary Therapies - An Overview - Prof. Trisha Dunning UKPDS - Unanswered Questions? - Prof. Rury Holman Platelets in Diabetes: An Important Therapeutic Target - Prof. Karlheinz Peter Insulin Resistance, Diabetes and Vascular Disease: The... - Prof. Nikolaus Marx Prevention and Treatment of Diabetic Nephropathy:... - Dr. Richard E. Gilbert Prevention and Treatment of Diabetic Nephropathy:... - Dr. Richard E. Gilbert Insulin Stabilisation - Prof. Trisha Dunning Transplantation in Diabetes Management - Dr. Philip O'Connell The FIELD Study - Prof. Timothy Davis Dual PPAR alpha/gamma Agonists - Promise and Problems - Prof. John Prins Obesity and Type 2 Diabetes: Impact of Major Weight Loss - Prof. Paul O'Brien The VICTORY Study: Assessing the efficacy of rosiglitazone... - TZDs and Atherosclerosis: Can They Make a Difference? - Dr. Lawrence A. Leiter Obesity Management Part I - Introduction - Dr. Trisha O'Moore-Sullivan The Role of Fibrates in Reducing Cardiovascular Risk - Prof. Philip Barter Obesity Management Part II - Lifestyle Modification - Dr. Trisha O'Moore-Sullivan Obesity Management Part III - Pharmacotherapy - Dr. Trisha O'Moore-Sullivan Obesity Management Part IV - Bariatric Surgery - Dr. Trisha O'Moore-Sullivan Diabetic Complications: Lessons from Pancreas... - Dr. Brian Nankivell Vascular Actions of Oral Hypoglycaemic Agents... - Dr. Peter Little Glucose Targets in and Around Pregnancy: How Low Can You... - Dr. David McIntyre Glucose Targets in and Around Pregnancy: How Low Can You... - Dr. David McIntyre Glucose Targets in and Around Pregnancy: How Low Can You... - Dr. David McIntyre Effect of Troglitazone on Pre-Clinical Carotid... - Prof. Thomas A. Buchanan The ORIGIN Study - Prof. Hertzel Gerstein New drugs for 'Prediabetes', Metabolic Syndrome and their... - Prof. Michael A. Nauck PPARs and Metabolic Control - Prof. John Prins Diabetes Treatments and Inflammatory Markers - Dr. Vivian A. Fonseca The DIGAMI studies: Implications for practice - Prof. Timothy Davis Treatment with insulin detemir provides improved glycaemic... - Dr. A. J. Garber Limitations to Achieving Good Glycaemic Control - Dr. Roger Chen PPAR effects linked to atherosclerosis independent of... - Dr. Karin Jandeleit-Dahm Strategies to prevent diabetic renal disease (bench to... - Prof. Mark E. Cooper Glitazones and Vascular Disease in Clinical Practice - Prof. Gerald Watts Have the Guidelines Jumped Ahead of the Evidence? - Dr. Stephen Colagiuri Glycaemic Control and Diabetes Complications - Dr. Stephen Twigg Evolving Therapies in Type 2 Diabetes - Prof. John Prins Based on these mechanisms, are beta-cells a therapeutic... - Dr. Julio Rosenstock What clinical guidelines are available to support the need... - Dr. Steven V. Edelman Should insulin resistance be considered a therapeutic... - Dr. Steven V. Edelman Good Morning Diabetes: Building a New Framework for... - Dr. James R. Gavin Could you please comment on recent clinical trials of... - Dr. Andrew P. Selwyn What clinical evidence is available to support... - Dr. Andrew P. Selwyn What is the rationale for earlier use of oral antidiabetic... - Dr. Steven V. Edelman What is the evidence for combination therapy with a TZD... - Dr. Julio Rosenstock What are some of the clinical management issues with TZDs... - Dr. Andrew P. Selwyn What is the increasing evidence that supports TZDs and... - Dr. Julio Rosenstock What clinical data is there regarding inflammatory markers... - Dr. Steven V. Edelman Are there any outcome measures that suggest a favorable... - Dr. Julio Rosenstock How can we make a difference in clinical practice to... - Dr. Andrew P. Selwyn Dr. Rosenstock Summary - Dr. Julio Rosenstock Dr. Edelman Summary - Dr. Steven V. Edelman Dr. Selwyn Summary - Dr. Andrew P. Selwyn Dr. Gavin Concludes - Dr. James R. Gavin Type 2 Diabetes Mellitus and Heart Failure: Implications... - Dr. Richard W. Nesto 2003 CDA Clinical Practice Guidelines for the prevention... - Dr. Amir Hanna Hypoglycemic Disorders: Investigation and Treatment - Dr. Amir Hanna Treating Dyslipidemia in Diabetes - Dr. Jeannette Goguen Novel Dietary Therapies in the Treatment of Diabetes and... - Dana Whitham Targets for Glucose Control: A Review of Recent Evidence - Dr. Gillian Booth Perioperative Glycemic Control - Dr. Alice Cheng The Value of Combination Therapy in Type 2 Diabetes - Prof. Bernard Zinman Sustaining Long-Term Glycemic Control: Are we ready for... - Dr. Stuart A Ross Thiazolidinediones to Preserve B-Cell Function and Prevent... - Prof. Thomas A. Buchanan Shifting the paradigm: from stepwise to early combination... - Prof. Rury Holman The case for rosiglitazone therapy : putting theory into... - Dr. Kathleen Wyne What are the optimal combination strategies in order to... - Dr. Lawrence A. Leiter Early combination therapy in type 2 diabetes: targeting... - Prof. John Nolan Scientific Update: Rosiglitazone in Perspective - Dr. Robin Buckingham Multifactorial Intervention and Cardiovascular Disease in... - Dr. Oluf Pedersen Looking at New Evidence: Immediate Solutions to a Long-Term... - Dr. Steven V. Edelman Type 2 diabetes-Early : Aggressive Treatment Strategies - Dr. Amir Hanna Canadian Diabetes Association Guidelines - Update - Dr. Stewart Harris Targeting Glycemia in Type 2 Diabetes - Prof. Bernard Zinman Sustaining Long-Term Glycemic Control - Dr. Stuart A Ross Hypoglycemia in Type 2 Diabetes: Impact and Management - Dr. Amir Hanna Type 2 Diabetes: A Multifactorial Syndrome - Dr. Stuart A Ross Treating Type 2 Diabetes Patients to Target - Dr. Lawrence A. Leiter Alternative Therapies in the Glycemic Control of Type 2... - Dr. Jeannette Goguen Use of Combination Therapy in the Treatment of Type 2... - Dr. Amir Hanna The Treatment of Obesity in Type 2 Diabetes - Dr. Lawrence A. Leiter  Presentation  "Medication Matters" Dr. Pat Phillips (biography) English - 2009-11-24 - 14 minutes (1 slides) Summary : Type 2 diabetic patients can take numerous types of medications both prescribed and complementary, and it is important to know which of these should be encouraged, stopped or better managed, according to their role in the context of diabetes management. Ideally, the “type 2 tablet” would exist and include metformin, an ACE inhibitor, aspirin, and a statin, which would be... Learning objectives : After viewing this presentation the participant will be able to discuss: - What the ideal “type 2 tablet” would contain and why - Side effects of commonly used hypoglycaemic and other types of drugs - Medications to consider stopping in type 2 diabetic patients - How to address the issue of adherence with the patient - Which drugs should be taken at a certain time/under certain conditions  Presentation  "Therapeutic Inertia" Dr. Pat Phillips (biography) English - 2009-11-24 - 1 minutes (35 slides) Bibliographic references : 1) Nathan DM, Buse JB, Davidson MB, Heine RJ, Holman RR, Sherwin R, Zinman B.Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy - A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes Diabetes Care. 2006 Aug;29(8):1963-72. 2) R. Rachmani, Z. Levi, I. Slavachevski, M. Avin and M. Ravid Teaching patients to monitor their risk factors retards the progression of vascular complications in high-risk patients with Type 2 diabetes mellitus—a randomized prospective study Diabetic Medicine 2002; Volume 19 Issue 5, Pages 385 - 392. 3) Peter Gæde, M.D., Pernille Vedel, M.D., Ph.D., Nicolai Larsen, M.D., Ph.D., Gunnar V.H. Jensen, M.D., Ph.D., Hans-Henrik Parving, M.D., D.M.Sc., and Oluf Pedersen, M.D., D.M.Sc.Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes NEJM 2003;348:383-393.  Presentation  "Hypoglycaemia" Dr. Pat Phillips (biography) English - 2009-10-17 - 12 minutes (26 slides) Summary : Hypoglycaemia risk per thousand patient years is higher in Type 1 patients compared to Type 2, according to a comparison of the data from the DCCT and UKPDS studies. Type 1 patients have no intrinsic compensatory mechanism, and hence are more sensitive to increases in the insulin dose. Type 2 patients with longstanding diabetes may have a similar risk of hypoglycaemia as Type 1... Learning objectives : After viewing this presentation the participant will be able to discuss: - Hypoglycaemia risk in Type 1 vs Type 2 diabetes - The ‘5,4,3,2,1’ rule for physiological responses to hypoglycaemia; loss of hypoglycaemic awareness - Circumstances leading to hypoglycaemia in Type 1 and Type 2 - Hypoglycaemia and drugs - Protocols for hypoglycaemia treatment  Presentation  "Starting insulin in Type 2 Diabetes" Dr. Pat Phillips (biography) English - 2009-08-24 - 48 minutes (35 slides) Summary : Dr Phillips talks about initiation of insulin therapy in type 2 diabetic patients using the KISS (Keep Insulin Safe and Simple) principle. The use of insulin sooner rather than later in type 2 diabetes is supported by findings from the United Kingdom Prospective Diabetes Study (UKPDS). As the study showed, there was an increasing loss of glycaemic control with time regardless of... Learning objectives : After viewing this presentation the participant will be able to: - Explain the progressive nature of type 2 diabetes - Demonstrate the rationale for and safety of earlier use of insulin in type 2 diabetes - Implement the KISS (Keep Insulin Safe and Simple) method for commencement of insulin therapy in type 2 patients Bibliographic references : Robert C. Turner, FRCP; Carole A. Cull, PhD; Valeria Frighi, MD; Rury R. Holman, FRCP; for the UK Prospective Diabetes Study (UKPDS) Group. Glycemic Control With Diet, Sulfonylurea, Metformin, or Insulin in Patients With Type 2 Diabetes Mellitus: Progressive Requirement for Multiple Therapies (UKPDS 49) JAMA. 1999;281:2005-2012. Brown JB, Nichols GA, Perry A.The Burden of Treatment Failure in Type 2 Diabetes Diabetes Care 27:1535-1540, 2004. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) Lancet 352; 837-53.1998 Irl B. Hirsch, MD, Richard M. Bergenstal, MD, Christopher G. Parkin, MS, Eugene Wright, Jr., MD and John B. Buse, MD, PhD A Real-World Approach to Insulin Therapy in Primary Care Practice Clinical Diabetes 23:78-86, 2005.  Presentation  "Post Prandial BGL – As simple as 1, 2, 3" Dr. Pat Phillips (biography) English - 2009-08-24 - 32 minutes (46 slides) Summary : Dr. Phillips discusses issues to consider when trying to control post prandial blood glucose. The three components of controlling post prandial blood glucose are: to count the carbohydrates (carbs) to be consumed in the meal, to check the blood glucose level, and to take the required amount of insulin. If the 2-hour blood glucose level is too high or too low, the carbs component or the blood... Learning objectives : After viewing this presentation the participant will be able to: - Establish with the patient a system of carbohydrate counting, blood glucose monitoring, and insulin dosing for controlling post prandial blood glucose - Explain to the patient the impact of basal glycaemia on the effectiveness of this system  Presentation  "Glycemic intervention studies in type 2 DM: implications for patient care" Dr. Lawrence A. Leiter (biography) English - 2009-08-14 - 40 minutes (31 slides) Summary : In this presentation Dr. Leiter reviews updated evidence from trials looking at the role of glycemic control in reducing the risk of diabetic complications. There is evidence to support the concept of “earlier is better” for glycemic control in the prevention of cardiovascular (CV) complications, in type 1 and type 2 diabetic patients. In type 1 patients, the 10-year EDIC... Learning objectives : After viewing this presentation the participant will be able to discuss: - Long-term reductions in cardiovascular outcomes associated with earlier glycemic control in type 1 and type 2 diabetic patients - Evidence for “earlier is better” regarding glycemic control in type 2 patients - Data suggesting harm from intensive treatment in some patients - Current Canadian glycemic targets - Treatment in patients with coronary artery disease Bibliographic references : The Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group Effect of Intensive Therapy on the Microvascular Complications of Type 1 Diabetes Mellitus JAMA Vol. 287 No. 19, May 15, 2002. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group Intensive Diabetes Treatment and Cardiovascular Disease in Patients with Type 1 Diabetes NEJM Volume 353:2643-2653. Peter Gæde, M.D., D.M.Sc., Henrik Lund-Andersen, M.D., D.M.Sc., Hans-Henrik Parving, M.D., D.M.Sc., and Oluf Pedersen, M.D., D.M.Sc. Effect of a Multifactorial Intervention on Mortality in Type 2 DiabetesNEJM Volume 358:580-591. Rury R. Holman, F.R.C.P., Sanjoy K. Paul, Ph.D., M. Angelyn Bethel, M.D., David R. Matthews, F.R.C.P., and H. Andrew W. Neil, F.R.C.P. 10-Year Follow-up of Intensive Glucose Control in Type 2 Diabetes NEJM Volume 359:1577-1589. The Action to Control Cardiovascular Risk in Diabetes Study GroupEffects of Intensive Glucose Lowering in Type 2 Diabetes N Engl J Med. 2008 Jun 12;358(24):2545-59.  Presentation  "Lung function and inhaled insulin in diabetes" Prof. Timothy Davis (biography) English - 2009-07-24 - 36 minutes (26 slides) Summary : Pulmonary involvement in diabetes was first reported about thirty years ago, and in 1989 a cross-sectional study from Denmark was published showing slightly impaired lung function among diabetic patients, which was more apparent in those taking insulin (1). More recently, cross-sectional and prospective data from the Fremantle Diabetes Study shed further light on the topic. In this... Learning objectives : After viewing this presentation the participant will be able to discuss: - The effect of diabetes on the lung - The rationale for inhaled insulin - The status of inhaled insulin Bibliographic references : 1. Lange P, Groth S, Kastrup J, Mortensen J, Appleyard M, Nyboe J, Jensen G, Schnohr P. Diabetes mellitus, plasma glucose and lung function in a cross-sectional population study. Eur Respir J. 1989 Jan;2(1):14-9. 2. Timothy M.E Davis, Matthew Knuiman, Peter Kendall, Hien Vu, Wendy A Davis Reduced pulmonary function and its associations in type 2 diabetes: the Fremantle Diabetes Study Diabetes Research and Clinical Practice - 1 October 2000 (Vol. 50, Issue 2, Pages 153-159) 3. Davis WA, Knuiman M, Kendall P, Grange V, Davis TM; Fremantle Diabetes Study.Glycemic Exposure Is Associated With Reduced Pulmonary Function in Type 2 Diabetes: The Fremantle Diabetes Study Diabetes Care. 2004 Mar;27(3):752-7.  Presentation  "Pros and cons of newer diabetes strategies - DPP-4 inhibitors and incretins" Prof. John Prins (biography) English - 2009-05-27 - 40 minutes (58 slides) Summary : After glucose, the incretin hormones are the most important stimulator of insulin secretion, says Prof. Prins. The incretin effect is reduced in type 2 diabetes. Glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are the two major incretin hormones. They can be increased by using oral dipeptidyl peptidase-4 (DPP-4) inhibitors which stop the... Learning objectives : After viewing this presentation the participant will be able to discuss: - Contributors to hyperglycaemia in T2DM - Regulation of glucose homeostasis by incretins - Similarities and differences between effects of DPP-4 inhibitors and GLP-1 analogues - Efficacy and safety of these agents Bibliographic references : M. Nauck et al. Reduced incretin effect in Type 2 (non-insulin-dependent) diabetes Diabetologia. Volume 29, Number 1 / January, 1986  Presentation  "Pros and cons of newer diabetes strategies - DPP-4 inhibitors and incretins" Prof. John Prins (biography) English - 2009-05-27 - 40 minutes (58 slides) Summary : After glucose, the incretin hormones are the most important stimulator of insulin secretion, says Prof. Prins. The incretin effect is reduced in type 2 diabetes. Glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP) are the two major incretin hormones. They can be increased by using oral dipeptidyl peptidase-4 (DPP-4) inhibitors which stop the... Learning objectives : After viewing this presentation the participant will be able to discuss: - Contributors to hyperglycaemia in T2DM - Regulation of glucose homeostasis by incretins - Similarities and differences between effects of DPP-4 inhibitors and GLP-1 analogues - Efficacy and safety of these agents Bibliographic references : M. Nauck et al. Reduced incretin effect in Type 2 (non-insulin-dependent) diabetes Diabetologia. Volume 29, Number 1 / January, 1986  Presentation  "Lifestyle modification: What does it achieve?" Prof. John Prins (biography) English - 2008-05-18 - 34 minutes (35 slides) Summary : Does lifestyle modification have proven benefits? Obesity is associated with increased risk for diabetes and coronary heart disease, and even a ten percent weight loss is associated with decreased mortality, diabetes risk, blood pressure and lipids. These improvements have been summarized in a publication by Jung et al. (1). In diabetic patients, lifestyle... Learning objectives : After viewing this presentation the participant will be able to discuss: - Obesity-associated health risks - Clinical benefits of weight loss - Effects of lifestyle intervention in diabetic patients - Weight loss and cancer risk (Women's Health Study) - Exercise and osteoporosis risk - Proatherogenic mechanisms in obesity Bibliographic references : 1. Roland T Jung. Obesity as a disease British Medical Bulletin 53:307-321 (1997). 2. Chinmay Patel, Husam Ghanim, Shreyas Ravishankar, Chang Ling Sia, Prabhakar Viswanathan, Priya Mohanty and Paresh Dandona. Prolonged Reactive Oxygen Species Generation and Nuclear Factor-{kappa}B Activation after a High-Fat, High-Carbohydrate Meal in the Obese J Clin Endocrinol Metab. 2007 Nov;92(11):4476-9.  Presentation  "Oral anti-diabetic action on the beta cell" Dr. Sof Andrikopoulos (biography) English - 2008-05-18 - 40 minutes (46 slides) Summary : Dr. Andrikopoulos first explains that type-2 diabetes results from the failure of beta cells to secrete amounts of insulin sufficient to compensate for the impact of muscle insulin resistance, obesity, and a glucose-rich diet. He then goes on to describe some of the main oral anti-diabetic agents used today. The first of these is sulfonylurea, which acts on the pancreas to... Learning objectives : After viewing this presentation the participant will be able to discuss the role the beta cell in type-2 diabetes and the effect of the following oral anti-diabetic agents on the beta cell: -Sulfonylureas -GLP-1 -Metformin -TZDs Bibliographic references : Kahn SE, Hull RL, Utzschneider KM Mechanisms linking obesity to insulin resistance and type 2 diabetes Nature. 2006 Dec 14;444(7121):840-6. Aston-Mourney K, Proietto J, Morahan G, Andrikopoulos S Too much of a good thing: why it is bad to stimulate the beta cell to secrete insulin Diabetologia 2008 Apr;51(4):540-5. Epub 2008 Feb 2. Lupi R, Mancarella R, Del Guerra S, Bugliani M, Del Prato S, Boggi U, Mosca F, Filipponi F, Marchetti P S Effects of exendin-4 on islets from type 2 diabetes patients Diabetes Obes Metab. 2008 Jun;10(6):515-9. Epub 2008 Jan 14.  Presentation  "Lowering blood glucose - Walking the tightrope between good and evil" Prof. Richard O'Brien (biography) English - 2008-05-17 - 44 minutes (48 slides) Summary : Glucose control in type 1 and type 2 diabetic patients has been shown to reduce microvascular complications, as seen in the DCCT and UKPDS trials, however there is some controversy about the relationship between intensive glycaemic control and cardiovascular (CV) risk. There is clinical trial data suggesting that intensive glucose control in type 2 patients is not effective in... Learning objectives : After viewing this presentation the participant will be able to discuss: Lowering blood glucose in the context of: - Microvascular effects - Macrovascular effects - Possible harm - Mechanisms for possible harm - Glitazones, glucose control and CVD Bibliographic references : 1. Philip D. Home, D.M., D.Phil., Stuart J. Pocock, Ph.D., Henning Beck-Nielsen, D.M.S.C., Ramón Gomis, M.D., Ph.D., Markolf Hanefeld, M.D., Ph.D., Nigel P. Jones, M.A., Michel Komajda, M.D., John J.V. McMurray, M.D., for the RECORD Study Group Rosiglitazone Evaluated for Cardiovascular Outcomes — An Interim Analysis NEJM 2007. Volume 357:28-38.  Presentation  "Lifestyle modification - What does it achieve?" Prof. John Prins (biography) English - 2008-05-17 - 39 minutes (36 slides) Summary : Does lifestyle modification have proven benefits? Obesity is associated with increased risk for diabetes and coronary heart disease, and even a ten percent weight loss is associated with decreased mortality, diabetes risk, blood pressure and lipids. These improvements have been summarized in a publication by Jung et al. (1). In diabetic patients, lifestyle... Learning objectives : After viewing this presentation the participant will be able to discuss: - Obesity-associated health risks - Clinical benefits of weight loss - Effects of lifestyle intervention in diabetic patients - Weight loss and cancer risk (Women's Health Study) - Exercise and osteoporosis risk - Proatherogenic mechanisms in obesity Bibliographic references : 1. Roland T Jung. Obesity as a disease British Medical Bulletin 53:307-321 (1997). 2. Chinmay Patel, Husam Ghanim, Shreyas Ravishankar, Chang Ling Sia, Prabhakar Viswanathan, Priya Mohanty and Paresh Dandona. Prolonged Reactive Oxygen Species Generation and Nuclear Factor-{kappa}B Activation after a High-Fat, High-Carbohydrate Meal in the Obese J Clin Endocrinol Metab. 2007 Nov;92(11):4476-9.  Presentation  "The importance of achieving glycemic control" Prof. Stephan Matthaei (biography) English - 2008-05-17 - 32 minutes (56 slides) Summary : The United Kingdom Prospective Diabetes Study (UKPDS) showed in type 2 diabetic patients that a fall in A1c of one percent results in a reduction in the relative risk of complications (1), however glycaemic targets are still not being met in large numbers of patients. This could be due to continuation of the traditional step-wise approach to therapy in which long delays can occur between the... Learning objectives : After viewing this presentation the participant will be able to discuss: - Effects of a fall in A1c on the relative risk of complications in T2DM - U.S. and German guidelines for therapy of T2DM - Efficacy and safety of combination therapies - Predicted health-economic benefits of treating to target in T2DM 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. Brown J et al., Diabetes 2003; 52(Suppl 1):A61-A62. 3. Nathan DM, Buse JB, Davidson MB, Heine RJ, Holman RR, Sherwin R, Zinman B. Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes Diabetes Care 29:1963-1972, 2006. 4. http://www.deutsche-diabetes-gesellschaft.de/  Presentation  "Medico-legal aspects of prescribing guidance" Dr. Paul Nisselle (biography) English - 2008-05-17 - 33 minutes (29 slides) Summary : The types of medication errors leading to claims include prescribing the wrong drug; incorrect dosing; over- or under-prescribing; inadequate monitoring and inadequate recording. Prescribing errors arise due to “latent conditions” (organisational sloppiness), “error-producing conditions” and “active failures.” Slips can occur when prescribing, for example when thinking of one name... Learning objectives : After viewing this presentation the participant will be able to discuss: - Types of medication errors leading to claims - Highest risk areas - Influences on successful prescribing - Recommendations for doctors  Presentation  "Lowering blood glucose - Walking the tightrope between good and evil" Prof. Richard O'Brien (biography) English - 2008-05-17 - 45 minutes (50 slides) Summary : Glucose control in type 1 and type 2 diabetic patients has been shown to reduce microvascular complications, as seen in the DCCT and UKPDS trials, however there is some controversy about the relationship between intensive glycaemic control and cardiovascular (CV) risk. There is clinical trial data suggesting that intensive glucose control in type 2 patients is not effective in... Learning objectives : After viewing this presentation the participant will be able to discuss: Lowering blood glucose in the context of: - Microvascular effects - Macrovascular effects - Possible harm - Mechanisms for possible harm - Glitazones, glucose control and CVD Bibliographic references : 1. Philip D. Home, D.M., D.Phil., Stuart J. Pocock, Ph.D., Henning Beck-Nielsen, D.M.S.C., Ramón Gomis, M.D., Ph.D., Markolf Hanefeld, M.D., Ph.D., Nigel P. Jones, M.A., Michel Komajda, M.D., John J.V. McMurray, M.D., for the RECORD Study Group Rosiglitazone Evaluated for Cardiovascular Outcomes — An Interim Analysis NEJM 2007. Volume 357:28-38.  Presentation  "Managing chronic renal failure and diabetes" Dr. Nicole Isbel (biography) English - 2008-05-17 - 45 minutes (59 slides) Summary : Renal replacement requirements have increased almost entirely due to the increase in the incidence of type 2 diabetes (T2D). Chronic kidney disease (CKD) occurs in about 13% of patients with T2D (1). However, loss of renal function is generally asymptomatic until the glomerular filtration rate (GFR) falls below 30 milliters per minute. Thus, it is important to monitor the GFR. ... Learning objectives : After viewing this presentation the participant will be able to discuss: -The prevalence of chronic kidney disease (CKD) among diabetic patients -How CKD is diagnosed -How to delay the loss of renal function -CKD as an independent cardiovascular risk factor -Who and when to refer to a nephrologist Bibliographic references : (1) Kramer et al Renal Insufficiency in the Absence of Albuminuria and Retinopathy Among Adults With Type 2 Diabetes Mellitus JAMA. 2003;289:3273-3277 (2) PREVEND study group Macroalbuminuria Is a Better Risk Marker than Low Estimated GFR to Identify Individuals at Risk for Accelerated GFR Loss in Population Screening J Am Soc Nephrol 17: 2582-2590, 2006 (3) Bakris and Weir Angiotensin-Converting Enzyme Inhibitor–Associated Elevations in Serum Creatinine Arch Intern Med. 2000;160:685-693  Presentation  "Oral anti-diabetic action on the beta cell" Dr. Sof Andrikopoulos (biography) English - 2008-04-17 - 39 minutes (39 slides) Summary : Dr. Andrikopoulos first explains that type-2 diabetes results from the failure of beta cells to secrete amounts of insulin sufficient to compensate for the impact of muscle insulin resistance, obesity, and a glucose-rich diet. He then goes on to describe some of the main oral anti-diabetic agents used today. The first of these is sulfonylurea, which acts on the pancreas to... Learning objectives : Learning objectives After viewing this presentation the participant will be able to discuss the role the beta cell in type-2 diabetes and the effect of the following oral anti-diabetic agents on the beta cell: -Sulfonylureas -GLP-1 -Metformin -TZDs Bibliographic references : Kahn SE, Hull RL, Utzschneider KM Mechanisms linking obesity to insulin resistance and type 2 diabetes Nature. 2006 Dec 14;444(7121):840-6. Aston-Mourney K, Proietto J, Morahan G, Andrikopoulos S Too much of a good thing: why it is bad to stimulate the beta cell to secrete insulin Diabetologia 2008 Apr;51(4):540-5. Epub 2008 Feb 2. Lupi R, Mancarella R, Del Guerra S, Bugliani M, Del Prato S, Boggi U, Mosca F, Filipponi F, Marchetti P S Effects of exendin-4 on islets from type 2 diabetes patients Diabetes Obes Metab. 2008 Jun;10(6):515-9. Epub 2008 Jan 14.  Presentation  "Insulin Pump Therapy in Children and Adolescents" A.Prof. Timothy W. Jones (biography) English - 2008-02-04 - 27 minutes (50 slides) Summary : In this presentation A.Prof. Jones talks about the rationale for, and clinical experience with insulin pump therapy in children and adolescents. The maintenance of good glycaemic control is difficult in children and adolescents with type 1 diabetes, due to a number of factors. Severe hypoglycemia remains a major problem, however insulin pump treatment was associated with reduced... Learning objectives : After viewing this presentation the participant will be able to discuss: - Obstacles to good glycaemic control in children and adolescents with T1DM - Safety and efficacy of insulin pump therapy in children and adolescents - Importance of a patient and family centred team approach for insulin pump therapy to be successful Bibliographic references : 1. Bulsara MK, Holman CD, Davis EA, Jones TW.The Impact of a Decade of Changing Treatment on Rates of Severe Hypoglycemia in a Population-Based Cohort of Children With Type 1 Diabetes Diabetes Care 27:2293-2298, 2004. 2. Battelino T.Risk and benefits of continuous subcutaneous insulin infusion (CSII) treatment in school children and adolescents Pediatr Diabetes. 2006 Aug;7 Suppl 4:20-4.  Presentation  "Antipsychotics and Diabetes" Prof. John Prins (biography) English - 2007-11-21 - 25 minutes (19 slides) Summary : In this presentation Prof. Prins talks about the relationship between the use of therapies for major psychiatric disorders and the increase in the incidence of metabolic dysfunction. Different types of studies have suggested a trend toward worsening metabolic dysfunction with antipsychotic therapies (1). An important effect of these therapies is weight gain, and related to the... Learning objectives : After viewing this presentation the participant will be able to discuss: - Metabolic dysfunction in schizophrenia - Metabolic effects of antipsychotic therapies - Data to suggest within-class differences in metabolic effects of antipsychotics - Management of patients taking atypical antipsychotics Bibliographic references : 1. Holt RIG and Peveler RC Association between antipsychotic drugs and diabetes Diabetes, Obesity and Metabolism 8 (2) , 125–135. 2. Haupt DW, Kane JM. Metabolic risks and effects of atypical antipsychotic treatment. J Clin Psychiatry. 2007 Oct;68(10):e24. 3. STEPHEN H. SCHULTZ, MD, STEPHEN W. NORTH, MD, mph, and CLEVELAND G. SHIELDS, PhD. Schizophrenia: A Review Am Fam Physician. 2007 Jun 15;75(12):1821-9.  Presentation  "The Edmonton protocol - Where to from now?" Dr. Philip O'Connell (biography) English - 2007-11-17 - 43 minutes (40 slides) Summary : In patients with type 1 diabetes, increasing hypoglycaemia with improving glycaemic control is a problem in patients on intensive insulin treatment. Although the DCCT study showed intensive insulin treatment to result in less complications, the accompanying risk of severe hypoglycaemia makes it harder to maintain long-term. Islet transplantation aims to achieve normal HbA1c using... Learning objectives : After viewing this presentation the participant will be able to discuss: - The rationale of the Edmonton protocol for islet transplantation - Results from the Edmonton group and the International Multicenter Trial of Islet Transplantation Using the Edmonton Protocol in Patients with Type 1 Diabetes - Benefits of and problems with the Edmonton protocol - Future directions for research Bibliographic references : A.M. James Shapiro, M.B., B.S., Jonathan R.T. Lakey, Ph.D., Edmond A. Ryan, M.D., Gregory S. Korbutt, Ph.D., Ellen Toth, M.D., Garth L. Warnock, M.D., Norman M. Kneteman, M.D., and Ray V. Rajotte, Ph.D.Islet Transplantation in Seven Patients with Type 1 Diabetes Mellitus Using a Glucocorticoid-Free Immunosuppressive Regimen N Engl J Med. 2000 Jul 27;343(4):230-8. 2.Ryan EA, Paty BW, Senior PA, Bigam D, Alfadhli E, Kneteman NM, Lakey JR, Shapiro AM. Five-Year Follow-Up After Clinical Islet Transplantation Diabetes 54:2060-2069, 2005. 3. A.M. James Shapiro, M.D., Ph.D., Camillo Ricordi, M.D., Bernhard J. Hering, M.D., Hugh Auchincloss, M.D., Robert Lindblad, M.D., R. Paul Robertson, M.D., Antonio Secchi, M.D., Mathias D. Brendel, M.D., Thierry Berney, M.D., Daniel C. Brennan, M.D., Enrico Cagliero, M.D., Rodolfo Alejandro, M.D., Edmond A. Ryan, M.D., Barbara DiMercurio, R.N., Philippe Morel, M.D., Kenneth S. Polonsky, M.D., Jo-Anna Reems, Ph.D., Reinhard G. Bretzel, M.D., Federico Bertuzzi, M.D., Tatiana Froud, M.D., Raja Kandaswamy, M.D., David E.R. Sutherland, M.D., Ph.D., George Eisenbarth, M.D., Ph.D., Miriam Segal, Ph.D., Jutta Preiksaitis, M.D., Gregory S. Korbutt, Ph.D., Franca B. Barton, M.S., Lisa Viviano, R.N., Vicki Seyfert-Margolis, Ph.D., Jeffrey Bluestone, Ph.D., and Jonathan R.T. Lakey, Ph.D.International Trial of the Edmonton Protocol for Islet Transplantation N Engl J Med. 2006 Sep 28;355(13):1318-30.  Presentation  "Management of Type 2 Diabetes: A GP's Perspective" Dr. Nestor Fuertes (biography) English - 2007-11-15 - 31 minutes (16 slides) Summary : The burden of diabetes in Australians is significant, and most patients are being managed in primary care. Dr. Fuertes talks about the diagnosis and treatment of type 2 diabetic patients, and strategies to reduce complications. Copyright © 2008 E-MedHosting.com Inc. Learning objectives : After viewing this presentation the participant will be able to discuss: - Incidence of T2DM in Australia - Diagnosis and treatment of T2DM - Aims to reduce risk of complications - Targets for HbA1c, BP and lipids  Presentation  "Glycaemic Efficacy of TZDs" Prof. Don Chisholm (biography) English - 2007-11-10 - 22 minutes (23 slides) Summary : The pathophysiology of type 2 diabetes involves both insulin resistance and β-cell dysfunction. As the United Kingdom Prospective Diabetes Study showed, in all arms of the study there was a progressive loss of glycaemic control, and a separate analysis showed there was a progressive failure of β-cell function after the first year. HOMA estimates of ß-cell... Learning objectives : After viewing this presentation the participant will be able to discuss: - Data on HOMA estimates of ß-cell function and insulin resistance in rosiglitazone-treated patients with type 2 diabetes (Lebovitz et al. JCEM 2001) - Reduction in the incidence of type 2 diabetes with rosiglitazone in prediabetic subjects (DREAM trial) - Glycaemic efficacy and durability data for rosiglitazone compared to sulfonylurea or metformin (ADOPT trial) Bibliographic references : 1. Rosiglitazone Monotherapy Is Effective in Patients with Type 2 Diabetes The Journal of Clinical Endocrinology & Metabolism Vol. 86, No. 1 280-288. 2. The DREAM (Diabetes REduction Assessment with ramipril and rosiglitazone Medication) Trial Investigators Effect of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: a randomised controlled trial The Lancet Volume 368, Issue 9541, 23 September 2006-29 September 2006, Pages 1096-1105. 3. Steven E. Kahn, M.B., Ch.B., Steven M. Haffner, M.D., Mark A. Heise, Ph.D., William H. Herman, M.D., M.P.H., Rury R. Holman, F.R.C.P., Nigel P. Jones, M.A., Barbara G. Kravitz, M.S., John M. Lachin, Sc.D., M. Colleen O'Neill, B.Sc., Bernard Zinman, M.D., F.R.C.P.C., Giancarlo Viberti, M.D., F.R.C.P., for the ADOPT Study GroupGlycemic Durability of Rosiglitazone, Metformin, or Glyburide Monotherapy NEJM 2006 Volume 355:2427-2443.  Presentation  "Thiazolidinediones and bone biology" Prof. John Prins (biography) English - 2007-11-10 - 29 minutes (27 slides) Summary : In this presentation Dr. Prins discusses the effects of TZDs on bone formation/resorption. Interestingly, these effects are partly caused by a TZD-induced increase in adipogenesis (1); the endocrinology of this phenomenon is discussed as well. TZDs have an effect on many hormones including adiponectin, osteocalcin and TNF alpha. They were also shown to modulate the ratio of OPG and... Learning objectives : After viewing this presentation the participant will be able to discuss: - Regulation of progenitor cell determination (osteoblasts and adipocytes) - Endocrinology of bone, fat and pancreas - Effects of TZDs on bone formation/resorption - Preclinical and genetic studies Bibliographic references : 1. M Adams, C T Montague, J B Prins, J C Holder, S A Smith, L Sanders, J E Digby, C P Sewter, M A Lazar, V K Chatterjee and S O'Rahilly Activators of peroxisome proliferator-activated receptor gamma have depot-specific effects on human preadipocyte differentiation J. Clin. Invest. 100(12): 3149-3153 (1997). 2. Simonet WS, Lacey DL, Dunstan CR, Kelley M, Chang MS, Lüthy R, Nguyen HQ, Wooden S, Bennett L, Boone T, Shimamoto G, DeRose M, Elliott R, Colombero A, Tan HL, Trail G, Sullivan J, Davy E, Bucay N, Renshaw-Gegg L, Hughes TM, Hill D, Pattison W, Campbell P, Sander S, Van G, Tarpley J, Derby P, Lee R, Boyle WJ.Osteoprotegerin: A Novel Secreted Protein Involved in the Regulation of Bone Density Cell. 1997 Apr 18;89(2):309-19. 3. Cock TA, Back J, Elefteriou F, Karsenty G, Kastner P, Chan S, Auwerx J.Enhanced bone formation in lipodystrophic PPARgamma(hyp/hyp) mice relocates haematopoiesis to the spleen. EMBO Rep. 2004 Oct;5(10):1007-12.  Presentation  "Where Do Glitazones Fit In in clinical practice?" Dr. Soji Swaraj (biography) English - 2007-11-10 - 39 minutes (39 slides) Summary : In this presentation Dr. Swaraj discusses the use of glitazones in diabetes treatment. Many treatment options are available and it is important to understand the place of each one in the general scheme. According to Dr. Swaraj, the traditional management of type 2 diabetes should be revised. Regarding therapies, he comments that they all have limitations, for example: the ceiling... Learning objectives : After viewing this presentation the participant will be able to discuss: - The objectives of type 2 diabetes therapy - The importance of changes in lifestyle as a treatment option - Case studies and the use of combination therapy Bibliographic references : 1- Garber AJ, Duncan TG, Goodman AM, Mills DJ, Rohlf JL.Efficacy of metformin in type II diabetes: results of a double-blind, placebo-controlled, dose-response trial. Am J Med. 1997 Dec;103(6):491-7. 2- Nesto RW, Bell D, Bonow RO, Fonseca V, Grundy SM, Horton ES, Le Winter M, Porte D, Semenkovich CF, Smith S, Young LH, Kahn R.Thiazolidinedione use, fluid retention, and congestive heart failure: a consensus statement from the American Heart Association and American Diabetes Association. Diabetes Care. 2004 Jan;27(1):256-63. Review.  Presentation  "Practical diabesity intervention: Strategies borrowed from the marketing and economics world" Dr. Soji Swaraj (biography) English - 2007-08-16 - 32 minutes (37 slides) Summary : In this presentation Dr. Swaraj talks about how disciplines outside of medicine, such as economics and marketing, can help in understanding the diabesity epidemic and motivating diabetic patients to adhere to therapy and lifestyle change. How can the current diabesity epidemic be explained? According to economic theory, human lifestyles have been 'optimised' to minimise energy... Learning objectives : After viewing this presentation the participant will be able to discuss: - Why bother with aggressive diabesity intervention? - Failure in achieving targets: economic and marketing hypotheses - Are standard approaches counterproductive? - Solutions: A patient-centric 'marketing' approach  Presentation  "Is self-monitoring of blood glucose (SMBG) worthwhile in type 2 diabetes? Findings from the Fremantle Diabetes Study" Prof. Timothy Davis (biography) English - 2007-05-31 - 37 minutes (32 slides) Summary : Although self-monitoring of blood glucose (SMBG) is unanimously recommended for type 2 diabetic patients treated with insulin, there is no international consensus on whether SMBG is required in those on diet or oral antihyperglycaemic treatment (1). Here Prof. Davis presents recently published data from the prospective, observational Fremantle Diabetes Study (FDS). These analyses... Learning objectives : After viewing this presentation the participant will be able to discuss: - The value of self-monitoring of blood glucose in type 2 diabetes Bibliographic references : 1. Burgers JS, Bailey JV, Klazinga NS, Van Der Bij AK, Grol R, Feder G; AGREE COLLABORATION.Comparative analysis of recommendations and evidence in diabetes guidelines from 13 countries Diabetes Care 25:1933-1939, 2002. 2. Wendy A. Davis, PHD, David G. Bruce, MD and Timothy M.E. Davis, DPHILIs Self-Monitoring of Blood Glucose Appropriate for All Type 2 Diabetic Patients? Diabetes Care 29:1764-1770, 2006. 3. W. A. Davis, D. G. Bruce1 and T. M. E. Davis. Does self-monitoring of blood glucose improve outcome in type 2 diabetes? The Fremantle Diabetes Study Diabetologia 2007;50:510-515. 4. S. Martin, B. Schneider, L. Heinemann, V. Lodwig, H.-J. Kurth, H. Kolb, W. A. Scherbaum and for the ROSSO Study Group.Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological cohort study Diabetologia 2006;49:271-278.  Presentation  "Treat to target" Prof. Richard O'Brien (biography) English - 2007-04-21 - 37 minutes (19 slides) Summary : With the current management of type 2 diabetes, a large proportion of patients are not achieving the glycaemic target. How can this be improved? Early combination treatment may help in keeping the HbA1c down longer, says Dr. O'Brien. As seen in the United Kingdom Prospective Diabetes Study, most type 2 diabetic patients require polypharmacy to achieve long-term glycaemic control... Learning objectives : After viewing this presentation the participant will be able to discuss: - Why there is a need for an early and intensive approach to type 2 diabetes management - Potential advantages of early combination therapy - Studies illustrating greater benefit with combination therapy versus monotherapy - Practical management considerations Bibliographic references : 1. Robert C. Turner, FRCP; Carole A. Cull, PhD; Valeria Frighi, MD; Rury R. Holman, FRCP; for the UK Prospective Diabetes Study (UKPDS) Group. Glycemic Control With Diet, Sulfonylurea, Metformin, or Insulin in Patients With Type 2 Diabetes Mellitus: Progressive Requirement for Multiple Therapies (UKPDS 49) JAMA. 1999;281:2005-2012. 2. Del Prato S, Felton AM, Munro N, Nesto R, Zimmet P, Zinman B; Global Partnership for Effective Diabetes Management. Improving glucose management: Ten steps to get more patients with type 2 diabetes to glycaemic goal: Recommendations from the Global Partnership for Effective Diabetes Management International Journal of Clinical Practice. Volume 59 Issue 11 Page 1345-1355, November 2005.  Presentation  "Introduction" Dr. Matthew Cohen (biography) English - 2007-04-21 - 9 minutes (6 slides)  Presentation  "Current treatments in type 2 diabetes" Dr. Neale Cohen (biography) English - 2007-04-21 - 29 minutes (19 slides) Summary : Type 2 diabetes develops due to insulin resistance as well as beta-cell dysfunction. There are various barriers to achieving good glycemic control in these patients, and one of them is inadequate targeting of the underlying pathophysiology. Different factors are recognised to drive beta-cell failure, such as oversecretion of insulin to compensate for insulin resistance,... Learning objectives : After viewing this presentation the participant will be able to discuss: - Core defects of type 2 diabetes: insulin resistance and beta-cell dysfunction - The progressive nature of type 2 diabetes - The link between insulin resistance and cardiovascular disease - Evidence for decreased risk of macrovascular complications with decreasing insulin resistance - Drawbacks of the traditional stepwise approach to management of glycaemia - Antidiabetic medications: mechanisms of action, efficacy, tolerability and safety Bibliographic references : 1. UK Prospective Diabetes Study (UKPDS) GroupEffect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34) 1: Lancet. 1998 Sep 12;352(9131):854-65. 2.U.K. prospective diabetes study 16. Overview of 6 years' therapy of type II diabetes: a progressive disease. U.K. Prospective Diabetes Study Group Diabetes, Vol 44, Issue 11 1249-1258. 3. Strutton DR, Stang PE, Erbey JR, Lydick E. Estimated coronary heart disease attributable to insulin resistance in populations with and without type 2 diabetes mellitus. Am J Manag Care. 2001 Aug;7(8):765-73.  Presentation  "Summary and Close" Dr. Matthew Cohen (biography) English - 2007-04-21 - 12 minutes (8 slides)  Presentation  "Case Study Presentation" Dr. Andrew Marangou (biography) English - 2007-04-21 - 31 minutes (40 slides) Summary : In this presentation Dr. Marangou talks about the management of type 2 diabetes, taking into account the guidelines and the latest clinical trial data. A case study is introduced in two modules, focusing on challenges likely to be encountered when facing newly diagnosed patients, initial management, and longer term treatment strategies. Copyright © 2007 E-MedHosting.com Inc. Learning objectives : After viewing this presentation the participant will be able to discuss: - Challenges likely to be encountered when facing newly diagnosed type 2 diabetic patients - Initial management and subsequent treatment options  Presentation  "‘Algorithm(s)’ for Glycaemic Control - Preceding ADOPT" Dr. Stephen Twigg (biography) English - 2007-03-03 - 37 minutes (28 slides) Summary : In this presentation Dr. Twigg focuses on a recently published consensus algorithm from the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD), discussing lifestyle intervention and medication use in type 2 diabetes and how to go about choosing between different antihyperglycemic agents. Last year the ADA/EASD published a consensus... Learning objectives : After viewing this presentation the participant will be able to discuss: - The ADA/EASD consensus algorithm for the initiation and adjustment of therapy in type 2 diabetes (Nathan DM et al. 2006) - Issues in glycemic control in type 2 diabetes: Lifestyle intervention, medications - Deciding amongst the options in therapy Bibliographic references : 1. Nathan DM, Buse JB, Davidson MB, Heine RJ, Holman RR, Sherwin R, Zinman B. Management of Hyperglycemia in Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of Therapy: A consensus statement from the American Diabetes Association and the European Association for the Study of Diabetes Diabetes Care 29:1963-1972, 2006. 2. Timothy M E Davis, Wendy A Davis and David G BruceGlycaemic levels triggering intensification of therapy in type 2 diabetes in the community: the Fremantle Diabetes Study MJA 2006; 184 (7): 325-328. 3. National Association of Diabetes Centres ANDIAB 2006. Australian National Diabetes Information Audit & Benchmarking. March 2007. 4. Hocking S et al. ADS Abs., 2004.  Presentation  "Effects of Thiazolidinediones on Insulin Secretion in Glucose Intolerant States" Prof. Kenneth Polonsky (biography) English - 2007-03-03 - 45 minutes (47 slides) Summary : What is the role of the beta-cell in type 2 diabetes? Abnormal insulin secretion is an essential component of the pathophysiology of type 2 diabetes and is present at each stage in the natural history of the disease, says Prof. Polonsky. As an autopsy study published by Butler et al. concluded, beta-cell mass is decreased in type 2 diabetes and the mechanism underlying this is increased beta-cell... Learning objectives : After viewing this presentation the participant will be able to discuss: - The role of the beta-cell in type 2 diabetes - The scientific evidence for beneficial effects of TZDs on insulin secretion - The mechanisms behind these effects Bibliographic references : 1. Butler AE, Janson J, Bonner-Weir S, Ritzel R, Rizza RA, Butler PC.ß-Cell Deficit and Increased ß-Cell Apoptosis in Humans With Type 2 Diabetes Diabetes 52:102-110, 2003. 2. Melissa K. Cavaghan, David A. Ehrmann, Maria M. Byrne, and Kenneth S. PolonskyTreatment with the Oral Antidiabetic Agent Troglitazone Improves beta Cell Responses to Glucose in Subjects with Impaired Glucose Tolerance J Clin Invest. 1997 Aug 1;100(3):530-7. 3. Claus B. Juhl, Malene Hollingdal, Niels Pørksen, Åge Prange, Frederik Lönnqvist and Ole SchmitzInfluence of Rosiglitazone Treatment on ß-Cell Function in Type 2 Diabetes: Evidence of an Increased Ability of Glucose to Entrain High-Frequency Insulin Pulsatility The Journal of Clinical Endocrinology & Metabolism Vol. 88, No. 8 3794-3800. 4. Buchanan TA, Xiang AH, Peters RK, Kjos SL, Marroquin A, Goico J, Ochoa C, Tan S, Berkowitz K, Hodis HN, Azen SP.Preservation 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.  Presentation  "A (brief) review of the UKPDS" Prof. Timothy Davis (biography) English - 2007-03-03 - 34 minutes (28 slides) Summary : In this presentation Prof. Davis talks about the justification for the United Kingdom Prospective Diabetes Study (UKPDS), characteristics of the patients, therapy-specific results, post-study monitoring data, and current-day relevance. The UKPDS participants were not a "typical" community-based cohort of type 2 diabetic patients. Compared to subjects in the Fremantle Diabetes... Learning objectives : After viewing this presentation the participant will be able to discuss: - The background to the UK Prospective Diabetes Study - The progressive loss of beta-cell function in type 2 diabetes - The issue of metformin's cardiovascular protection independent of glycaemia  Presentation  "Adding PS to the ABCss of Diabetes Care – An Australian Perspective" Dr. Pat Phillips (biography) English - 2006-12-07 - 29 minutes (35 slides) Summary : In this presentation, Dr. Phillips talks about the importance of adding psychosocial (PS) issues to the "ABCss" of diabetes care or working to achieve the targets for A1c, blood pressure, cholesterol, salicylate use and smoking cessation. Psychosocial issues can impact on diabetes control/care and vice versa. In addition, depression has been found to be an independent risk factor... Learning objectives : After viewing this presentation, the participant will be able to discuss: - Why diabetes is commonly associated with psychosocial issues. - The importance of psychosocial issues affecting and being affected by diabetes control and care. - The risk of diabetes complications associated with psychosocial issues, particularly depression. - Ways to incorporate assessment and intervention into the routine cycle of diabetes care. Bibliographic references : 1. Stephen J Bunker, David M Colquhoun, Murray D Esler, Ian B Hickie, David Hunt, V Michael Jelinek, Brian F Oldenburg, Hedley G Peach, Denise Ruth, Christopher C Tennant and Andrew M Tonkin"Stress" and coronary heart disease: psychosocial risk factors - National Heart Foundation of Australia position statement update MJA 2003 178 (6): 272-276.  Presentation  "The Progressive Nature of Type 2 Diabetes - Update on Clinical Management: Results of the ADOPT Trial" Prof. Giancarlo Viberti (biography) English - 2006-12-04 - 43 minutes (31 slides) Summary : Clinical management of type 2 diabetes has conventionally relied on a stepwise approach, in which therapy is intensified, from diet and exercise, through monotherapy and then on to combination therapy, in response to steadily worsening glycaemic control. As such, the stepwise approach implicitly acknowledges type 2 diabetes as an inevitably progressive disorder and principally aims to respond to... Learning objectives : After viewing this presentation the participant will be able to discuss: Newly-released results from the ADOPT trial - Effects of rosiglitazone versus metformin or glyburide as initial therapy in recently diagnosed type 2 diabetic patients: - Primary outcome: Time to monotherapy failure - FPG > 180 mg/dl (> 10 mmol/L) - Secondary outcomes: FPG > 140 mg/dl (> 7.8 mmol/L); Changes in FPG, HbA1c, insulin sensitivity and beta-cell function - Adverse events - Clinical implications Bibliographic references : Steven E. Kahn, Steven M. Haffner, Mark A. Heise, William H. Herman, Rury R. Holman, Nigel P. Jones, Barbara G. Kravitz, John M. Lachin, M. Colleen O'Neill, Bernard Zinman, Giancarlo Viberti, for the ADOPT Study Group Glycemic Durability of Rosiglitazone, Metformin, or Glyburide Monotherapy NEJM. 2006 Dec;(23) 355:2427-2443  Presentation  "Are We Making Progress With Slowing Disease Progression?" Prof. Peter J. Grant (biography) English - 2006-12-04 - 17 minutes (9 slides) Summary : Our understanding of the pathophysiological relationship between diabetes and cardiovascular disease has been markedly increased over the last 15 years. The seminal ADA lecture by Reaven in 1989, which described the existence of cardiovascular risk clustering in the presence of underlying insulin resistance, has been followed by a wave of publications linking changes in classical and novel... Learning objectives : After viewing this presentation the participant will be able to discuss: - Diabetes and cardiovascular disease: the "common soil" hypothesis - Targeting of beta-cell dysfunction and increasing insulin resistance - The DREAM trial: summary and conclusions - The ADOPT trial: summary of glycaemic efficacy; outstanding questions - Clinical trials across the diabetes continuum  Presentation  "Complementary Therapies - An Overview" Prof. Trisha Dunning (biography) English - 2006-10-28 - 59 minutes (46 slides) Summary : What are complementary therapies? According to the British Medical Association, they are therapies which can work alongside and in conjunction with orthodox medical treatment. People with diabetes have been found to be more likely to use complementary therapies than non-diabetics (1). What do people with diabetes use? Among the range of therapies used are glucose-lowering and... Learning objectives : After viewing this presentation the participant will be able to discuss: - The philosophical basis of complementary therapies - Frequency of complementary therapy use in diabetic patients - Types of herbs and supplements used by diabetic patients - Safety issues associated with complementary therapy use - Potential interactions between herbal and conventional medicines Bibliographic references : 1. Leonard E. Egede, MD, MS, Xiaobou Ye, MD, MS, Deyi Zheng, MB, PHD and Marc D. Silverstein, MDThe Prevalence and Pattern of Complementary and Alternative Medicine Use in Individuals With Diabetes Diabetes Care 25:324-329, 2002  Presentation  "UKPDS - Unanswered Questions?" Prof. Rury Holman (biography) English - 2006-09-13 - 31 minutes (33 slides) Summary : The UKPDS was a landmark 20-year trial which showed that the complications of type 2 diabetes could be reduced by more intensive management of glycaemia and blood pressure. In 5, 102 patients recruited with newly-diagnosed type 2 diabetes, the study demonstrated that maintaining improved blood glucose control with sulphonylurea or insulin monotherapy over median 10.3 years reduced the risk of the... Learning objectives : After viewing this presentation the participant will be able to discuss: - Additive effects of glucose and blood pressure control in T2DM - Ongoing studies on glucose control and macrovascular risk - Macrovascular benefits of metformin - T2DM, metabolic syndrome and CVD mortality - CHD case fatality with and without SU therapy in the UKPDS - The progressive nature of T2DM  Presentation  "Platelets in Diabetes: An Important Therapeutic Target" Prof. Karlheinz Peter (biography) English - 2006-05-07 - 39 minutes (23 slides) Summary : In this presentation Prof. Peter talks about the role of platelets in diabetes-induced atherosclerosis and its complications, as well as anti-platelet therapy and associated issues in diabetic patients. Platelets are now thought to play an important role not only in the end stage of atherosclerosis but in the beginning and middle phases as well. In the context of diabetes, in a... Learning objectives : After viewing this presentation, the participant will be able to discuss: - The history of anti-platelet therapy - The role of platelets in different phases of atherosclerosis - Platelet activation in diabetic patients - Targets for platelet inhibition - Response to and benefit of anti-platelet therapy in diabetic patients Bibliographic references : 1. Angiolillo DJ, Fernandez-Ortiz A, Bernardo E, Ramirez C, Sabate M, Jimenez-Quevedo P, Hernandez R, Moreno R, Escaned J, Alfonso F, Banuelos C, Costa MA, Bass TA, Macaya C.Platelet Function Profiles in Patients With Type 2 Diabetes and Coronary Artery Disease on Combined Aspirin and Clopidogrel Treatment Diabetes 54:2430-2435, 2005. 2. Marc S. Sabatine, MD; Eugene Braunwald, MD Will Diabetes Save the Platelet Blockers? Circulation. 2001;104:2759.  Presentation  "Insulin Resistance, Diabetes and Vascular Disease: The Emerging Role of Glitazones" Prof. Nikolaus Marx (biography) English - 2006-05-06 - 41 minutes (56 slides) Summary : Insulin resistance is associated with several cardiovascular risk factors. In this presentation Prof. Marx focuses on inflammation, endothelial dysfunction and arteriosclerosis, and evidence for how they can be improved with glitazone treatment. The insulin-sensitising glitazones work by activating the nuclear transcription factor PPARγ. They are known to reduce inflammation... Learning objectives : After viewing this presentation the participant will be able to discuss: - Effects of glitazone treatment on inflammation, endothelial function and arteriosclerosis in type 2 diabetic patients and nondiabetic individuals Bibliographic references : 1. Franz Meisner; Daniel Walcher; Florence Gizard; Xaver Kapfer; Roman Huber; Anja Noak; Ludger Sunder-Plassmann; Helga Bach; Cornelia Haug; Max Bachem; Tatjana Stojakovic; Winfried März; Vinzenz Hombach; Wolfgang Koenig; Bart Staels; Nikolaus Marx. Effect of Rosiglitazone Treatment on Plaque Inflammation and Collagen Content in Nondiabetic Patients: Data From a Randomized Placebo-Controlled Trial Arteriosclerosis, Thrombosis, and Vascular Biology. 2006;26:845. 2. Jürgen Hetzel; Bernd Balletshofer; Kilian Rittig; Daniel Walcher; Wolfgang Kratzer; Vinzenz Hombach; Hans-Ulrich Häring; Wolfgang Koenig; Nikolaus Marx Rapid Effects of Rosiglitazone Treatment on Endothelial Function and Inflammatory Biomarkers Arteriosclerosis, Thrombosis, and Vascular Biology. 2005;25:1804. 3. Donghoon Choi, MD, PHD, Soo-Kyung Kim, MD, Sung-Hee Choi, MD, Young-Guk Ko, MD, Chul-Woo Ahn, MD, PHD, Yangsoo Jang, MD, PHD, Sung-Kil Lim, MD, PHD, Hyun-Chul Lee, MD, PHD and Bong-Soo Cha, MD, PHD. Preventative Effects of Rosiglitazone on Restenosis After Coronary Stent Implantation in Patients With Type 2 Diabetes Diabetes Care 27:2654-2660, 2004. 4. Nikolaus Marx, MD; Jochen Wöhrle, MD; Thorsten Nusser, MD; Daniel Walcher, MD; Angelika Rinker, MS; Vinzenz Hombach, MD; Wolfgang Koenig, MD; Martin Höher, MD. Pioglitazone Reduces Neointima Volume After Coronary Stent Implantation: A Randomized, Placebo-Controlled, Double-Blind Trial in Nondiabetic Patients Circulation. 2005;112:2792-2798.  Presentation  "Prevention and Treatment of Diabetic Nephropathy: Controversies Resolved?" Dr. Richard E. Gilbert (biography) English - 2006-04-28 - 26 minutes (44 slides) Summary : In this presentation Dr. Gilbert talks about anti-hypertensive therapy in the prevention and treatment of diabetic nephropathy, recent advances in understanding and remaining questions. Are ACE inhibitors and ARBs equally good at slowing the progression of diabetic nephropathy? Studies such as IDNT and RENAAL have demonstrated renal benefits with ARBs in type 2 diabetic patients... Learning objectives : After viewing this presentation the participant will be able to discuss: - Prevalence of diabetic nephropathy and associated cardiovascular risk - Effects of ARBs and ACE inhibitors on progression of diabetic nephropathy: current knowledge and remaining questions - Evidence for decreased incidence of microalbuminuria with anti-hypertensive therapy in diabetic patients - Approach to anti-hypertensive therapy in diabetes Bibliographic references : 1. Anthony H. Barnett, M.D., Stephen C. Bain, M.D., Paul Bouter, Ph.D., Bengt Karlberg, M.D., Sten Madsbad, M.D., Jak Jervell, Ph.D., Jukka Mustonen, Ph.D., for the Diabetics Exposed to Telmisartan and Enalapril Study GroupAngiotensin-Receptor Blockade versus Converting–Enzyme Inhibition in Type 2 Diabetes and Nephropathy N Engl J Med. 2004 Nov 4;351(19):1952-61. 2. Piero Ruggenenti, M.D., Anna Fassi, M.D., Anelja Parvanova Ilieva, M.D., Simona Bruno, M.D., Ilian Petrov Iliev, M.D., Varusca Brusegan, M.D., Nadia Rubis, R.N., Giulia Gherardi, R.N., Federica Arnoldi, R.N., Maria Ganeva, Stat.Sci.D., Bogdan Ene-Iordache, Eng.D., Flavio Gaspari, Ph.D., Annalisa Perna, Stat.Sci.D., Antonio Bossi, M.D., Roberto Trevisan, M.D., Alessandro R. Dodesini, M.D., Giuseppe Remuzzi, M.D., for the Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) InvestigatorsPreventing Microalbuminuria in Type 2 Diabetes N Engl J Med. 2004 Nov 4;351(19):1941-51.  Presentation  "Prevention and Treatment of Diabetic Nephropathy: Controversies Resolved?" Dr. Richard E. Gilbert (biography) English - 2006-04-28 - 26 minutes (44 slides) Summary : In this presentation Dr. Gilbert talks about anti-hypertensive therapy in the prevention and treatment of diabetic nephropathy, recent advances in understanding and remaining questions. Are ACE inhibitors and ARBs equally good at slowing the progression of diabetic nephropathy? Studies such as IDNT and RENAAL have demonstrated renal benefits with ARBs in type 2 diabetic patients... Learning objectives : After viewing this presentation the participant will be able to discuss: - Prevalence of diabetic nephropathy and associated cardiovascular risk - Effects of ARBs and ACE inhibitors on progression of diabetic nephropathy: current knowledge and remaining questions - Evidence for decreased incidence of microalbuminuria with anti-hypertensive therapy in diabetic patients - Approach to anti-hypertensive therapy in diabetes Bibliographic references : 1. Anthony H. Barnett, M.D., Stephen C. Bain, M.D., Paul Bouter, Ph.D., Bengt Karlberg, M.D., Sten Madsbad, M.D., Jak Jervell, Ph.D., Jukka Mustonen, Ph.D., for the Diabetics Exposed to Telmisartan and Enalapril Study GroupAngiotensin-Receptor Blockade versus Converting–Enzyme Inhibition in Type 2 Diabetes and Nephropathy N Engl J Med. 2004 Nov 4;351(19):1952-61. 2. Piero Ruggenenti, M.D., Anna Fassi, M.D., Anelja Parvanova Ilieva, M.D., Simona Bruno, M.D., Ilian Petrov Iliev, M.D., Varusca Brusegan, M.D., Nadia Rubis, R.N., Giulia Gherardi, R.N., Federica Arnoldi, R.N., Maria Ganeva, Stat.Sci.D., Bogdan Ene-Iordache, Eng.D., Flavio Gaspari, Ph.D., Annalisa Perna, Stat.Sci.D., Antonio Bossi, M.D., Roberto Trevisan, M.D., Alessandro R. Dodesini, M.D., Giuseppe Remuzzi, M.D., for the Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) InvestigatorsPreventing Microalbuminuria in Type 2 Diabetes N Engl J Med. 2004 Nov 4;351(19):1941-51.  Presentation  "Insulin Stabilisation" Prof. Trisha Dunning (biography) English - 2006-04-07 - 62 minutes (45 slides) Summary : In this presentation Prof. Dunning discusses insulin action and the types of insulin available, factors concerning insulin use, education issues and commencing insulin in type 2 diabetes. Insulin stabilisation needs to be maintained over time. In the context of diabetes this refers to replacing endogenous insulin in type 1 diabetes, augmenting endogenous insulin in type 2... Learning objectives : After viewing this presentation the participant will be able to discuss: - Insulin action and types of insulin - Insulin regimens and administration - Factors affecting insulin absorption - Adjusting insulin doses - Insulin-related fears - Patient education about insulin - Commencing insulin in type 2 diabetes Bibliographic references : H Ilkova, B Glaser, A Tunckale, N Bagriacik, and E Cerasi Induction of long-term glycemic control in newly diagnosed type 2 diabetic patients by transient intensive insulin treatment. Diabetes Care, Vol 20, Issue 9 1353-1356. Cavaghan, MK. The Beta Cell and First-Phase Insulin Secretion. Medscape Diabetes and Endocrinology, 2004 6(2): 1-5. Dunning P., Martin M. Beliefs About Diabetes and Diabetic Complications. Professional Nurse, 1998 13(7): 429-434. Gerich, J. Physiology and Pathophysiology of Postprandial Glucose Regulation. Medscape Diabetes and Endocrinology. 2004 6(2): 1-6. Nathan, D. Initial Management of Glycemia in Type 2 Diabetes Mellitus New England Journal of Medicine. 2002 347(17): 1342-1349. Olsson, P., Hans, A., Henning, V. Miscibility of Human Semisynthetic Regular and Lente Insulin and Human Biosynthetic Regular and NPH insulin. Diabetes Care. 1987 10(4): 473-477. UK Prospective Diabetes Study Group. UK Prospective Diabetes Study (UKPDS) VIII. Study Design, Progress and Performance. Diabetologia. 1991 34(12): 877-890. Zinman, B. Glucose Control in Type 1 Diabetes: From Conventional to Intensive Therapy. Clinical Cornerstone. 1998 1(3): 29-38. UK Prospective Diabetes Study 7: Response of Fasting Plasma Glucose to Diet Therapy in Newly Presenting Type II Diabetic Patients Metabolism. 1990 39(9): 905-912 American Diabetes Association. Insulin Administration. Diabetes Care. 2004 27 (Supp): 106S – 107S Boyages S., When and How to Start Insulin Therapy in Type 2 Diabetes. Medicine Today. September (Supp): 10-16 Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2003. Clinical Practice Guidelines For the Prevention and Management of Diabetes in Canada. Canadian Journal of Diabetes. 2003 27(2) (Supp): 128-140. Rutherford, A., Wright, E., Hussaine, Z., Colagiuri, R. On Behalf of the DAWN Advisory Committee. DAWN: Diabetes Attitudes, Wishes and Needs, the Australian Experience. 2004 Zinman, B. Translating the Diabetes Control and Complications Trial (DCCT) Into Clinical Practice: Overcoming the Barriers. Diabetologia. 1997 40(Supp 2): S88 – S90. Dunning T., Martin M., 1998 Type 2 Diabetes: Is It Serious? Journal of Diabetes Nursing 2(3): 70-76. BOOKS: Colwell, J. Diabetes – Hot Topics. Philadelphia: Hanley & Belfus. 2003. ISBN 1560535628 Davidson, M. Diabetes Mellitus Diagnosis and Treatment. 4th ed. Philadelphia: W.B. Saunders Company. 1998. ISBN 0721664032 Klingensmith, GJ. Intensive Diabetes Management, 3rd ed. Virginia: American Diabetes Association. 2003. ISBN 1580401643  Presentation  "Transplantation in Diabetes Management" Dr. Philip O'Connell (biography) English - 2006-02-20 - 54 minutes (46 slides) Summary : In this presentation Dr. O'Connell talks about the rationale for transplantation in diabetes, which patients are eligible for these procedures, and how this field is likely to progress. In type 1 diabetic patients, intensive insulin treatment has been associated with reduced complications, however aggressive control with exogenous insulin increases the risk of severe hypoglycemia... Learning objectives : After viewing this presentation the participant will be able to discuss: - The rationale for transplantation in subsets of diabetic patients - Benefits of simultaneous pancreas kidney transplantation - Pancreatic islet transplantation: history, current status and future goals Bibliographic references : 1. The Diabetes Control and Complications Trial Research GroupThe Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus NEJM 1993;329:977-986. 2. A.M. James Shapiro, M.B., B.S., Jonathan R.T. Lakey, Ph.D., Edmond A. Ryan, M.D., Gregory S. Korbutt, Ph.D., Ellen Toth, M.D., Garth L. Warnock, M.D., Norman M. Kneteman, M.D., and Ray V. Rajotte, Ph.D.Islet Transplantation in Seven Patients with Type 1 Diabetes Mellitus Using a Glucocorticoid-Free Immunosuppressive Regimen NEJM 2000;343:230-238.  Presentation  "The FIELD Study" Prof. Timothy Davis (biography) English - 2005-12-07 - 35 minutes (43 slides) Summary : The results of the FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) study were presented at the AHA meeting held in Dallas in November 2005. This was a randomised trial of the effects of fenofibrate on coronary morbidity and mortality in people with diabetes, and in this talk Prof. Davis presents the data and discusses its implications. Fenofibrate reduces... Learning objectives : After viewing this presentation the participant will be able to discuss randomised evidence from the prospective FIELD study: - Effects of fenofibrate on the risk of major coronary disease events in patients with type 2 diabetes - Secondary and tertiary outcomes including total CVD events, stroke, progression of renal disease and others - Safety - Implications of the data Bibliographic references : The FIELD study investigators. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial Lancet. 2005 Nov 26;366(9500):1849-61.  Presentation  "Dual PPAR alpha/gamma Agonists - Promise and Problems" Prof. John Prins (biography) English - 2005-12-07 - 29 minutes (22 slides) Summary : In this presentation Prof. Prins talks about a newer class of compounds, the dual PPAR α/γ agonists, collectively known as the glitazars. The Peroxisome Proliferator-Activated Receptors (PPARs) are ligand-activated transcription factors belonging to the nuclear hormone receptor superfamily. PPAR α ligands include the fibrate drugs which are used in patients with... Learning objectives : After viewing this presentation the participant will be able to discuss: - PPAR isoforms, their effects and ligands - Dual PPAR α/γ agonists (glitazars): development and recent clinical data - Safety issues related to glitazar treatment in type 2 diabetic patients Bibliographic references : 1. Buse JB, Rubin CJ, Frederich R, Viraswami-Appanna K, Lin KC, Montoro R, Shockey G, Davidson JA.Muraglitazar, a dual (α/γ) PPAR activator: A randomized, double-blind, placebo-controlled, 24-week monotherapy trial in adult patients with type 2 diabetes Clin Ther. 2005 Aug;27(8):1181-95. 2. Nissen SE, Wolski K, Topol EJ.Effect of muraglitazar on death and major adverse cardiovascular events in patients with type 2 diabetes mellitus. JAMA. 2005 Nov 23;294(20):2581-6.  Presentation  "Obesity and Type 2 Diabetes: Impact of Major Weight Loss" Prof. Paul O'Brien (biography) English - 2005-12-07 - 29 minutes (27 slides) Summary : In this presentation Prof. O'Brien talks about the effects of major weight loss in type 2 diabetes. A direct relationship exists between BMI and the risk of developing type 2 diabetes (1,2). Obesity promotes insulin resistance, hyperinsulinaemia and eventual beta-cell failure, so can weight loss “cure” diabetes before beta-cell failure has occurred? For severely... Learning objectives : After viewing this presentation the participant will be able to discuss: - BMI as a risk factor for type 2 diabetes - Efficacy of conventional weight loss programs - Benefits of Lap-Band surgery in severely obese type 2 diabetic patients Bibliographic references : 1. JM Chan, EB Rimm, GA Colditz, MJ Stampfer and WC Willett. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men Diabetes Care. 1994 Sep;17(9):961-9. 2. Graham A. Colditz; Walter C. Willett; Andrea Rotnitzky; and JoAnn E. Manson Weight Gain as a Risk Factor for Clinical Diabetes Mellitus in Women Ann Intern Med. 1995 Apr 1;122(7):481-6. 3. John B. Dixon, MBBS and Paul E. O’Brien, MDHealth Outcomes of Severely Obese Type 2 Diabetic Subjects 1 Year After Laparoscopic Adjustable Gastric Banding Diabetes Care 25:358-363, 2002. 4. J. B. Dixon, A. F. Dixon and P. E. O'BrienImprovements in insulin sensitivity and β-cell function (HOMA) with weight loss in the severely obese Diabetic Medicine 20 (2), 127-134.  Presentation  "The VICTORY Study: Assessing the efficacy of rosiglitazone in inhibiting the progression of atherosclerosis in CABG surgery" (biography) English - 2005-10-25 - 29 minutes (23 slides) Summary : In this talk Dr. Bertrand gives an overview of the design and objectives of the VICTORY (VeIn-Coronary ATherOsclerosis and Rosiglitazone after Bypass surgerY) trial. Research conducted at the Montreal Heart Institute on bypass patients has shown that the majority of vein grafts show atherosclerotic changes after 10 years. The overall objectives of VICTORY are to assess the efficacy... Learning objectives : Key learning points: 1. Presentation of the VICTORY trial protocol, the first cardio-metabolic trial in type 2 diabetes patients to assess atherosclerosis progression and its detailed interrelations with metabolic abnormalities. 2. Understand the combinations of intravascular ultrasound, angiography, DEXA, abdominal CT-scan, exercise test, holter monitoring and biological markers to assess cardio-metabolic abnormalities in type 2 diabetes patients. 3. Understand the use of saphenous vein graft as a clinical model of accelerated atherosclerosis. 4. Understand the use of DEXA and abdominal CT-scan to assess morphology abnormalities in type 2 diabetes patients.  Presentation  "TZDs and Atherosclerosis: Can They Make a Difference?" Dr. Lawrence A. Leiter (biography) English - 2005-10-25 - 36 minutes (65 slides) Summary : Vascular disease is a leading cause of death in diabetes, and cardiovascular risk is increased even before the diagnosis of diabetes, as seen in the Nurses' Health Study (1). How well is glycemia being controlled in type 2 diabetic patients in Canada? The cross-sectional DICE (Diabetes in Canada Evaluation) study showed that half of the patients are not at target. Although physicians seem to be... Learning objectives : Key learning points: 1. TZDs can decrease multiple traditional and non-traditional CV risk factors. 2. There are now a number of trials using surrogate endpoints suggesting decreased CV risk in TZD-treated patients. 3. The results of the PROACTIVE study, although not definitive, are consistent with the anti-atherosclerotic effects of TZDs. 4. Ongoing clinical trials will hopefully definitively reveal if TZDs reduce CV risk. Bibliographic references : 1. Haffner SJ, Cassells H. Hyperglycemia as a cardiovascular risk factor. The American Journal of Medicine. 115(8), 6-11. 2. Hanley AJ, Williams K, Stern MP, Haffner SM. Homeostasis Model Assessment of Insulin Resistance in Relation to the Incidence of Cardiovascular Disease. Diabetes Care. 2002 Vol. 25, 1177-1184. 3. Enzo Bonora, Gianni Formentini, Francesco Calcaterra, Simonetta Lombardi, Franco Marini, Luciano Zenari, Francesca Saggiani, Maurizio Poli, Sandro Perbellini, Andrea Raffaelli, Vittorio Cacciatori, Lorenza Santi, Giovanni Targher, Riccardo Bonadonna, and Michele Muggeo. HOMA-Estimated Insulin Resistance Is an Independent Predictor of Cardiovascular Disease in Type 2 Diabetic Subjects - Prospective data from the Verona Diabetes Complications Study. Diabetes Care. 2002 Vol. 25, 1135-1141. 4. Jagdip S. Sidhu; Zoltan Kaposzta; Hugh S. Markus; Juan Carlos Kaski. Effect of Rosiglitazone on Common Carotid Intima-Media Thickness Progression in Coronary Artery Disease Patients Without Diabetes Mellitus. Arteriosclerosis, Thrombosis, and Vascular Biology. May 2004; 24 930 – 934. 5. Hiroyuki Koshiyama, Dai Shimono, Naomitsu Kuwamura, Jun Minamikawa, and Yoshio Nakamura. RAPID COMMUNICATION: Inhibitory Effect of Pioglitazone on Carotid Arterial Wall Thickness in Type 2 Diabetes. The Journal of Clinical Endocrinology and Metabolism. July 2001; 86, 3452-6. 6. Choi SH et al. Diabetes. 2003;52 (suppl 1):A18. Oral presentation 82-0R. 7. Masoudi F.A. et al. Diabetes 2004; 53(Suppl.2);A29. 8. The official PROactive results website  Presentation  "Obesity Management Part I - Introduction" Dr. Trisha O'Moore-Sullivan (biography) English - 2005-09-11 - 17 minutes (15 slides) Summary : The WHO recognizes obesity as a major unmet health need worldwide, and in Australia itself obesity has doubled in the last 20 years, according AUSDIAB data. When clinically assessing the overweight/obese patient, it is important to measure height, weight and waist circumference, and to measure blood pressure using an appropriate cuff size. Insulin resistance can be detected by the... Learning objectives : After viewing this presentation the participant will be able to discuss: - The current burden of overweight and obesity - Clinical assessment of overweight/obese individuals - Benefits of weight loss  Presentation  "The Role of Fibrates in Reducing Cardiovascular Risk" Prof. Philip Barter (biography) English - 2005-09-11 - 24 minutes (43 slides) Summary : In this presentation Prof. Barter reviews data showing how certain types of individuals receive enhanced benefit from fibrate treatment, in terms of reduced cardiovascular risk. Fibrates activate the nuclear receptor PPAR-alpha, and have several possible anti-atherogenic mechanisms. Prof. Barter presents data from the Helsinki Heart Study (HHS)and the VA-HIT Study both using... Learning objectives : After viewing this presentation the participant will be able to discuss: - Data from the HHS and VA-HIT studies - Data from the BIP Study - Introduction to the FIELD Study Bibliographic references : 1. Manninen V, Tenkanen L, Koskinen P, Huttunen JK, Manttari M, Heinonen OP, Frick MH.Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study. Implications for treatment. Circulation. 1992 Jan;85(1):37-45. 2. Leena Tenkanen, PhD; Matti Mänttäri, MD; Vesa Manninen, MD. Some Coronary Risk Factors Related to the Insulin Resistance Syndrome and Treatment With Gemfibrozil: Experience From the Helsinki Heart Study Circulation. 1995;92:1779-1785. 3. Rubins HB, Robins SJ, Collins D, Nelson DB, Elam MB, Schaefer EJ, Faas FH, Anderson JW.Diabetes, plasma insulin, and cardiovascular disease: subgroup analysis from the Department of Veterans Affairs high-density lipoprotein intervention trial (VA-HIT).Arch Intern Med. 2002 Dec 9-23;162(22):2597-604. 4. BIP Study Group. Circulation.2000. 5. Tenenbaum A, Motro M, Fisman EZ, Tanne D, Boyko V, Behar S. Bezafibrate for the secondary prevention of myocardial infarction in patients with metabolic syndrome. Arch Intern Med. 2005 May 23;165(10):1154-60.  Presentation  "Obesity Management Part II - Lifestyle Modification" Dr. Trisha O'Moore-Sullivan (biography) English - 2005-09-11 - 16 minutes (13 slides) Summary : In this segment Dr. O'Moore-Sullivan talks about the methods of lifestyle modification that can be used to reduce weight, and what kinds of results they can achieve. Diets used for weight loss fall under the broad categories of energy reduced, low energy, very low energy, and low glycaemic index diets. Dr. O'Moore-Sullivan describes some different kinds of diets and their pros and... Learning objectives : After viewing this presentation the participant will be able to discuss: - Various diets used for weight loss - Exercise and weight loss - Health benefits of exercise  Presentation  "Obesity Management Part III - Pharmacotherapy" Dr. Trisha O'Moore-Sullivan (biography) English - 2005-09-11 - 15 minutes (14 slides) Summary : Pharmacotherapies for obesity are currently few in number and costly. They might possibly be more cost-effective if used for weight maintenance, and should always be seen as adjuncts to calorie restriction and lifestyle therapy, says Dr. O'Moore-Sullivan. Commonly used agents are orlistat, which inhibits the absorption of dietary fat, and sibutramine, a noradrenaline-serotonin... Learning objectives : After viewing this presentation the participant will be able to discuss: - Targets for pharmacotherapy of obesity - Commonly used agents, their mechanisms of action and effects Bibliographic references : 1. ProfLuc F Van Gaal, Aila M Rissanen, André J Scheen, Olivier Ziegler, Stephan Rössner and for the RIO-Europe Study Group Effects of the cannabinoid-1 receptor blocker rimonabant on weight reduction and cardiovascular risk factors in overweight patients: 1-year experience from the RIO-Europe study The Lancet, Volume 365, Issue 9468, 16 April 2005-22 April 2005, Pages 1389-1397.  Presentation  "Obesity Management Part IV - Bariatric Surgery" Dr. Trisha O'Moore-Sullivan (biography) English - 2005-09-11 - 15 minutes (12 slides) Summary : In this last segment of the presentation Dr. O'Moore-Sullivan discusses surgery for the management of obesity, and the importance of managing comorbidities associated with obesity. Bariatric surgery undertaken to achieve weight loss can be divided into restrictive and malabsorptive procedures. Dr. O'Moore-Sullivan describes these procedures and the results of a meta-analysis by... Learning objectives : After viewing this presentation the participant will be able to discuss: - Types of bariatric surgery procedures - Effects of bariatric surgery as a treatment for severe obesity - Comorbidities of obesity Bibliographic references : 1. Henry Buchwald, MD, PhD; Yoav Avidor, MD; Eugene Braunwald, MD; Michael D. Jensen, MD; Walter Pories, MD; Kyle Fahrbach, PhD; Karen Schoelles, MD Bariatric Surgery: A Systematic Review and Meta-analysis JAMA. 2004;292:1724-1737. 2. Lars Sjöström, M.D., Ph.D., Anna-Karin Lindroos, Ph.D., Markku Peltonen, Ph.D., Jarl Torgerson, M.D., Ph.D., Claude Bouchard, Ph.D., Björn Carlsson, M.D., Ph.D., Sven Dahlgren, M.D., Ph.D., Bo Larsson, M.D., Ph.D., Kristina Narbro, Ph.D., Carl David Sjöström, M.D., Ph.D., Marianne Sullivan, Ph.D., Hans Wedel, Ph.D., for the Swedish Obese Subjects Study Scientific Group. Lifestyle, Diabetes, and Cardiovascular Risk Factors 10 Years after Bariatric Surgery NEJM 2004;351(26):2683-93.  Presentation  "Diabetic Complications: Lessons from Pancreas Transplantation" Dr. Brian Nankivell (biography) English - 2005-06-18 - 47 minutes (80 slides) (2 questions) Summary : In this presentation Dr. Nankivell talks about the effects of pancreas transplantation on diabetic complications. In patients with type 1 diabetes, those with a normal or near normal GFR tend to get a pancreas transplant alone, whereas simultaneous pancreas and kidney transplantation (SPK) is common in those with renal failure. Dr. Nankivell begins by describing the surgical... Learning objectives : After viewing this presentation the participant will be able to discuss: - Surgical techniques and new innovations in pancreas transplantation - The effects of pancreas transplantation in type 1 diabetic patients: --- Microvascular and macrovascular complications Bibliographic references : 1. Smets YF, Westendorp RG, van der Pijl JW, de Charro FT, Ringers J, de Fijter JW, Lemkes HH.Effect of simultaneous pancreas-kidney transplantation on mortality of patients with type-1 diabetes mellitus and end-stage renal failure Lancet. 1999 Jun 5;353(9168):1915-9. 2. Larsen JL, Ratanasuwan T, Burkman T, Lynch T, Erickson J, Colling C, Lane J, Mack-Shipman L, Lyden E, Loseke M, Miller S, Leone J. Carotid intima media thickness decreases after pancreas transplantation.Transplantation. 2002 Mar 27;73(6):936-40. 3. Nankivell BJ, Lau SG, Chapman JR, O'Connell PJ, Fletcher JP, Allen RD.Progression of macrovascular disease after transplantation. Transplantation. 2000 Feb 27;69(4):574-81.  Presentation  "Vascular Actions of Oral Hypoglycaemic Agents (Sulphonylureas, Biguanides and Glitazones) Related to Atherosclerosis" Dr. Peter Little (biography) English - 2005-06-18 - 47 minutes (30 slides) (2 questions) Summary : In this presentation Dr. Little talks about the cellular and biochemical mechanisms of atherosclerosis, and pathways for the development of drugs to prevent cardiovascular disease (CVD) in diabetes. As seen in the Steno-2 trial, an intensive broad spectrum therapy is important for reducing CVD in patients with diabetes, however there still remains a substantial amount of residual... Learning objectives : After viewing this presentation the participant will be able to discuss: - Cellular and biochemical mechanisms of atherosclerosis - The effects of OHAs on atherosclerosis and restenosis: ----> Cholesterol binding to matrix proteoglycans ----> VSMC proliferation Bibliographic references : 1. Peter Gæde, M.D., Pernille Vedel, M.D., Ph.D., Nicolai Larsen, M.D., Ph.D., Gunnar V.H. Jensen, M.D., Ph.D., Hans-Henrik Parving, M.D., D.M.Sc., and Oluf Pedersen, M.D., D.M.Sc.Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes N Engl J Med. 2003 Jan 30;348(5):383-93. 2. Stephanie T. de Dios, BAppSC(Hons); Dennis Bruemmer, MD; Rodney J. Dilley, PhD; Melanie E. Ivey, BAppSci; Garry L.R. Jennings, MBBS, PhD; Ronald E. Law, PhD; Peter J. Little, PhD Inhibitory Activity of Clinical Thiazolidinedione Peroxisome Proliferator Activating Receptor- Ligands Toward Internal Mammary Artery, Radial Artery, and Saphenous Vein Smooth Muscle Cell Proliferation Circulation. 2003;107:2548.  Presentation  "Glucose Targets in and Around Pregnancy: How Low Can You Go? Part I" Dr. David McIntyre (biography) English - 2005-06-15 - 31 minutes (28 slides) Summary : In this presentation Dr. McIntyre discusses several aspects of importance to diabetes care in pre-pregnancy and early pregnancy. Teratogenesis or fetal anomalies in diabetes are related to a number of metabolic disturbances including hyperglycaemia (1), and studies have shown an increased risk of fetal malformations in type 1 and type 2 diabetic women with even slightly raised... Learning objectives : After viewing this presentation the participant will be able to discuss: - Diabetes and teratogenesis - Glycaemic control in Australian diabetics - NDiPAC consensus statement and ADIPS guidelines concerning diabetes treatment before and during pregnancy - Action to improve pre-pregnancy glycaemic control Bibliographic references : 1. Reece EA, Homko CJ."Why do diabetic women deliver malformed infants?" Clin Obstet Gynecol. 2000 Mar;43(1):32-45. 2. L. Suhonen, V. Hiilesmaa, K. Teramo. Glycaemic control during early pregnancy and fetal malformations in women with Type I diabetes mellitus Diabetologia. 2000;43(1):79 - 82. 3. Towner D, Kjos SL, Leung B, Montoro MM, Xiang A, Mestman JH, Buchanan TA.Congenital malformations in pregnancies complicated by NIDDM.Diabetes Care. 1995 Nov;18(11):1446-51. 4. A. Plagemann A, T. Harder A, R. Kohlhoff A, W. Rohde A, G. Dörner. Glucose tolerance and insulin secretion in children of mothers with pregestational IDDM or gestational diabetes Diabetologia. 1997;40(9):1094 - 1100. 5. Plagemann A, Harder T, Kohlhoff R, Rohde W, Dorner G.Overweight and obesity in infants of mothers with long-term insulin-dependent diabetes or gestational diabetes. Int J Obes Relat Metab Disord. 1997 Jun;21(6):451-6. 6. Silverman BL, Rizzo TA, Cho NH, Metzger BE. Long-term effects of the intrauterine environment. The Northwestern University Diabetes in Pregnancy Center. Diabetes Care. 1998 Aug;21 Suppl 2:B142-9. 7. Eugène Sobngwi MD, Philippe Boudou PhD, Franck Mauvais-Jarvis MD, Hervé Leblanc MD, Gilberto Velho MD, Patrick Vexiau MD, Raphaël Porcher PhD, Samy Hadjadj MD, Richard Pratley MD, P Antonio Tataranni MD, Fabien Calvo MD and DrJean-François Gautier MD. Effect of a diabetic environment in utero on predisposition to type 2 diabetes The Lancet. Volume 361, Issue 9372 , 31 May 2003, Pages 1861-1865. 8. Dabelea D, Knowler WC, Pettitt DJ. Effect of diabetes in pregnancy on offspring: follow-up research in the Pima Indians.J Matern Fetal Med. 2000 Jan-Feb;9(1):83-8.  Presentation  "Glucose Targets in and Around Pregnancy: How Low Can You Go? Part II" Dr. David McIntyre (biography) English - 2005-06-15 - 32 minutes (47 slides) Summary : In this presentation Dr. McIntyre talks about diabetes care in pre-pregnancy and early pregnancy, with a focus on action to improve pre-pregnancy glycaemic control. Studies have shown a reduced frequency of malformed infants born to mothers who received pre-conception diabetes care. Even with widespread knowledge of the value of pre-conception care, less than half the diabetic... Learning objectives : After viewing this presentation the participant will be able to discuss: Action to improve pre pregnancy glycaemic control - Pre conception care - Intensive therapy options - Factors other than glycaemia - Insulin analogs Bibliographic references : 1. EV Holing, CS Beyer, ZA Brown and FA Connell.Why don't women with diabetes plan their pregnancies? Diabetes Care 1998;Vol 21, Issue 6 889-895.  Presentation  "Glucose Targets in and Around Pregnancy: How Low Can You Go? Part III" Dr. David McIntyre (biography) English - 2005-06-15 - 15 minutes (12 slides) Summary : In this final segment of the presentation Dr. McIntyre discusses type 2 diabetes issues in women of reproductive age. Type 2 diabetes is still often viewed as “mild diabetes” but the implications for pregnancy are at least as serious as for women with type 1 diabetes, says Dr. McIntyre. Further, upto 50 percent of cases of type 2 diabetes are undiagnosed. Careful screening for... Learning objectives : After viewing this presentation the participant will be able to discuss: Type 2 diabetes issues in pregnancy: - Prevalence of T2DM - Role of oral agents - Possible role of bariatric surgery Bibliographic references : 1. Gutzin SJ, Kozer E, Magee LA, Feig DS, Koren G.The safety of oral hypoglycemic agents in the first trimester of pregnancy: a meta-analysis. Can J Clin Pharmacol. 2003 Winter;10(4):179-83. 2. David Simmons, Barry N J Walters, Janet A Rowan and H David McIntyre. Metformin therapy and diabetes in pregnancy MJA 2004; 180 (9): 462-464. 3. Skull AJ, Slater GH, Duncombe JE, Fielding GA.Laparoscopic adjustable banding in pregnancy: safety, patient tolerance and effect on obesity-related pregnancy outcomes. Obes Surg. 2004 Feb;14(2):230-5.  Presentation  "Effect of Troglitazone on Pre-Clinical Carotid Atherosclerosis in Women with Recent Gestational Diabetes" Prof. Thomas A. Buchanan (biography) English - 2005-06-10 - 26 minutes (18 slides) Summary : In this presentation Prof. Buchanan discusses data from the TRIPOD (Troglitazone in the Prevention of Diabetes) study on the impact of troglitazone treatment on the progression of pre-clinical atherosclerosis in high-risk Hispanic women with recent gestational diabetes, and mechanisms by which troglitazone may slow this progression. Carotid intima media thickness (IMT) serves as a... Learning objectives : After viewing this presentation the participant will be able to discuss: - Data from the IMT analysis of the TRIPOD Study, showing the effect of troglitazone on IMT progression in Hispanic women at high risk for type 2 diabetes. Bibliographic references : 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 J Clin Endocrinol Metab. 2005 Apr;90(4):1986-91.  Presentation  "The ORIGIN Study" Prof. Hertzel Gerstein (biography) English - 2005-04-16 - 27 minutes (22 slides) Summary : In this presentation Prof. Gerstein describes the rationale and design of the ORIGIN (Outcome Reduction with an Initial Glargine INtervention) trial. ORIGIN is a large, international, multicentre trial investigating in high risk people with IFG, IGT or early diabetes, whether insulin replacement therapy targeting fasting normoglycaemia with insulin glargine reduces the risk of CV... Learning objectives : After viewing this presentation the participant will be able to discuss: - The rationale and design of the ORIGIN trial  Presentation  "New drugs for 'Prediabetes', Metabolic Syndrome and their CVD consequences: GLP-1" Prof. Michael A. Nauck (biography) English - 2005-04-15 - 23 minutes (21 slides) Summary : Glucagon-like Peptide 1 (GLP-1) is a gut hormone with incretin and "ileal brake" activity. There are many facets of its action that add up to antidiabetic effects: (a) glucose-dependent stimulation of insulin secretion, (b) a glucagonostatic activity, (c) a deceleration of gastric emptying, (d) a suppression of appetite (and reduction in food intake), and effects on islet B cells demonstrated in... Learning objectives : After viewing this presentation the participant will be able to discuss: - Antidiabetic effects of GLP-1 - Incretin mimetics: GLP-1 receptor antagonists with prolonged pharmacokinetic profiles - Efficacy of GLP-1 in subjects with IGT - Antiapoptotic effect of GLP-1  Presentation  "PPARs and Metabolic Control" Prof. John Prins (biography) English - 2005-03-10 - 30 minutes (34 slides) Summary : Peroxisome Proliferator-Activated Receptors (PPARs) are ligand-dependent transcription factors that are expressed in tissues involved in energy metabolism. The three PPAR isoforms (alpha, delta and gamma) have overlapping and complementary roles, PPAR-alpha having a predominant effect in liver and muscle, PPAR-delta in fat and muscle, and PPAR gamma in all three insulin-sensitive... Learning objectives : After viewing this presentation the participant will be able to discuss: - Metabolic effects resulting from activation of the different Peroxisome Proliferator-Activated Receptor (PPAR) isoforms; - The clinical aspects of PPARs and their implications for diabetes and metabolic dysfunction.  Presentation  "Diabetes Treatments and Inflammatory Markers" Dr. Vivian A. Fonseca (biography) English - 2004-09-30 - 46 minutes (56 slides) Summary : It is by now well recognized that atherosclerosis is an inflammatory disease and diabetics appear to be disproportionately affected by both cardiovascular disease and inflammation. What is the effect of chronic inflammation on the pathophysiology of diabetes? What is the effect of diabetes on inflammatory processes? Dr. Fonseca examines the evidence for the inter-relatedness of... Learning objectives : After viewing this presentation, participants will be able to discuss: - The role of inflammation in diabetes - The role of diabetes in inflammation - The effect of insulin sensitizers on CRP and other markers of inflammation - The effect of insulin on CRP and other markers of inflammation - The effect of statins other cholesterol lowering medications on CRP and other markers of inflammation - How ACE-inhibitors and ARBs impact on serum levels of markers of inflammation - The role of anti-inflammatory medications, such as ASA, in diabetes Bibliographic references : Peter Libby, Paul M. Ridker, and Attilio Maseri Inflammation and Atherosclerosis Circulation 2002 105: 1135 - 1143 Grimble, Robert F.Inflammatory status and insulin resistance. Current Opinion in Clinical Nutrition & Metabolic Care. 5(5):551-559, September 2002. Kaplan, Robert C. PhD; Frishman, William H. MDSystemic Inflammation as a Cardiovascular Disease Risk Factor and as a Potential Target for Drug Therapy. Heart Disease. 3(5):326-332, September/October 2001. Steven M. Haffner, Andrew S. Greenberg, Wayde M. Weston, Hongzi Chen, Ken Williams, and Martin I. Freed Effect of Rosiglitazone Treatment on Nontraditional Markers of Cardiovascular Disease in Patients With Type 2 Diabetes Mellitus Circulation 2002 106: 679 - 684; Neelima V. Chu, Alice P. S. Kong, Dennis D. Kim, Debra Armstrong, Sunita Baxi, Reena Deutsch, Michael Caulfield, Sunder R. Mudaliar, Richard Reitz, Robert R. Henry, and Peter D. ReavenDifferential Effects of Metformin and Troglitazone on Cardiovascular Risk Factors in Patients With Type 2 Diabetes Diabetes Care 25: 542-549 Burton E. Sobel, Janet Woodcock-Mitchell, David J. Schneider, Robert E. Holt, Kousuke Marutsuka, and Herman Gold Increased Plasminogen Activator Inhibitor Type 1 in Coronary Artery Atherectomy Specimens From Type 2 Diabetic Compared With Nondiabetic Patients : A Potential Factor Predisposing to Thrombosis and Its Persistence Circulation 1998 97: 2213 – 2221 Nakamura, Tsukasa; Ushiyama, Chifuyu; Shimada, Noriaki; Hayashi, Kayo; Ebihara, Isao; Koide, Hikaru Comparative effects of pioglitazone, glibenclamide, and voglibose on urinary endothelin-1 and albumin excretion in diabetes patients J Diabetes Complications Vol: 14, Issue: 5, September - October, 2000 Stefan Engeli, Mareike Feldpausch, Kerstin Gorzelniak, Frauke Hartwig, Ute Heintze, Jürgen Janke, Matthias Möhlig, Andreas F.H. Pfeiffer, Friedrich C. Luft, and Arya M. Sharma Association Between Adiponectin and Mediators of Inflammation in Obese Women Diabetes 2003; 52: 942-947 Paresh Dandona, Ahmad Aljada, Priya Mohanty, Husam Ghanim, Wael Hamouda, Ezzat Assian, and Shakeel AhmadInsulin Inhibits Intranuclear Nuclear Factor B and Stimulates I B in Mononuclear Cells in Obese Subjects: Evidence for an Anti-inflammatory Effect? J. Clin. Endocrinol. Metab., Jul 2001; 86: 3257 - 3265. Troels Krarup Hansen, Steffen Thiel, Pieter Jozef Wouters, Jens Sandahl Christiansen, and Greet Van den BergheIntensive Insulin Therapy Exerts Antiinflammatory Effects in Critically Ill Patients and Counteracts the Adverse Effect of Low Mannose-Binding Lectin Levels J. Clin. Endocrinol. Metab., Mar 2003; 88: 1082 - 1088. Van den Berghe G., Wouters P., Weekers F., Verwaest C., Bruyninckx F., Schetz M., Vlasselaers D., Ferdinande P., Lauwers P., Bouillon R.Intensive Insulin Therapy in Critically Ill Patients N Engl J Med 2001; 345:1359-1367, Nov 8, 2001. Ajay Chaudhuri, David Janicke, Michael F. Wilson, Devjit Tripathy, Rajesh Garg, Arindam Bandyopadhyay, Janeen Calieri, Debbie Hoffmeyer, Tufail Syed, Husam Ghanim, Ahmad Aljada, and Paresh DandonaAnti-Inflammatory and Profibrinolytic Effect of Insulin in Acute ST-Segment–Elevation Myocardial Infarction Circulation 2004 109: 849 – 854 Hannes Gaenzer, Günther Neumayr, Peter Marschang, Wolfgang Sturm, Monika Lechleitner, Bernhard Föger, Rudolf Kirchmair and Josef PatschEffect of insulin therapy on endothelium-dependent dilation in type 2 diabetes mellitus The American Journal of Cardiology Volume 89, Issue 4 , 15 February 2002, Pages 431-434 JP Albertini, P Valensi, B Lormeau, MH Aurousseau, F Ferriere, JR Attali, and L GattegnoElevated concentrations of soluble E-selectin and vascular cell adhesion molecule-1 in NIDDM. Effect of intensive insulin treatment Diabetes Care 21: 1008-1013. I. Jialal, D. Stein, D. Balis, S. M. Grundy, B. Adams-Huet, and S. Devaraj Effect of Hydroxymethyl Glutaryl Coenzyme A Reductase Inhibitor Therapy on High Sensitive C-Reactive Protein Levels Circulation 2001 103: 1933 - 1935 Steven E. Nissen; E. Murat Tuzcu; Paul Schoenhagen; B. Greg Brown; Peter Ganz; Robert A. Vogel; Tim Crowe; Gail Howard; Christopher J. Cooper; Bruce Brodie; Cindy L. Grines; Anthony N. DeMariaEffect of Intensive Compared With Moderate Lipid-Lowering Therapy on Progression of Coronary Atherosclerosis: A Randomized Controlled Trial JAMA. 2004;291:1071-1080 Christie M. Ballantyne, John Houri, Alberto Notarbartolo, Lorenzo Melani, Leslie J. Lipka, Ramachandran Suresh, Steven Sun, Alexandre P. LeBeaut, Philip T. Sager, and Enrico P. VeltriEffect of Ezetimibe Coadministered With Atorvastatin in 628 Patients With Primary Hypercholesterolemia: A Prospective, Randomized, Double-Blind Trial Circulation 2003 107: 2409 - 2415 Philip T. Sager, Lorenzo Melani, Leslie Lipka, John Strony, Bo Yang, Ramachandran Suresh, Enrico Veltri and Ezetimibe Study GroupEffect of coadministration of ezetimibe and simvastatin on high-sensitivity C-reactive protein The American Journal of Cardiology Volume 92, Issue 12 , 15 December 2003, Pages 1414-1418 Sushant Navalkar, Sampath Parthasarathy, Nalini Santanam and Bobby V. KhanIrbesartan, an angiotensin type 1 receptor inhibitor, regulates markers of inflammation in patients with premature atherosclerosis Journal of the American College of Cardiology Volume 37, Issue 2 , February 2001, Pages 440-444 Paul M. Ridker, M.D., Mary Cushman, M.D., Meir J. Stampfer, M.D., Russell P. Tracy, Ph.D., and Charles H. Hennekens, M.D. Inflammation, Aspirin, and the Risk of Cardiovascular Disease in Apparently Healthy Men NEJM 1997; Volume 336:973-979 Ripudaman S. Hundal, Kitt F. Petersen, Adam B. Mayerson, Pritpal S. Randhawa, Silvio Inzucchi, Steven E. Shoelson, and Gerald I. ShulmanMechanism by which high-dose aspirin improves glucose metabolism in type 2 diabetes J. Clin. Invest. 2002 109:1321-1326  Presentation  "The DIGAMI studies: Implications for practice" Prof. Timothy Davis (biography) English - 2004-09-23 - 26 minutes (21 slides) Summary : In this presentation Prof. Davis reviews the results of the DIGAMI-1 (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction-1) study and preliminary results from the DIGAMI-2 study. In a systematic review and meta-analysis published by Capes et al., it was found that hyperglycaemia increased mortality in patients with acute myocardial infarction (AMI) (1), and... Learning objectives : - To review the results of DIGAMI-1 and their implications for management of acute coronary syndromes in diabetes - To assess the recently presented preliminary results of DIGAMI-2 and their possible impact on the recommendations arising out of DIGAMI-1 Bibliographic references : 1. Capes SE, Hunt D, Malmberg K, Gerstein HC.Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview Lancet. 2000 Mar 4;355(9206):773-8. 2. Farzin Fath-Ordoubadi, BSc, MB BCHIR, MRCP; ; Kevin J. Beatt, PhD, FESC, FACC.Glucose-Insulin-Potassium Therapy for Treatment of Acute Myocardial Infarction Circulation. 1997;96:1152-1156. 3. Rafael Díaz, MD; Ernesto A. Paolasso, MD; Leopoldo S. Piegas, MD; Carlos D. Tajer, MD; Manuel Gil Moreno, MD; Ramón Corvalán, MD; Jesús E. Isea, MD; Graciela Romero, MD.Metabolic Modulation of Acute Myocardial Infarction: The ECLA Glucose-Insulin-Potassium Pilot Trial Circulation. 1998;98:2227-2234. 4. Klas Malmberg, for the DIGAMI (Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction) Study Group. Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus BMJ 1997;314:1512.  Presentation  "Treatment with insulin detemir provides improved glycaemic control and less weight gain compared to NPH insulin in people with diabetes" Dr. A. J. Garber (biography) English - 2004-09-09 - 23 minutes (16 slides) Summary : In this presentation Dr. Garber discusses the advantages of treatment with insulin detemir compared to NPH insulin. Insulin detemir is a new basal insulin analogue containing a myristic acid fatty acid chain, and having three modes of protracted action. In the results of a meta-analysis of six randomised, prospective trials done in type1 and type 2 diabetic patients, detemir was... Learning objectives : After viewing this presentation, the participant will be able to discuss: - The characteristics and modes of protracted action of insulin detemir - The effects of insulin detemir compared to NPH insulin in terms of: Glycaemic control Day-to-day variation in fasting blood glucose levels Change in body weight Risk of minor hypoglycaemia  Presentation  "Limitations to Achieving Good Glycaemic Control" Dr. Roger Chen (biography) English - 2004-06-26 - 36 minutes (33 slides) (2 questions) Summary : Several studies have demonstrated the prevalence of suboptimal glycaemic control in diabetic patients from different parts of the world. A recent survey of 300 primary health care physicians done by Blonde et al. and presented at the 64th ADA meeting of June 2004, showed that apparent reasons for suboptimal glycaemic control were non-adherence to pharmacological and... Learning objectives : After viewing this presentation the participant will be able to discuss: - The prevalence of suboptimal glycaemic control in type 2 diabetes - Possible causes of suboptimal glycaemic control Bibliographic references : C.R.Bruce, A.D.Kriketos, G.J.Cooney and J.A.Hawley. Disassociation of muscle triglyceride content and insulin sensitivity after exercise training in patients with Type 2 diabetes Diabetologia 2004; 47(1):23-30. Joyce A. Cramer. A Systematic Review of Adherence With Medications for Diabetes Diabetes Care 2004; 27:1218-1224. Alison Kirk, BSC, Nanette Mutrie, PHD, Paul MacIntyre, MD and Miles Fisher, MD. Increasing Physical Activity in People With Type 2 Diabetes Diabetes Care 2003; 26:1186-1192. Arch G. Mainous, III, PhD, Richelle J. Koopman, MD, James M. Gill, MD, MPH, Richard Baker, MD and William S. Pearson, MHA Relationship Between Continuity of Care and Diabetes Control: Evidence From the Third National Health and Nutrition Examination Survey American Journal of Public Health 2004; 94(1):66-70. Marre, M. Before oral agents fail: the case for starting insulin early Int'l J Obesity 2002; Volume 26, Supplement 3, Pages S25-S30. Yuzo Sato, Masaru Nagasaki, Naoya Nakai and Takashi Fushimi. Physical Exercise Improves Glucose Metabolism in Lifestyle-Related Diseases Experimental Biology and Medicine 2003; 228:1208-1212. Kevin R. Short, Janet L. Vittone, Maureen L. Bigelow, David N. Proctor, Robert A. Rizza, Jill M. Coenen-Schimke, and K. Sreekumaran Nair. Impact of Aerobic Exercise Training on Age-Related Changes in Insulin Sensitivity and Muscle Oxidative Capacity Diabetes 2003 52(8):1888-1896.  Presentation  "PPAR effects linked to atherosclerosis independent of insulin sensitisation" Dr. Karin Jandeleit-Dahm (biography) English - 2004-06-26 - 34 minutes (37 slides) (4 questions) Summary : In this presentation Dr. Jandeleit-Dahm describes the Peroxisome Proliferator-Activated Receptor (PPAR) isoforms and their distribution in different tissue types, and presents data from experimental studies focusing on the investigation of vascular and anti-atherosclerotic effects of thiazolidinediones, which are PPAR gamma agonists. Previous animal studies have demonstrated... Learning objectives : After viewing this presentation the participant will be able to discuss: - The distribution and effects of PPAR isoforms - Preliminary experimental data and proposed mechanisms for the direct vascular and anti-atherosclerotic effects of PPAR gamma ligands - Evidence for a role of the renin-angiotensin system in the progression of diabetes-associated atherosclerosis Bibliographic references : O Braissant, F Foufelle, C Scotto, M Dauca and W Wahli. Differential expression of peroxisome proliferator-activated receptors (PPARs): tissue distribution of PPAR-alpha, -beta, and -gamma in the adult rat Endocrinology 1996; Vol 137, 354-366. Riccardo Candido, MD; Terri J. Allen, PhD; Markus Lassila, PhD; Zemin Cao, MD; Vicki Thallas, BSc; Mark E. Cooper, MBBS, FRACP, PhD; Karin A. Jandeleit-Dahm, MD, PhD. Irbesartan but Not Amlodipine Suppresses Diabetes-Associated Atherosclerosis Circulation 2004; 109:1536-1542. Riccardo Candido, MD; Karin A. Jandeleit-Dahm, MD, PhD; Zemin Cao, MD; Stefan P. Nesteroff;; Wendy C. Burns, BSc, (Hons), BEd; Stephen M. Twigg, MBBS, FRACP, PhD; Rodney J. Dilley, PhD; Mark E. Cooper, MBBS, FRACP, PhD; Terri J. Allen, PhD. Prevention of Accelerated Atherosclerosis by Angiotensin-Converting Enzyme Inhibition in Diabetic Apolipoprotein E–Deficient Mice Circulation. 2002;106:246 Chao-Hung Wang, MD; Nadia Ciliberti, BSc; Shu-Hong Li, MSc; Paul E. Szmitko, BSc; Richard D. Weisel, MD; Paul W.M. Fedak, MD; Mohammed Al-Omran, MD, MSc; Wen-Jin Cherng, MD; Ren-Ke Li, MD, PhD; William L. Stanford, PhD; Subodh Verma, MD, PhD. Rosiglitazone Facilitates Angiogenic Progenitor Cell Differentiation Toward Endothelial Lineage Circulation. 2004;109:1392-1400.  Presentation  "Strategies to prevent diabetic renal disease (bench to bedside)" Prof. Mark E. Cooper (biography) English - 2004-06-26 - 37 minutes (34 slides) Summary : In this presentation Dr. Cooper presents scientific data relating to possible future therapeutic interventions for preventing diabetic renal disease. The metallopeptidase enzymes such as angiotensin converting enzyme (ACE) and neutral endopeptidase (NEP) are homologous, so it is possible to make a drug targeting both enzymes. Inhibition of both enzymes with the drug omapatrilat... Learning objectives : After viewing this presentation the participant will be able to discuss scientific data relating to possible therapeutic interventions to prevent diabetic renal disease: - Dual ACE and NEP inhibition - Reduction of AGEs - PKC beta inhibition - Growth factor inhibition Bibliographic references : M. E. Cooper. Interaction of metabolic and haemodynamic factors in mediating experimental diabetic nephropathy Diabetologia 2001; 44(11):1957 - 1972. B. J. Davis, C. I. Johnston, L. M. Burrell, W. C. Burns, E. Kubota, Z. Cao, M. E. Cooper and T. J. Allen. Renoprotective effects of vasopeptidase inhibition in an experimental model of diabetic nephropathy Diabetologia 2003;46(7):961 - 971. Josephine M. Forbes, Louis Teo Loon Yee, Vicki Thallas, Markus Lassila, Riccardo Candido, Karin A. Jandeleit-Dahm, Merlin C. Thomas, Wendy C. Burns, Elizabeth K. Deemer, Susan M. Thorpe, Mark E. Cooper, and Terri J. Allen. Advanced Glycation End Product Interventions Reduce Diabetes-Accelerated Atherosclerosis Diabetes 2004; 53:1813-1823. Forbes JM, Thallas V, Thomas MC, Founds HW, Burns WC, Jerums G, Cooper ME. The breakdown of preexisting advanced glycation end products is associated with reduced renal fibrosis in experimental diabetes. FASEB J. 2003 Sep;17(12):1762-4. Forbes JM, Soulis T, Thallas V, Panagiotopoulos S, Long DM, Vasan S, Wagle D, Jerums G, Cooper ME.Renoprotective effects of a novel inhibitor of advanced glycation. Diabetologia 2001 Jan;44(1):108-14. DAISUKE KOYA, MASAKAZU HANEDA, HIROKO NAKAGAWA, KEIJI ISSHIKI, HARUHISA SATO, SHIRO MAEDA, TOSHIRO SUGIMOTO, HITOSHI YASUDA, ATSUNORI KASHIWAGI, D. KIRK WAYS, GEORGE L. KING§ and RYUICHI KIKKAWA.Amelioration of accelerated diabetic mesangial expansion by treatment with a PKC ß inhibitor in diabetic db/db mice, a rodent model for type 2 diabetes FASEB.2000;14:439-447. Park L, Raman KG, Lee KJ, Lu Y, Ferran LJ Jr, Chow WS, Stern D, Schmidt AM.Suppression of accelerated diabetic atherosclerosis by the soluble receptor for advanced glycation endproducts. Nat Med. 1998 Sep;4(9):1025-31.  Presentation  "Glitazones and Vascular Disease in Clinical Practice" Prof. Gerald Watts (biography) English - 2004-06-26 - 37 minutes (32 slides) (2 questions) Summary : Despite the beneficial effects of statins and ACE-inhibitors, Cardiovascular (CVS) risk remains high in diabetic patients. Classical markers of CVS risk do not explain all of the risk in Type-2 diabetics. Dr. Gerald Watts examines the effects of glitazones (with established effects on traditional CVS risk factors and diabetes pathogenesis) on CVS non-traditional CVS risk factors, their direct... Learning objectives : After viewing this presentation, participants will be able to discuss: • The distribution of PPAR-receptors and their actions in various tissues. • The role that PPAR-gamma agonists may play in reducing CVS risk. • Both broad and specific mechanisms by which this might be accomplished. • Effect of glitazones on endothelial dysfunction • Effect of glitazones on coronary blood flow • Effect of glitazones on non-traditional markes of CVS risk. Bibliographic references : Bakris G, Viberti G, Weston WM, Heise M, Porter LE, Freed MI. Rosiglitazone reduces urinary albumin excretion in type II diabetes. J Hum Hypertens. 2003 Jan;17(1):7-12. Calnek DS, Mazzella L, Roser S, Roman J, Hart CM. Peroxisome proliferator-activated receptor gamma ligands increase release of nitric oxide from endothelial cells. Arterioscler Thromb Vasc Biol. 2003 Jan 1;23(1):52-7. Collins AR, Meehan WP, Kintscher U, Jackson S, Wakino S, Noh G, Palinski W, Hsueh WA, Law RE. Troglitazone inhibits formation of early atherosclerotic lesions in diabetic and nondiabetic low density lipoprotein receptor-deficient mice. Arterioscler Thromb Vasc Biol. 2001 Mar;21(3):365-71. Delerive P, Gervois P, Fruchart JC, Staels B. Induction of IkappaBalpha expression as a mechanism contributing to the anti-inflammatory activities of peroxisome proliferator-activated receptor-alpha activators. J Biol Chem. 2000 Nov 24;275(47):36703-7. Haffner SM, Greenberg AS, Weston WM, Chen H, Williams K, Freed MI. Effect of rosiglitazone treatment on nontraditional markers of cardiovascular disease in patients with type 2 diabetes mellitus. Circulation. 2002 Aug 6;106(6):679-84. Heitzer T, Schlinzig T, Krohn K, Meinertz T, Munzel T. Endothelial dysfunction, oxidative stress, and risk of cardiovascular events in patients with coronary artery disease. Circulation. 2001 Nov 27;104(22):2673-8. Koshiyama H, Shimono D, Kuwamura N, Minamikawa J, Nakamura Y. Rapid communication: inhibitory effect of pioglitazone on carotid arterial wall thickness in type 2 diabetes. J Clin Endocrinol Metab. 2001 Jul;86(7):3452-6. Law RE, Meehan WP, Xi XP, Graf K, Wuthrich DA, Coats W, Faxon D, Hsueh WA. Troglitazone inhibits vascular smooth muscle cell growth and intimal hyperplasia. J Clin Invest. 1996 Oct 15;98(8):1897-905. Law RE, Goetze S, Xi XP, Jackson S, Kawano Y, Demer L, Fishbein MC, Meehan WP, Hsueh WA.Expression and function of PPARgamma in rat and human vascular smooth muscle cells. Circulation. 2000 Mar 21;101(11):1311-8. Marx N, Froehlich J, Siam L, Ittner J, Wierse G, Schmidt A, Scharnagl H, Hombach V, Koenig W. Antidiabetic PPAR gamma-activator rosiglitazone reduces MMP-9 serum levels in type 2 diabetic patients with coronary artery disease. Arterioscler Thromb Vasc Biol. 2003 Feb 1;23(2):283-8. Marx N, Imhof A, Froehlich J, Siam L, Ittner J, Wierse G, Schmidt A, Maerz W, Hombach V, Koenig W. Effect of rosiglitazone treatment on soluble CD40L in patients with type 2 diabetes and coronary artery disease. Circulation. 2003 Apr 22;107(15):1954-7. Epub 2003 Apr 14. Minamikawa J, Tanaka S, Yamauchi M, Inoue D, Koshiyama H. Potent inhibitory effect of troglitazone on carotid arterial wall thickness in type 2 diabetes. J Clin Endocrinol Metab. 1998 May;83(5):1818-20. Mohanty P, Aljada A, Ghanim H, Hofmeyer D, Tripathy D, Syed T, Al-Haddad W, Dhindsa S, Dandona P. Evidence for a potent antiinflammatory effect of rosiglitazone. J Clin Endocrinol Metab. 2004 Jun;89(6):2728-35. Satoh N, Ogawa Y, Usui T, Tagami T, Kono S, Uesugi H, Sugiyama H, Sugawara A, Yamada K, Shimatsu A, Kuzuya H, Nakao K. Antiatherogenic effect of pioglitazone in type 2 diabetic patients irrespective of the responsiveness to its antidiabetic effect. Diabetes Care. 2003 Sep;26(9):2493-9. Takagi T, Akasaka T, Yamamuro A, Honda Y, Hozumi T, Morioka S, Yoshida K. Troglitazone reduces neointimal tissue proliferation after coronary stent implantation in patients with non-insulin dependent diabetes mellitus: a serial intravascular ultrasound study. J Am Coll Cardiol. 2000 Nov 1;36(5):1529-35. Wang TD, Chen WJ, Lin JW, Chen MF, Lee YT. Effects of rosiglitazone on endothelial function, C-reactive protein, and components of the metabolic syndrome in nondiabetic patients with the metabolic syndrome. Am J Cardiol. 2004 Feb 1;93(3):362-5. Yoshimoto T, Naruse M, Shizume H, Naruse K, Tanabe A, Tanaka M, Tago K, Irie K, Muraki T, Demura H, Zardi L. Vasculo-protective effects of insulin sensitizing agent pioglitazone in neointimal thickening and hypertensive vascular hypertrophy. Atherosclerosis. 1999 Aug;145(2):333-40. Additional References of Interest Natali A, Baldeweg S, Toschi E, Capaldo B, Barbaro D, Gastaldelli A, Yudkin JS, Ferrannini E. Vascular effects of improving metabolic control with metformin or rosiglitazone in type 2 diabetes. Diabetes Care. 2004 Jun;27(6):1349-57.  Presentation  "Have the Guidelines Jumped Ahead of the Evidence?" Dr. Stephen Colagiuri (biography) English - 2004-06-26 - 32 minutes (34 slides) (3 questions) Summary : In this presentation, Dr. Stephen Colagiuri examines how clinical practice guidelines are developed and asks “have the guidelines jumped ahead of the evidence” in diabetes. Dr. Colagiuri discusses what our expectations of clinical practice guidelines are, the limitations of guidelines, and gives an overview of how guidelines are developed and what is involved in their... Learning objectives : After viewing this presentation, participants will be able to discuss: - What is expected of Guidelines - What are the limitations of Guidelines - The general process by which guidelines are developed - The CARDS study (Collaborative Atorvastatin Diabetes Study) Bibliographic references : Allen IE, Olkin I. Estimating time to conduct a meta-analysis from number of citations retrieved. Estimating time to conduct a meta-analysis from number of citations retrieved. Colhoun HM, Betteridge DJ, Durrington PN, Hitman GA, Neil HA, Livingstone SJ, Thomason MJ, Mackness MI, Charlton-Menys V, Fuller JH; CARDS investigators. Primary prevention of cardiovascular disease with atorvastatin in type 2 diabetes in the Collaborative Atorvastatin Diabetes Study (CARDS): multicentre randomised placebo-controlled trial. Lancet. 2004 Aug 21;364(9435):685-96. Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ. 2003 Jun 28;326(7404):1423.  Presentation  "Glycaemic Control and Diabetes Complications" Dr. Stephen Twigg (biography) English - 2004-06-26 - 44 minutes (40 slides) Summary : In this presentation, Dr. Stephen Twigg examines the evidence in the literature for better glycemic control. Dr. Twigg presents the available evidence for the prevention of end-organ damage through better glycemic control, citing the UKPDS, DDCT, and EDIC trials in particular. He discusses proposed mechanisms for the effects of hyperglycmemia on end-organs and presents some of his... Learning objectives : After viewing this presentation, participants will be able to discuss: • The evidence for the prevention of end-organ complications by better glycemic control (eg. UKPDS, DCCT, EDIC) • Proposed mechanisms for the effects of glycemia on end-organs • The role of advanced glycosylation end-products in end-organ damage • The evidence for the reversal of end-organ complications with improved glycemic control • Prospective methods to minimise diabetes complications Bibliographic references : The Diabetes Control and Complications Trial Research Group The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus New Engl J Med. 329(14):977-986. 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 Aug 12;321(7258):405-12. Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: the Epidemiology of Diabetes Interventions and Complications (EDIC) study. JAMA. 2003 Oct 22;290(16):2159-67. Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature. 2001 Dec 13;414(6865):813-20. Twigg SM, Cao Z, MCLennan SV, Burns WC, Brammar G, Forbes JM, Cooper ME. Renal connective tissue growth factor induction in experimental diabetes is prevented by aminoguanidine. Endocrinology. 2002 Dec;143(12):4907-15. Twigg SM, Chen MM, Joly AH, Chakrapani SD, Tsubaki J, Kim HS, Oh Y, Rosenfeld RG. Advanced glycosylation end products up-regulate connective tissue growth factor (insulin-like growth factor-binding protein-related protein 2) in human fibroblasts: a potential mechanism for expansion of extracellular matrix in diabetes mellitus. Endocrinology. 2001 May;142(5):1760-9. McLennan SV, Wang XY, Moreno V, Yue DK, Twigg SM. Connective tissue growth factor mediates high glucose effects on matrix degradation through tissue inhibitor of matrix metalloproteinase type 1: implications for diabetic nephropathy. Endocrinology. 2004 Sep 2 [Epub ahead of print] McCarter RJ, Hempe JM, Gomez R, Chalew SA. Biological variation in HbA1c predicts risk of retinopathy and nephropathy in type 1 diabetes. Diabetes Care. 2004 Jun;27(6):1259-64. Additional References of Interest The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group Retinopathy and Nephropathy in Patients with Type 1 Diabetes Four Years after a Trial of Intensive Therapy New Engl J Med. 342(6):381-389 Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. JAMA. 2002 May 15;287(19):2563-9.  Presentation  "Evolving Therapies in Type 2 Diabetes" Prof. John Prins (biography) English - 2004-06-04 - 24 minutes (22 slides) Summary : The AusDiab Study showed a steadily rising prevalence of type 2 diabetes in the Australian population, with over 1 million people estimated to have the disease by 2010. In this presentation Dr. Prins reviews the natural history of type 2 diabetes and describes how treatment strategies can be adapted to prevent conversion from IGT to diabetes, lower insulin resistance and preserve beta cell... Learning objectives : The participant will learn about: - The natural history of type 2 diabetes - Treatment strategies to prevent diabetes, lower insulin resistance and preserve beta cell function  Presentation  "Based on these mechanisms, are beta-cells a therapeutic target for slowing or possibly preventing disease progression?" Dr. Julio Rosenstock (biography) English - 2004-06-04 - 17 minutes (12 slides) Summary : The UKPDS showed that conventional monotherapy does not affect the progressive decline in beta cell function. Different factors drive this process, such as hyperglycemia, lipotoxicity (elevated free fatty acids and triglycerides) and protein glycation. Autopsy studies have demonstrated that diabetic patients also have a reduced beta cell volume. This in turn is a result of increased beta cell... Learning objectives : After viewing these slides the participant will be able to discuss: - Factors driving the progressive decline in beta cell function in type 2 diabetes - Pharmacologic options which may preserve beta cell function Bibliographic references : 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. Azen. Preservation of Pancreatic ß-Cell Function and Prevention of Type 2 Diabetes by Pharmacological Treatment of Insulin Resistance in High-Risk Hispanic Women Diabetes 2002;51:2796-2803. Alexandra E. Butler, Juliette Janson, Susan Bonner-Weir, Robert Ritzel, Robert A. Rizza, and Peter C. Butler. ß-Cell Deficit and Increased ß-Cell Apoptosis in Humans With Type 2 Diabetes Diabetes 2003;52:102-110. 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 2001;50:1021-1029. UKPDS Group (UKPDS 16).U.K. prospective diabetes study 16. Overview of 6 years' therapy of type II diabetes: a progressive disease. U.K. Prospective Diabetes Study Group Diabetes 1995;44(11):1249-1258. Giancarlo Viberti, MD, Steven E. Kahn, MB, CHB, Douglas A. Greene, MD, William H. Herman, MD, Bernard Zinman, MD, Rury R. Holman, MD, Steven M. Haffner, MD, Daniel Levy, MD, John M. Lachin, SCD, Rhona A. Berry, BSC, Mark A. Heise, PHD, Nigel P. Jones, MA and Martin I. Freed, MD.A Diabetes Outcome Progression Trial (ADOPT)An international multicenter study of the comparative efficacy of rosiglitazone, glyburide, and metformin in recently diagnosed type 2 diabetes Diabetes Care 2002;25:1737-1743.  Presentation  "What clinical guidelines are available to support the need for aggressive HbA1c, blood pressure, and lipid control?" Dr. Steven V. Edelman (biography) English - 2004-06-04 - 16 minutes (6 slides) Summary : A discussion of the goals of therapy for diabetic patients from the American Diabetes Association (ADA) and the American College of Endocrinology (ACE), Joint National Committee on Prevention, Detection, and Treatment of High Blood Pressure (JNC 7) blood pressure classification and management, and lipid targets in diabetic patients (ADA, NCEP ATP III). Copyright © 2004... Learning objectives : After viewing these slides the participant will be able to discuss: - Targets for diabetes treatment (ADA vs ACE) - JNC7 blood pressure classification and management - The effect of diastolic blood pressure control on cardiovascular mortality in diabetic patients (HOT Trial) - Lipid goals in patients with type 2 diabetes Bibliographic references : ADA. Standards of Medical Care in Diabetes Diabetes Care. 2004;27:S15-S35. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) JAMA. 2001;285:2486-2497. Hansson L, Zanchetti A, Carruthers SG, Dahlof B, Elmfeldt D, Julius S, Menard J, Rahn KH, Wedel H, Westerling S.Effects of intensive blood-pressure lowering and low-dose aspirin in patients with hypertension: principal results of the Hypertension Optimal Treatment (HOT) randomised trial. HOT Study Group. Lancet. 1998 Jun 13;351(9118):1755-62. JNC7 Express. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure JNC 7 Express. 2003 Vincenza Snow, MD; Mark D. Aronson, MD; E. Rodney Hornbake, MD; Christel Mottur-Pilson, PhD; and Kevin B. Weiss, MD, the Clinical Efficacy Assessment Subcommittee of the American College of Physicians. Lipid Control in the Management of Type 2 Diabetes Mellitus: A Clinical Practice Guideline from the American College of Physicians The Lancet. 2004;140:644-649.  Presentation  "Should insulin resistance be considered a therapeutic target to slow or prevent macrovascular complications?" Dr. Steven V. Edelman (biography) English - 2004-06-04 - 12 minutes (7 slides) Summary : Numerous cardiovascular risk factors are associated with insulin resistance, which can be improved with the thiazolidinedione class of drugs. Also, impaired glucose tolerance has been shown to increase CHD mortality risk, therefore the identification of these patients is important. Copyright © 2004 E-MedHosting.com Inc. Learning objectives : After viewing these slides the participant will be able to discuss: - The cardiovascular risk factors associated with insulin resistance - Metabolic effects of oral antidiabetic agents - Atherosclerosis therapy in type 2 diabetes - The relationship between CHD risk factors and glucose tolerance Bibliographic references : Joshua A. Beckman, MD,MS; Mark A. Creager, MD; Peter Libby, MD. Diabetes and Atherosclerosis: Epidemiology, Pathophysiology, and Management JAMA. 2002;287:2570-2581. Eschwege E, Richard JL, Thibult N, Ducimetiere P, Warnet JM, Claude JR, Rosselin GE.Coronary heart disease mortality in relation with diabetes, blood glucose and plasma insulin levels. The Paris Prospective Study, ten years later. Horm Metab Res Suppl. 1985;15:41-6. Samy I. McFarlane, Maryann Banerji and James R. Sowers. Insulin Resistance and Cardiovascular Disease The Journal of Clinical Endocrinology & Metabolism 2001;82(2):713-718.  Presentation  "Good Morning Diabetes: Building a New Framework for Combination Therapy" Dr. James R. Gavin (biography) English - 2004-06-04 - 14 minutes (5 slides) Summary : Dr. Gavin begins the symposium with a call to action. Current treatment practices for type 2 diabetes are suboptimal, and it is important to understand why they are failing, and what improvements can be made. Copyright © 2004 E-MedHosting.com Inc. Learning objectives : After viewing these slides the participant will be able to discuss: - Data from NHANES 1999-2000 on the proportion of diabetics actually reaching the targets for glucose control, blood pressure and total cholesterol. Bibliographic references : Sharon H. Saydah, PhD; Judith Fradkin, MD; Catherine C. Cowie, PhD. Poor Control of Risk Factors for Vascular Disease Among Adults With Previously Diagnosed Diabetes JAMA. 2004;291:335-342.  Presentation  "Could you please comment on recent clinical trials of cardiovascular events in patients with type 2 diabetes?" Dr. Andrew P. Selwyn (biography) English - 2004-06-04 - 16 minutes (9 slides) Summary : Recent studies of prevention of cardiovascular events with lipid-lowering therapy include the PROVE-IT (Pravastatin or Atorvastatin Evaluation and Infection Therapy) trial and the CARDS (Collaborative AtoRvastatin Diabetes Study). The PROVE-IT trial was conducted in over 4000 patients over 30 months of follow up, and showed the superiority of an intensive lipid-lowering therapy... Learning objectives : After viewing these slides the participant will be able to discuss: - The benefit of intensive lipid-lowering therapy in subjects having undergone an acute coronary syndrome (PROVE-IT study) - The benefit of lipid-lowering therapy for the primary prevention of CVD in type 2 diabetic patients having at least one other CVD risk factor (CARDS study). Bibliographic references : Christopher P. Cannon, M.D., Eugene Braunwald, M.D., Carolyn H. McCabe, B.S., Daniel J. Rader, M.D., Jean L. Rouleau, M.D., Rene Belder, M.D., Steven V. Joyal, M.D., Karen A. Hill, B.A., Marc A. Pfeffer, M.D., Ph.D., Allan M. Skene, Ph.D., for the Pravastatin or Atorvastatin Evaluation and Infection Therapy–Thrombolysis in Myocardial Infarction 22 Investigators. Intensive versus Moderate Lipid Lowering with Statins after Acute Coronary Syndromes NEJM.2004;350:1495-1504. H. M. Colhoun, M. J. Thomason, M. I. Mackness*, S. M. Maton, D. J. Betteridge, P. N. Durrington*, G. A. Hitman§, H. A. W. Neil¶, J. H. Fuller andthe CARDS Investigators.Design of the Collaborative AtoRvastatin Diabetes Study (CARDS) in patients with Type 2 diabetesDiabetic Medicine. 2002;19(3):201.  Presentation  "What clinical evidence is available to support multifactorial intervention?" Dr. Andrew P. Selwyn (biography) English - 2004-06-04 - 12 minutes (3 slides) Summary : The Steno-2 was a small study that randomized type 2 diabetic patients with microalbuminuria to either a conventional or intensive treatment regimen. The study aimed to achieve not only glycemic control but also blood pressure and lipid control. It was found that a target-driven intensive treatment approach lowered cardiovascular and microvascular events by about fifty percent. Learning objectives : After viewing these slides the participant will be able to discuss: - The results of the STENO-2 study which looked at the efficacy of a multifactorial treatment intervention in patients with type 2 diabetes and microalbuminuria. Bibliographic references : Peter Gæde, M.D., Pernille Vedel, M.D., Ph.D., Nicolai Larsen, M.D., Ph.D., Gunnar V.H. Jensen, M.D., Ph.D., Hans-Henrik Parving, M.D., D.M.Sc., and Oluf Pedersen, M.D., D.M.Sc. Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes NEJM 2003;348:383-393.  Presentation  "What is the rationale for earlier use of oral antidiabetic combination therapy?" Dr. Steven V. Edelman (biography) English - 2004-06-04 - 19 minutes (9 slides) Summary : Dr. Edelman reviews the mechanism of action of various oral antidiabetic agents and discusses their relative significance in the prevention of type 2 diabetes as shown in clinical trials. Data from DeFronzo et al. published in 1995 showed the superior glucose-lowering efficacy of adding metformin to glyburide compared to using glyburide alone or metformin alone. A more recent study... Learning objectives : After viewing these slides the participant will be able to discuss: - The mechanism of action of different oral antidiabetic agents - Data relating to the benefit of combination therapy versus uptitration or switching of agents in monotherapy Bibliographic references : ADA.Standards of Medical Care for Patients With Diabetes Mellitus Diabetes Care 2002;25:S33-S49. Ralph A. DeFronzo, M.D., Anita M. Goodman, M.D., for The Multicenter Metformin Study Group. Efficacy of Metformin in Patients with Non-Insulin-Dependent Diabetes MellitusNEJM. 1995;333:541-549. Alan J. Garber, Daniel S. Donovan, Jr., Paresh Dandona, Simon Bruce and Jong-Soon Park.Efficacy of Glyburide/Metformin Tablets Compared with Initial Monotherapy in Type 2 Diabetes JCEM 2003;Vol. 88, No. 8 3598-3604. UK Prospective Diabetes Study (UKPDS) Group.Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34) The Lancet 1998;352(9131):854-865.  Presentation  "What is the evidence for combination therapy with a TZD added to metformin or a sulfonylurea?" Dr. Julio Rosenstock (biography) English - 2004-06-04 - 21 minutes (12 slides) Summary : Combination therapy for type 2 diabetes should achieve a durable effect as well as targeting the dual defects of insulin resistance and beta cell dysfunction. The insulin-sensitizing effects of glitazones result in less strain on the pancreatic beta cell. When combined with submaximal doses of metformin or sulfonylurea (SU), combination therapy with TZDs has been shown to provide a... Learning objectives : After viewing these slides the participant will be able to discuss: - The advantages of adding a TZD to metformin or SU monotherapy Bibliographic references : Daniel Einhorn MD, Marc Rendell MD, James Rosenzweig MD, John W. Egand, Annette L. Mathisen PhD, Roberta L. Schneider MD and The Pioglitazone 027 Study Group. Pioglitazone hydrochloride in combination with metformin in the treatment of type 2 diabetes mellitus: A randomized, placebo-controlled study Clinical Therapeutics.2000;22(12):1395-1409.  Presentation  "What are some of the clinical management issues with TZDs in regard to associated weight gain, fluid retention, and CHF?" Dr. Andrew P. Selwyn (biography) English - 2004-06-04 - 14 minutes (10 slides) Summary : Edema is most likely to occur when combining a TZD with insulin. Edema is however not unique to TZDs and the glycaemic and potential cardiovascular benefits of TZDs may outweigh the risk of weight gain and fluid retention. Combination therapy of rosiglitazone added to glipizide showed an increase in the incidence of peripheral edema and modest weight gain. Weight gain is however... Learning objectives : After viewing these slides the participant will be able to discuss: -The incidence of edema and weight gain in patients on TZD monotherapy versus combination therapy -The AHA/ADA Consensus Statement for TZDs -Liver function with the use of newer generation TZDs Bibliographic references : Vivian Fonseca MD.Effect of thiazolidinediones on body weight in patients with diabetes mellitus Am J of Med.2003;115(8)suppl1:42-48. Norman K. Hollenberg MD, PhD.Considerations for management of fluid dynamic issues associated with thiazolidinediones The American Journal of Medicine.2003;115(8)suppl 1:111-115. Harold E. Lebovitz.Differentiating members of the thiazolidinedione class: a focus on safety Diabetes Metab Rev.2003;18(S2):S23 - S29. Richard W. Nesto, MD, David Bell, MD, Robert O. Bonow, MD, Vivian Fonseca, MD, Scott M. Grundy, MD, PHD, Edward S. Horton, MD, Martin Le Winter, MD, Daniel Porte, MD, Clay F. Semenkovich, MD, Sidney Smith, MD, Lawrence H. Young, MD and Richard Kahn, PHD.Thiazolidinedione Use, Fluid Retention, and Congestive Heart Failure Diabetes Care. 2004;27:256-263. Van Gaal LF, De Leeuw IH.Rationale and options for combination therapy in the treatment of Type 2 diabetes. Diabetologia 2003;46 Suppl 1:M44-50.  Presentation  "What is the increasing evidence that supports TZDs and their extraglycemic benefits?" Dr. Julio Rosenstock (biography) English - 2004-06-04 - 10 minutes (3 slides) Summary : Thiazolidinediones have been shown to cause improvements in dyslipidemia, microalbuminuria, blood pressure, vascular smooth muscle cell prolferation/migration in the arterial wall, and Plasminogen Activator Inhibitor-1 (PAI-1) and C-reactive protein (CRP) levels. More information is available about C-Reactive Protein. Learning objectives : After viewing these slides the participant will be able to discuss: - The improvement of cardiovascular risk factors with thiazolidinediones - Inflammation as a link between diabetes and atherosclerosis Bibliographic references : Neelima V. Chu, MD, Alice P. S. Kong, MRCP, Dennis D. Kim, MD, Debra Armstrong, RN, Sunita Baxi, MD, Reena Deutsch, PHD, Michael Caulfield, PHD, Sunder R. Mudaliar, MD, MRCP, Richard Reitz, MD, Robert R. Henry, MD, FRCP and Peter D. Reaven, MD. Differential Effects of Metformin and Troglitazone on Cardiovascular Risk Factors in Patients With Type 2 Diabetes Diabetes Care.2002;25:542-549. Peter Libby, MD; Paul M. Ridker, MD; Attilio Maseri, MD.Inflammation and Atherosclerosis Circulation. 2002;105:1135. Suwattee, Pitiporn M.D.; DeSouza, Cyrus M.D.; Asnani, Sunil M.D.; Gilling, Lucia M.D.; Fonseca, Vivian A. M.D.Cardiovascular Effects of Thiazolidinediones. The Endocrinologist 2002;12(2):126-134.  Presentation  "What clinical data is there regarding inflammatory markers and antidiabetic agents ?" Dr. Steven V. Edelman (biography) English - 2004-06-04 - 12 minutes (7 slides) Summary : Dr. Edelman presents data showing the reduction in inflammatory markers with metformin and thiazolidinediones (TZDs). The Diabetes Prevention Program (DPP) showed the lowering of C-reactive protein (CRP) with metformin. A study by Satoh et al. showed the lowering of CRP with pioglitazone not only in responders but non-responders as well, suggesting an anti-inflammatory effect of... Learning objectives : After viewing these slides the participant will be able to discuss: - The effects of lifestyle intervention and metformin on CRP (DPP Study) - The effect of pioglitazone on plasma CRP levels in responders and non-responders - The reduction of inflammatory markers with early addition of rosiglitazone to 1g metformin Bibliographic references : Neelima V. Chu, MD, Alice P. S. Kong, MRCP, Dennis D. Kim, MD, Debra Armstrong, RN, Sunita Baxi, MD, Reena Deutsch, PHD, Michael Caulfield, PHD, Sunder R. Mudaliar, MD, MRCP, Richard Reitz, MD, Robert R. Henry, MD, FRCP and Peter D. Reaven, MD.Differential Effects of Metformin and Troglitazone on Cardiovascular Risk Factors in Patients With Type 2 Diabetes Diabetes Care.2002; 25:542-549. Dmitri Kirpichnikov, MD; Samy I. McFarlane, MD; and James R. Sowers, MD.Metformin: An Update Ann Int Med.2002;137(1):25-33. Noriko Satoh, MD, PHD, Yoshihiro Ogawa, MD, PHD, Takeshi Usui, MD, PHD, Tetsuya Tagami, MD, PHD, Shigeo Kono, MD, PHD, Hiroko Uesugi, MD, PHD, Hiroyuki Sugiyama, MD, PHD, Akira Sugawara, MD, PHD, Kazunori Yamada, MD, PHD, Akira Shimatsu, MD, PHD, Hideshi Kuzuya, MD, PHD and Kazuwa Nakao, MD, PHD.Antiatherogenic Effect of Pioglitazone in Type 2 Diabetic Patients Irrespective of the Responsiveness to Its Antidiabetic Effect Diabetes Care.2003; 26:2493-2499. PETER N. WEISSMAN, BARRY J. GOLDSTEIN, JOHN C. CAMPBELL, ERROL M. GOULD, BRIAN R. WATERHOUSE, LEANNE J. STROW, ALEXANDER R. COBITZ.Rosiglitazone Plus Metformin Combination Effects on CV Risk Markers Suggest Potential CV Benefits in Type 2 Diabetic Patients ADA 64th Scientific Sessions Abstract 121-OR.  Presentation  "Are there any outcome measures that suggest a favorable vascular effect with TZDs?" Dr. Julio Rosenstock (biography) English - 2004-06-04 - 15 minutes (4 slides) Summary : Numerous outcome studies are ongoing to test the durability of TZD treatment and their effects on cardiovascular risk and diabetes prevention. Dr. Rosenstock provides a recap of these studies stating their main objectives and the medications being tested. Copyright © 2004 E-MedHosting.com Inc. Learning objectives : After viewing these slides the participant will be able to discuss: - Outcome studies with TZDs testing their durability, cardiovascular effects and ability to prevent diabetes: --->ADOPT --->DREAM --->RECORD --->BARI 2D --->PROactive --->PERISCOPE --->CHICAGO  Presentation  "How can we make a difference in clinical practice to improve outcomes?" Dr. Andrew P. Selwyn (biography) English - 2004-06-04 - 11 minutes (3 slides) Summary : Dr. Selwyn points out the rising incidence of cardiovascular disease and diabetes in the last few years, and the problem of lack of compliance observed in patients with known cardiovascular disease who receive no medication for secondary prevention of CVD events. To address this problem a Cardiac Hospital Atherosclerosis Management Program (CHAMP) was carried out and this resulted in a... Learning objectives : After viewing these slides the participant will be able to discuss: - the underutilization of medications for secondary prevention of cardiovascular events - the efficacy of a comprehensive diabetes management program including risk stratification Bibliographic references : Charles M. Clark, Jr., MD, James W. Snyder, MD, Robert L. Meek, MS, Linda M. Stutz, RN, MBA and Christopher G. Parkin, MS.A Systematic Approach to Risk Stratification and Intervention Within a Managed Care Environment Improves Diabetes Outcomes and Patient Satisfaction Diabetes Care 2001;24:1079-1086. Gregg C. Fonarow MD, Anna Gawlinski DNSc, Samira Moughrabi MN and Jan H. Tillisch MD.Improved treatment of coronary heart disease by implementation of a Cardiac Hospitalization Atherosclerosis Management Program (CHAMP) Am J Cardiol 2001;87(7):819-822.  Presentation  "Dr. Rosenstock Summary" Dr. Julio Rosenstock (biography) English - 2004-06-04 - 6 minutes (3 slides) Summary : Dr. Rosenstock highlights the need for early combination therapy to preserve beta cell function and achieve durable glycemic control. The goal should be to maximize the treatment intervention so as to reach glycemic targets without unacceptable side effects and hypoglycemia. Copyright © 2004 E-MedHosting.com Inc.  Presentation  "Dr. Edelman Summary" Dr. Steven V. Edelman (biography) English - 2004-06-04 - 7 minutes (3 slides) Summary : It is important to identify and treat patients early, according to Dr. Edelman. Furthermore it is important to educate and motivate patients to take control of their diabetes. Copyright © 2004 E-MedHosting.com Inc.  Presentation  "Dr. Selwyn Summary" Dr. Andrew P. Selwyn (biography) English - 2004-06-04 - 6 minutes (3 slides) Summary : Dr. Selwyn stresses the importance of health-promoting behaviours. Glycemic control is important in the management of type 2 diabetes, but so is blood pressure and lipid control, as cardiovascular disease is a major cause of mortality in these patients. Copyright © 2004 E-MedHosting.com Inc.  Presentation  "Dr. Gavin Concludes" Dr. James R. Gavin (biography) English - 2004-06-04 - 8 minutes (2 slides) Summary : Diabetes is now understood to be a complex metabolic disease involving the accelerated development of vascular abnormalities and atherosclerosis. The treatment strategy would now maintain aggressive lifestyle interventions for promoting insulin sensitivity, and focus on earlier use of combination therapy in lieu of uptitration in monotherapy. It is now thought that early...  Presentation  "Type 2 Diabetes Mellitus and Heart Failure: Implications for the Use of TZDs" Dr. Richard W. Nesto (biography) English - 2004-04-30 - 51 minutes (42 slides) Summary : In this One on One presentation Dr. Nesto answers the following question posed by CMEonDiabetes editorial board member Dr. Lawrence Leiter: "What is the latest data on the risk/benefit ratio of using thiazolidinediones in patients with heart disease?" Dr. Nesto gives a cardiologist's perspective on heart disease in the setting of diabetes mellitus, the effects of thiazolidinediones... Learning objectives : The participant will learn about the following: - heart disease in diabetes mellitus - use of TZDs in diabetic patients with CHD Bibliographic references : Thomas E. Delea, MBA, John S. Edelsberg, MD, MPH, May Hagiwara, PHD, Gerry Oster, PHD and Lawrence S. Phillips, MD. Use of Thiazolidinediones and Risk of Heart Failure in People With Type 2 Diabetes Diabetes Care 26:2983-2989, 2003. Richard B. Devereux, MD; Mary J. Roman, MD; Mary Paranicas, BA; Michael J. O’Grady, BA; Elisa T. Lee, PhD; Thomas K. Welty, MD, MPH; Richard R. Fabsitz, MA; David Robbins, MD; Everett R. Rhoades, MD; Barbara V. Howard, PhD. Impact of Diabetes on Cardiac Structure and Function Circulation. 2000;101:2271. Nassirah Khandoudi, Philippe Delerive, Isabelle Berrebi-Bertrand, Robin E. Buckingham, Bart Staels, and Antoine Bril. Rosiglitazone, a Peroxisome Proliferator-Activated Receptor-, Inhibits the Jun NH2-Terminal Kinase/Activating Protein 1 Pathway and Protects the Heart From Ischemia/Reperfusion Injury Diabetes 51:1507-1514, 2002. Klas Malmberg, MD, PhD; Salim Yusuf, MBBS, DPhil; Hertzel C. Gerstein, MD, MSc; Joanne Brown, BSc; Feng Zhao, MSc; David Hunt, MD; Leopoldo Piegas, MD; James Calvin, MD; Matyas Keltai, MD; Andrzej Budaj, MD; for the OASIS Registry Investigators. Impact of Diabetes on Long-Term Prognosis in Patients With Unstable Angina and Non–Q-Wave Myocardial Infarction Circulation. 2000;102:1014. Frederick A. Masoudi, MD, MSPH; Yongfei Wang, MS; Silvio E. Inzucchi, MD; John F. Setaro, MD; Edward P. Havranek, MD; JoAnne M. Foody, MD; Harlan M. Krumholz, MD, SM. Metformin and Thiazolidinedione Use in Medicare Patients With Heart Failure JAMA. 2003;290:81-85. Richard W. Nesto, MD; David Bell, MD; Robert O. Bonow, MD; Vivian Fonseca, MD; Scott M. Grundy, MD, PhD; Edward S. Horton, MD; Martin Le Winter, MD; Daniel Porte, MD; Clay F. Semenkovich, MD; Sidney Smith, MD; Lawrence H. Young, MD; Richard Kahn, PhD.Thiazolidinedione Use, Fluid Retention, and Congestive Heart Failure Circulation. 2003;108:2941. Gregory A. Nichols PHD, Teresa A. Hillier, MD, MS, John R. Erbey, PHD and Jonathan B. Brown, PHD, MPP. Congestive Heart Failure in Type 2 Diabetes Diabetes Care 24:1614-1619, 2001 Anna Norhammar, Klas Malmberg, Erik Diderholm, Bo Lagerqvist, Bertil Lindahl, Lars Rydén and Lars Wallentin. Diabetes mellitus: the major risk factor in unstable coronary artery disease even after consideration of the extent of coronary artery disease and benefits of revascularization JACC 2004; 43(4):585-91. Susumu Ogawa, Kazuhisa Takeuchi and Sadayoshi Ito. Plasma BNP Levels in the Treatment of Type 2 Diabetes with Pioglitazone JCEM 2003; 88(8):3993-3996. Martin K. Rutter, MB, ChB; Helen Parise, ScD; Emelia J. Benjamin, MD, ScM; Daniel Levy, MD; Martin G. Larson, ScD; James B. Meigs, MD, MPH; Richard W. Nesto, MD; Peter W.F. Wilson, MD; Ramachandran S. Vasan, MD. Impact of Glucose Intolerance and Insulin Resistance on Cardiac Structure and Function Circulation. 2003;107:448. Tetsuya Shiomi, MD; Hiroyuki Tsutsui, MD; Shunji Hayashidani, MD; Nobuhiro Suematsu, MD; Masaki Ikeuchi, MD; Jing Wen, MD; Minako Ishibashi, MD; Toru Kubota, MD; Kensuke Egashira, MD; Akira Takeshita, MD. Pioglitazone, a Peroxisome Proliferator–Activated Receptor- Agonist, Attenuates Left Ventricular Remodeling and Failure After Experimental Myocardial Infarction Circulation. 2002;106:3126. ROGER H. UNGER, and LELIO ORCI. Diseases of liporegulation: new perspective on obesity and related disorders The FASEB Journal. 2001;15:312-321. NICOLE S. WAYMAN, YOSHIYUKI HATTORI, MICHELLE C. MCDONALD, HELDER MOTA-FILIPE, SALVATORE CUZZOCREA, BARBARA PISANO, PRABAL K. CHATTERJEE and CHRISTOPH THIEMERMANN. Ligands of the peroxisome proliferator-activated receptors (PPAR-gamma and PPAR-alpha) reduce myocardial infarct size The FASEB Journal. 2002;16:1027-1040. Tian-li Yue, PhD; Jun Chen, MS; Weike Bao, MD; Padma K. Narayanan, PhD; Antoine Bril, PhD; Wen Jiang, MD; Paul G. Lysko, PhD; Juan-Li Gu, MD; Rogely Boyce, PhD; Dawn M. Zimmerman, MS; Timothy K. Hart, PhD; Robin E. Buckingham, PhD; Eliot H. Ohlstein, PhD. In Vivo Myocardial Protection From Ischemia/Reperfusion Injury by the Peroxisome Proliferator–Activated Receptor- Agonist Rosiglitazone Circulation. 2001;104:2588.  Presentation  "2003 CDA Clinical Practice Guidelines for the prevention and management of diabetes mellitus, what is new?" Dr. Amir Hanna (biography) English - 2004-02-14 - 71 minutes (59 slides) (13 questions) Summary : In this presentation Dr Hanna talks about new features apparent in the Canadian Diabetes Association Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada, which were published in December 2003. Screening for type 2 diabetes must now be done every 3 years starting at age 40, and sooner and more frequently in the presence of risk factors, which in the... Learning objectives : The participant will review new features of the 2003 CDA Guidelines, in the following aspects: - Screening for diabetes - Prevention of diabetes - New targets for control of glucose, BP, lipids - Vascular and renal protection Bibliographic references : 1. Harris MI. ''Impaired glucose tolerance--prevalence and conversion to NIDDM.'' Diabet Med. 1996;13(3 Suppl 2):S9-11. 2. Saydah SH, Loria CM, Eberhardt MS, Brancati FL. ''Subclinical states of glucose intolerance and risk of death in the U.S.'' Diabetes Care. 2001 Mar;24(3):447-53. 3. DECODE Study Group, the European Diabetes Epidemiology Group. ”Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria.” Arch Intern Med. 2001 Feb 12;161(3):397-405. 4. Torgerson JS, Hauptman J, Boldrin MN, Sjostrom L. ''XENical in the prevention of diabetes in obese subjects (XENDOS) study: a randomized study of orlistat as an adjunct to lifestyle changes for the prevention of type 2 diabetes in obese patients.'' Diabetes Care. 2004 Jan;27(1):155-61. 5. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. ''Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.'' N Engl J Med. 2003 Jan 30;348(5):383-93.  Presentation  "Hypoglycemic Disorders: Investigation and Treatment" Dr. Amir Hanna (biography) English - 2003-10-31 - 20 minutes (26 slides) Summary : Fasting hypoglycemia can have a variety of underlying causes and so once the hypoglycemia has been clinically confirmed, the next step is to use the process of elimination to rule out different causes one by one, starting with the most obvious, for example drugs or critical illness. In some cases, endogenous hyperinsulinemia is indicated based on plasma glucose response to... Learning objectives : The participant will learn how to detect the underlying cause of fasting hypoglycemia and how to detect and treat endogenous hyperinsulinemia. Summary: Hypoglycemia is a symptom Look for an underlying cause Fulfill Whipple's triad (atypical symptoms) Rule out: - Drugs - Critical illness - Hormonal deficiency - Non-beta cell tumor 72-hour fast: to clarify different causes of hyperinsulinemia Localize insulinoma when suspected Surgery: treatment of choice for insulinoma De-bulking surgery in malignant insulinoma Medical treatment: - Preparation for surgery - Failed surgery - Malignant insulinoma Bibliographic references : 1. O'Brien T, O'Brien PC, Service FJ. “Insulin surrogates in insulinoma.” J Clin Endocrinol Metab. 1993 Aug;77(2):448-51. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8345050&dopt=Abstract  Presentation  "Treating Dyslipidemia in Diabetes" Dr. Jeannette Goguen (biography) English - 2003-10-31 - 50 minutes (44 slides) Summary : This presentation will review the new CDA 2003 lipid guidelines, their scientific basis, and the use of combination therapy to achieve target lipid levels. As it is not always possible for the diabetic patient to achieve target or optimal levels of triglycerides, HDL and LDL on hypolipidemic monotherapy, various studies have been looking at the safety and efficacy of different... Learning objectives : After viewing this presentation the participant will be familiar with: - The 2003 CDA lipid guidelines - The evidence that the guidelines are based upon - How to safely achieve lipid targets Bibliographic references : 1. Brown BG, Zhao XQ, Chait A, Fisher LD, Cheung MC, Morse JS, Dowdy AA, Marino EK, Bolson EL, Alaupovic P, Frohlich J, Albers JJ. “Simvastatin and niacin, antioxidant vitamins, or the combination for the prevention of coronary disease.” N Engl J Med. 2001 Nov 29;345(22):1583-92. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11757504&dopt=Abstract 2. Alan Marcus, M.D. “Current Lipid-lowering Strategies for the Treatment of Diabetic Dyslipidemia: An Integrated Approach to Therapy.” The Endocrinologist 2001;11:368-383. http://ipsapp006.lwwonline.com/content/getfile/3320/2/5/abstract.htm 3. Athyros VG, Papageorgiou AA, Athyrou VV, Demitriadis DS, Kontopoulos AG. “Atorvastatin and micronized fenofibrate alone and in combination in type 2 diabetes with combined hyperlipidemia.” Diabetes Care. 2002 Jul;25(7):1198-202. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12087019&dopt=Abstract  Presentation  "Novel Dietary Therapies in the Treatment of Diabetes and Cardiovascular Disease" Dana Whitham (biography) English - 2003-10-31 - 22 minutes (40 slides) Summary : Nutritional therapy for the type 2 diabetic patient is important, and should be chosen with the aim of reducing not only obesity but CVD risk. Many popular diets have emerged in recent years, including the low carbohydrate Atkin's diet, but how good are they for the diabetic patient? A review of low carb diets by Bravata et al found that weight lost while on these diets was... Learning objectives : The participant will review evidence on various diets, to determine which kind is appropriate for type 2 diabetics: - Calories in versus calories out is the biggest determinant of weight - Low fat diet results in the best metabolic parameters - All dieters need support Bibliographic references : 1. Bravata DM, Sanders L, Huang J, Krumholz HM, Olkin I, Gardner CD, Bravata DM. “Efficacy and safety of low-carbohydrate diets: a systematic review.”JAMA. 2003 Apr 9;289(14):1837-50. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12684364&dopt=Abstract 2. Samaha FF, Iqbal N, Seshadri P, Chicano KL, Daily DA, McGrory J, Williams T, Williams M, Gracely EJ, Stern L. “A low-carbohydrate as compared with a low-fat diet in severe obesity.” N Engl J Med. 2003 May 22;348(21):2074-81. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12761364&dopt=Abstract 3. Foster GD, Wyatt HR, Hill JO, McGuckin BG, Brill C, Mohammed BS, Szapary PO, Rader DJ, Edman JS, Klein S. "A randomized trial of a low-carbohydrate diet for obesity." N Engl J Med. 2003 May 22;348(21):2082-90. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12761365&dopt=Abstract  Presentation  "Targets for Glucose Control: A Review of Recent Evidence" Dr. Gillian Booth (biography) English - 2003-10-31 - 29 minutes (44 slides) Summary : The UKPDS and DCCT studies showed the need for good glycemic control in terms of HbA1c, to reduce the risk of microvascular complications (1, 2). However some studies have also looked at the relationship between fasting blood glucose and post prandial glycemia, and the risk of complications. For example, the Kumamoto study looked at FBG (3) and 2-hour postprandial glycemia (4) and risk of... Learning objectives : The participant will learn about: - Evidence relating FBG, HbA1c, and postprandial glycemia to complications of DM - Targets for glycemic control recommended in the 2003 CDA Guidelines - Recent studies of Intensive therapy – STENO-2 - Upcoming studies of Intensive therapy – ACCORD Bibliographic references : 1. Stratton IM, Kohner EM, Aldington SJ, Turner RC, Holman RR, Manley SE, Matthews DR. “UKPDS 50: risk factors for incidence and progression of retinopathy in Type II diabetes over 6 years from diagnosis”. Diabetologia. 2001 Feb;44(2):156-63. 2. The Diabetes Control and Complications Trial Research Group: “The relationship of glycemic exposure (HbA1c) to the risk of development and progression of retinopathy in the Diabetes Control and Complications Trial. (1995).” Diabetes, 44, 968-983. 3. Ohkubo Y, Kishikawa H, Araki E, Miyata T, Isami S, Motoyoshi S, Kojima Y, Furuyoshi N, Shichiri M. “Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study.” Diabetes Res Clin Pract. 1995 May;28(2):103-17. 4.Shichiri M, Kishikawa H, Ohkubo Y, Wake N. Long-term results of the Kumamoto Study on optimal diabetes control in type 2 diabetic patients. Diabetes Care. 2000 Apr;23 Suppl 2:B21-9. 5. Coutinho M, Gerstein HC, Wang Y, Yusuf S.“The relationship between glucose and incident cardiovascular events. A metaregression analysis of published data from 20 studies of 95,783 individuals followed for 12.4 years.” Diabetes Care. 1999 Feb;22(2):233-40. 6.Louis Monnier, MD, Hélène Lapinski, MD and Claude Colette, PHD. “Contributions of Fasting and Postprandial Plasma Glucose Increments to the Overall Diurnal Hyperglycemia of Type 2 Diabetic Patients.” Diabetes Care 26:881-885, 2003.  Presentation  "Perioperative Glycemic Control" Dr. Alice Cheng (biography) English - 2003-10-31 - 6 minutes (30 slides) Summary : This presentation will discuss the 2003 CDA Guidelines for perioperative glycemic control, with a review of studies on hyperglycemia and surgical outcomes and supporting evidence for blood glucose targets in perioperative glycemic control. The need for optimal perioperative glycemic control is becoming evident with information from studies looking at perioperative glycemia in... Learning objectives : The participant will be able to: - Describe the short- and long-term effects of hyperglycemia on surgical outcomes - Outline the evidence for perioperative glycemic control and appropriate targets - Discuss the 2003 CDA Clinical Practice Guidelines recommendations for perioperative glycemic control Bibliographic references : 1. McAlister FA, Man J, Bistritz L, Amad H, Tandon P. “Diabetes and Coronary Artery Bypass Surgery: An examination of perioperative glycemic control and outcomes.” Diabetes Care. 2003 May;26(5):1518-24. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12716815&dopt=Abstract 2. Furnary AP, Zerr KJ, Grunkemeier GL, Starr A. “Continuous intravenous insulin infusion reduces the incidence of deep sternal wound infection in diabetic patients after cardiac surgical procedures.” Ann Thorac Surg. 1999 Feb;67(2):352-60; discussion 360-2. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10197653&dopt=Abstract 3. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, Vlasselaers D, Ferdinande P, Lauwers P, Bouillon R.Intensive insulin therapy in the critically ill patients.N Engl J Med. 2001 Nov 8;345(19):1359-67. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11794168&dopt=Abstract  Presentation  "The Value of Combination Therapy in Type 2 Diabetes" Prof. Bernard Zinman (biography) English - 2003-10-18 - 31 minutes (28 slides) (4 questions) Summary : The pathophysiology of type 2 diabetes is complex. In addition to insulin resistance and beta cell dysfunction, there is increased hepatic glucose production, and also adipocytokines that affect beta cell function and insulin action. It therefore makes sense to target more than one aspect of pathophysiology in the management of type 2 diabetes. The UKPDS showed the inability of... Learning objectives : The participant will learn about the rationale behind using combination therapy early in type 2 diabetes treatment, and about the characteristics of Avandamet, a combination of rosiglitazone and metformin: -Targets pathophysiology at two complimentary pathways: improved insulin sensitivity and reduced hepatic glucose output -Robust effect on lowering HbA1c -Low incidence of hypoglycemia -Less weight gain -Well tolerated -Potential added value on beta cell function and cardiovascular risk Bibliographic references : 1. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) ". UK Prospective Diabetes Study (UKPDS) Group." Lancet. 1998; 352(9131):837-53. 2. Buchanan TA, Xiang AH, Peters RK, Kjos SL, Marroquin A, Goico J, Ochoa C, Tan S, Berkowitz K, Hodis HN, Azen SP. Preservation of pancreatic beta-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk hispanic women. "" Diabetes. 2002 Sep;51(9):2796-803.  Presentation  "Sustaining Long-Term Glycemic Control: Are we ready for change?" Dr. Stuart A Ross (biography) English - 2003-10-17 - 34 minutes (30 slides) Summary : The challenge to effectively manage type 2 diabetes has perhaps never been so critical. We are now aware of the increasing number of people who will develop diabetes over the coming years. There is also the recognition that diabetes is a complex disorder with major disturbances in glucose control and blood pressure and lipid abnormalities leading to not only the microvascular complications of... Learning objectives : The participant will review how traditional type 2 diabetes therapy has failed, and learn about promising new concepts in therapy. Bibliographic references : Festa A, D'Agostino R Jr, Howard G, Mykkanen L, Tracy RP, Haffner SM. “Chronic subclinical inflammation as part of the insulin resistance syndrome: the Insulin Resistance Atherosclerosis Study (IRAS).” Circulation. 2000 Jul 4;102(1):42-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi Reaven GM. “Role of insulin resistance in human disease (syndrome X): an expanded definition.” Annu Rev Med. 1993;44:121-31. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi  Presentation  "Thiazolidinediones to Preserve B-Cell Function and Prevent Type 2 Diabetes" Prof. Thomas A. Buchanan (biography) English - 2003-08-28 - 39 minutes (32 slides) (1 question) Summary : Recorded during the 18th IDF Meeting, Paris: Type 2 diabetes is not just a disease of hyperglycemia but indeed one of progressive beta cell failure. This beta cell failure begins long before the diagnosis of diabetes, and this presentation will deal with how to intervene in such a way to preserve beta cell function and preclude the development of diabetes. Fat accumulation in the... Learning objectives : The participant will review the results of the TRIPOD (Troglitazone in the Prevention of Diabetes) Study and learn about first year’s results of the PIPOD (Pioglitazone in the Prevention of Diabetes) Study being conducted with women who finished from TRIPOD: TRIPOD Summary: •Troglitazone reduced the incidence of diabetes by 55% in high-risk Hispanic women. •Protection from diabetes: orequired an increase in insulin sensitivity owas greatest in women who had the largest reduction in insulin requirements (“ß-cell rest”) •Women who were protected during the trial: oremained protected 8 months later ohad stable ß-cell function over a 54-month period PIPOD Year 1 Summary: •The low incidence of diabetes and the beta cell rest observed at 1 year in women who entered PIPOD without diabetes suggests a protective effect similar to TRIPOD •Treatment of insulin resistance with TZDs may have different effects at different stages in the evolution of diabetes: oEarly intervention in patients without diabetes resulted in lowered insulin levels with a minimal effect on glucose oLater intervention resulted in lowered glucose and insulin concentrations This suggests a loss of beta cell autoregulation with disease progression. Bibliographic references : Bergman RN, Phillips LS, Cobelli C. Physiologic evaluation of factors controlling glucose tolerance in man: measurement of insulin sensitivity and beta-cell glucose sensitivity from the response to intravenous glucose. J Clin Invest. 1981 Dec;68(6):1456-67. Weyer C, Bogardus C, Mott DM, Pratley RE. The natural history of insulin secretory dysfunction and insulin resistance in the pathogenesis of type 2 diabetes mellitus. J Clin Invest. 1999 Sep;104(6):787-94. Homko C, Sivan E, Chen X, Reece EA, Boden G. Insulin secretion during and after pregnancy in patients with gestational diabetes mellitus. J Clin Endocrinol Metab. 2001 Feb;86(2):568-73. Buchanan TA, Xiang AH, Peters RK, Kjos SL, Marroquin A, Goico J, Ochoa C, Tan S, Berkowitz K, Hodis HN, Azen SP. Preservation of pancreatic beta-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk hispanic women. Diabetes. 2002 Sep;51(9):2796-803.  Presentation  "Shifting the paradigm: from stepwise to early combination therapy?" Prof. Rury Holman (biography) English - 2003-08-26 - 27 minutes (24 slides) Summary : The number of people worldwide with diabetes is predicted to exceed 300 million by the year 2025, more than all of the people living currently in North America. Despite major efforts to improve the management of diabetes, it remains in the 21st century the leading cause of blindness, end stage renal disease and lower extremity amputations in industrialized nations. The U.K. Prospective Diabetes... Learning objectives : The participant will review evidence supporting the need for early combination therapy: Treating progressive hyperglycemia: - Existing hypoglycaemic therapies can be given in combination at a much earlier stage, whenever therapeutic targets are not met - Combination therapy is required to address the multiple risk factors in T2DM - Thiazolidinediones offer additional therapeutic possibilities Summary: - Early combination therapy is essential if glycaemic targets are to be achieved and maintained in T2DM - Therapies with different modes of action can be combined to address: o Both fasting and postprandial hyperglycemia o Insulin resistance and loss of B-cell function - Outcome trials are evaluating potential benefits of new therapeutic options and combinations Bibliographic references : Sulfonylurea inadequacy: efficacy of addition of insulin over 6 years in patients with type 2 diabetes in the U.K. Prospective Diabetes Study (UKPDS 57). Wright A, Burden AC, Paisey RB, Cull CA, Holman RR; U.K. Prospective Diabetes Study Group. Diabetes Care. 2002 Feb;25(2):330-6. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi The UKPDS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56). Stevens RJ, Kothari V, Adler AI, Stratton IM; United Kingdom Prospective Diabetes Study (UKPDS) Group. Clin Sci (Lond). 2001 Dec;101(6):671-9. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi A randomized double-blind trial of acarbose in type 2 diabetes shows improved glycemic control over 3 years (U.K. Prospective Diabetes Study 44). Holman RR, Cull CA, Turner RC. Diabetes Care. 1999 Jun;22(6):960-4. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi  Presentation  "The case for rosiglitazone therapy : putting theory into practice" Dr. Kathleen Wyne (biography) English - 2003-08-26 - 30 minutes (32 slides) (5 questions) Summary : Historically, the aim of physicians treating type 2 diabetes has been to reduce hyperglycaemia through diet and exercise supplemented with oral anti-diabetic agents and/or insulin. Even with intensive use of these therapies, however, many of our patients fail to reduce HbA1c to the ADA target level of < 7%, and we are seeing increasing numbers of individuals with cardiovascular disease (CVD).... Learning objectives : The participant will review data supporting the use of rosiglitazone. Conclusions: - A1c target is now below 6.5% - Most patients will require combination therapy to attain this target A1c - Combination therapy needs to be oriented toward the disease process - It’s not just about sugar which is the end result of the process Bibliographic references : Wyne KL, Drexler AJ, Miller JL, Bell DS, Braunstein S, Nuckolls JG. Constructing an algorithm for managing type 2 diabetes. Focus on role of the thiazolidinediones. Postgrad Med. 2003 May;Spec No:63-72. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi  Presentation  "What are the optimal combination strategies in order to achieve glycaemic control?" Dr. Lawrence A. Leiter (biography) English - 2003-08-26 - 27 minutes (39 slides) (4 questions) Summary : Current guidelines for the management of type 2 diabetes emphasize the importance of optimal glycaemia in an attempt to reduce the risk of complications. Given the inadequacy of conventional monotherapies in maintaining blood glucose targets in the long term, new approaches to treating type 2 diabetes are required. In particular, earlier introduction of combination therapy is being increasingly... Learning objectives : The participant will review new evidence about optimal combination strategies for achieving optimal glucose control. Conclusions: - Despite increasingly aggressive glycaemic targets, many persons with DM are still are still not achieving target. - Although the cause of this is multifactorial, rigid adherence to a stepwise approach has led to significant delays in reaching targets. - Combination therapy has been shown to improve glycaemic control and increase the proportion of patients achieving goals. - Outcome studies with combination therapy are underway. Bibliographic references : Kipnes MS, Krosnick A, Rendell MS, Egan JW, Mathisen AL, Schneider RL. Pioglitazone hydrochloride in combination with sulfonylurea therapy improves glycemic control in patients with type 2 diabetes mellitus: a randomized, placebo-controlled study. Am J Med. 2001 Jul;111(1):10-7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi Fonseca V, Rosenstock J, Patwardhan R, Salzman A. Effect of metformin and rosiglitazone combination therapy in patients with type 2 diabetes mellitus: a randomized controlled trial. JAMA. 2000 Apr 5;283(13):1695-702. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi  Presentation  "Early combination therapy in type 2 diabetes: targeting insulin resistance and beta-cell dysfunction" Prof. John Nolan (biography) English - 2003-08-26 - 25 minutes (25 slides) Summary : Type 2 diabetes is a complex metabolic disease with major cardiovascular complications. The rapid increase in the prevalence of obesity and type 2 diabetes, with their complications, is a global health problem in terms of health expenditure and human cost. 'Diabesity' is increasingly used to describe the syndrome of diabetes and its associated complications that typically present as the... Learning objectives : The participant will review the pathophysiology and evolution of type 2 diabetes and learn about treating the patient at different stages of the disease. Bibliographic references : Bergman RN, Phillips LS, Cobelli C. "Physiologic evaluation of factors controlling glucose tolerance in man: measurement of insulin sensitivity and beta-cell glucose sensitivity from the response to intravenous glucose." J Clin Invest. 1981 Dec;68(6):1456-67. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7033284&dopt=Abstract Bonadonna RC, De Fronzo RA. "Glucose metabolism in obesity and type 2 diabetes." Diab Metab. 1991 May;17(1 Pt 2):112-35. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=1936466&dopt=Abstract Buchanan TA, Xiang AH, Peters RK, Kjos SL, Marroquin A, Goico J, Ochoa C, Tan S, Berkowitz K, Hodis HN, Azen SP. "Preservation of pancreatic beta-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk hispanic women." Diabetes. 2002 Sep;51(9):2796-803. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12196473&dopt=Abstract  Presentation  "Scientific Update: Rosiglitazone in Perspective" Dr. Robin Buckingham (biography) English - 2003-07-02 - 64 minutes (55 slides) (20 slides) (8 questions) Summary : We now understand the major pathophysiological defects of type 2 diabetes to be insulin resistance and beta cell failure. Epidemiological data suggest that inflammatory factors predict the future development of type 2 diabetes. What is the link between these inflammatory factors and the underlying pathophysiology of the disease? One hypothesis is that insulin resistance and... Learning objectives : The participant will review data supporting the properties of thiazolidinediones as being consistent with those of agents most likely to reduce the rate of beta cell apoptosis, and thereby, the rate of deterioration of glycaemic control: - Epidemiological data suggest that the pre-diabetic insulin resistant state, and Type 2 diabetes itself, are characterized by chronic, low-grade systemic inflammation. - Insulin resistance and compensatory hyperinsulinemia, in tandem with chronic systemic inflammation, might explain the elevated rate of beta cell apoptosis in Type 2 Diabetes. - To test this hypothesis, reducing insulin resistance and plasma insulin, together with reducing systemic inflammation, should reduce the rate of beta cell apoptosis and the rate of deterioration of glycaemic control. - The ADOPT and DREAM studies are 2 long-term studies currently underway to test this hypothesis using rosiglitazone, an insulin-sensitizing, insulin-sparing AND anti-inflammatory drug: o It reduced serum CRP levels in type 2 diabetic patients (Haffner et al, Circulation 106: 679-684, 2002). o It reduced serum CD40 ligand (CD40L) concentrations (Marx et al, Circulation 107: 1954-57, 2003). CD40 and CD40L are surface proteins found on activated platelets (Ruggeri, Nature Medicine 8: 1227-34, 2002). They are also found in the activation cascade between T-lymphocytes and macrophages (Libby, Nature 420: 868-874, 2002). o It inhibited IFN-?-induced expression of chemokines IP-10, Mig and I-TAC (Marx et al. J Immunology 164: 6503-08, 2000), which are involved in the recruitment of T-lymphocytes to the area of inflammation on the vascular wall (Libby, Nature 420: 868-874, 2002). o It limited the expression of proinflammatory cytokines such as IFN-?, in activated human T-lymphocytes (Marx et al. Circ Res 90: 703-710, 2002). - The ability of troglitazone to prevent diabetes was seen in the recent DPP data presented at the 63rd ADA Meeting, although the average duration of treatment was only 9 months (Diabetes 52 (Suppl 1): A58, 251-OR, 2003). - The TRIPOD Study, however, showed over a 4 year follow up period a significant reduction in incidence of diabetes in women who had had gestational diabetes (Buchanan et al Diabetes 51: 2796 – 2803, 2002). The protective action of troglitazone was associated was persistent at 8 months after the medication was stopped, suggesting some kind of re-programming of the destructive mechanism on beta cells. - We now have the first evidence that rosiglitazone is vascular-protective, as it has been shown to reduce restinosis after coronary stenting in Type 2 diabetics (Choi et al. Diabetes 52 (suppl 1): A19, 82-OR, 2003). - Data coming out of the 2-year RESULT Study (Rosiglitazone Early vs SULfonylurea Titration) show that the combination of rosiglitazone with glipizide provides better glycaemic control than escalating the dose of glipizide alone. Bibliographic references : Sample Publications (of >50) Buckingham RE, Al-Barazanji KA, Toseland CDN, Slaughter M, Connor SC, West A, Bond B, Turner NC, Clapham JC. The PPARg agonist, rosiglitazone, protects against nephropathy and pancreatic islet abnormalities in Zucker fatty rats. Diabetes 47: 1326-1334, 1998. Walker AB, Chatington PD, Buckingham RE, Williams G. The thiazolidinedione rosiglitazone (BRL 49653) lowers blood pressure and protects against impairment of endothelial function in Zucker fatty rats. Diabetes 48: 1448-1453, 1999. Smith SA, Lister CA, Toseland CDN, Buckingham RE. Rosiglitazone prevents the onset of hyperglycemia and proteinuria in the Zucker Diabetic Fatty (ZDF) rat. Diabetes, Obesity & Metabolism 2: 363-372, 2000. Yue Y-I, Chen J, Bao W, Narayanan PK, Bril A, Jiang W, Lysko PG, Gu J-L, Boyce R, Zimmerman DM, Hart TK, Buckingham RE, Ohlstein EH. In vivo myocardial protection from ischemia/reperfusion injury by the peroxisome proliferator-activated receptor-g agonist rosiglitazone. Circulation 104: 2588-2594, 2001. Carpentier A, Taghibiglou C, Leung N, Szeto L, Van Iderstine S, Uffelman K, Buckingham R, Adeli K, Lewis GF. Ameliorated hepatic insulin resistance is associated with normalization of microsomal triglyceride transfer protein (MTP) expression and reduction in very low density lipoprotein assembly and secretion in the fructose-fed hamster. J Biol Chem 277: 28795-28802, 2002. Scheuermann-Freestone M, Madsen PL, Manners D, Blamire AM, Buckingham RE, Styles P, Radda GK, Neubauer S, Clarke K. Abnormal cardiac and skeletal muscle energy metabolism in patients with Type 2 diabetes. Circulation (in press).  Presentation  "Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes - 'Steno 2'" Dr. Oluf Pedersen (biography) English - 2003-06-16 - 49 minutes (47 slides) Summary : The Steno-2 Study was designed in 1990, when there was no evidence base for the treatment of type 2 diabetes, and studies such as the UKPDS were ongoing. Steno-2 was an attempt to validate the efficacy of daily clinical practice, i.e., the multifactorial treatment of type 2 diabetes, in high-risk type 2 diabetes patients. The aim of the study was to investigate the impact on microvascular and... Learning objectives : The participant will learn about the objectives and findings of the Steno-2 Study, which took place in Denmark in the 1990s: - The aim of the study was to investigate the impact on microvascular and cardiovascular disorders, of a target driven behaviour modification and polypharmacy as compared to a conventional multifactorial treatment of high-risk type 2 diabetic patients with the metabolic syndrome including microalbuminuria. - After 7.8 years duration the study showed an absolute risk reduction of 20% for CVD, and the relative risk reductions for microvascular events were as follows: nephropathy 61%, retinopathy 58% and autonomic neuropathy 63%. Bibliographic references : Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003 Jan 30;348(5):383-93. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi  Presentation  "Looking at New Evidence: Immediate Solutions to a Long-Term Problem" Dr. Steven V. Edelman (biography) English - 2003-06-16 - 37 minutes (44 slides) Summary : Dr Edelman presents here new data supporting the rationale for treating insulin resistance and preserving beta cell function early in treatment. The RESULT (Rosiglitazone Early vs Sulfonylurea Titration) study was the first 2-year, randomized, double blind, parallel-group study comparing titration to maximum dose of SU versus half the maximum dose of SU plus rosiglitazone. This study showed that... Learning objectives : The participant will review data from two new studies: RESULT (Rosiglitazone Early vs Sulfonylurea Titration) and Rosiglitazone Added Early to 1 g Metformin: - Early addition of rosiglitazone to half the maximum dose of SU is more effective than maximizing monotherapy with SU alone. - Adding rosiglitazone to low dose metformin is more effective and more tolerable than high dose metformin alone. - New data strengthens the rationale for targeting insulin resistance and preserving beta cell function early in treatment. - Early diagnosis and treatment with drugs that improve insulin resistance may alter the natural history of type 2 diabetes. Bibliographic references : Ramlo-Halsted BA, Edelman SV. The natural history of type 2 diabetes. Implications for clinical practice. Prim Care. 1999 Dec;26(4):771-89. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi  Presentation  "Type 2 diabetes-Early : Aggressive Treatment Strategies" Dr. Amir Hanna (biography) English - 2002-11-23 - 27 minutes (46 slides) Summary : Studies in Type 1 and 2 diabetes clearly show that using intensive regimens in the management of hyperglycemia results in significant reduction in microvascular disease and a trend towards amelioration of macrovascular disease (1-4). Early aggressive glycemic control in Type 1 diabetes resulted in long-term protection against microvascular disease (5). Treatment paradigms in type 2... Learning objectives : The participant will learn about the rationale for early combination therapy and the use of different agents in mono- or combination therapy: - Decreasing HbAIc to 7% reduces microvascular complications - This target is not achieved in the majority of patients - Initial combination therapy decreases glucose more than mono-therapy and has less side effects - Complication prevention for type 2 diabetes should start promptly after diagnosis - Agents used in combination therapy should be tailored to the individual patient - The stepwise approach should be left behind in favour of early/initial combination therapy targeting HbA1c < 7% - Choice of agents should take into account results of clinical studies, rate of secondary failure and non glycemic effects Bibliographic references : 1. The Diabetes Control and Complications Trial Research Group. The effect of intensive therapy of diabetes on the developpment and progression of long-term complications in insulin-dependent diabtes mellitus. N Engl J Med 1993: 329:977-986 2. Ohkubo Y, Kishikawa H, Araki E et al. Intensive Insulin Therapy prevents the progression of diabetic microvascular complications in Japanese patients with Non-insulin dependent Diabetes Mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract 1995; 28:103-117 3. UKPDS Group. Intensive Blood Glucose control with sulponylurea or insulin compared with conventional treatment and risk of complications in patients with Type 2 diabetes (UKPDS 33). Lancet 1998; 352:837-853. 4. Effect of Intesive blood-glucose control with metformin on complications in overweight patients with Type 2 diabetes (UKPDS 34) Lancet 1998; 352 (9131): 854-865 5. Retinopathy and Nephropathy in patients with Type1 Diabetes Four Years after a Trial of Intensive Therapy. The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions And Complications Research Group. N Engl J Med 2000; 3452:381-389 6. Meltzer S, Leiter L, Daneman D et al. 1998 Clinical Practice Guidelines for the Management And Complications Research Group. N Engl J Med 2000; 3452:381-389. 7. Nathan DM. N Engl J Med 2002; 347:1342. 8. Riddle M. American J Med 2000; 106 (6A): 165-22S. 9. UKPDS JAMA 1999; 281:2005. 10. Fonseca V et al. JAMA 2000; 283:1695-1702. 11. Garber AJ, Larsen J, Schneider SH, et al. Diabetes Obes Metab 2002; 4(3) 201-8.  Presentation  "Canadian Diabetes Association Guidelines - Update" Dr. Stewart Harris (biography) English - 2002-11-16 - 41 minutes (23 slides) (45 slides) Summary : In the late 2003, the CDA Expert Committee of the Canadian Diabetes Association will be publishing a revised set of evidence-based Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Many of the proposed changes reflect new evidence published since the 1998 set of guidelines were presented in a public forum recently at the CDA conference in Vancouver. This... Learning objectives : To present and discuss some of the main changes to the Clinical Practice Guidelines of the CDA which are due to take effect in late 2003. The proposed changes include early and aggressive monitoring and treatment of dysglycemia and hypertension, new glycemic targets and management, and simplified screening for nephropathy. Bibliographic references : The role of patient, physician and systemic factors in the management of type 2 diabetes mellitus. Brown JB, Harris SB, Webster-Bogaert S, Wetmore S, Faulds C, Stewart M. Centre for Studies in Family Medicine, Department of Family Medicine, The University of Western Ontario, 100 Collip Circle, London, Ontario N6G 4X8, Canada. jbbrown@uwo.ca BACKGROUND: Few studies have explored the contextual dimensions and subsequent interactions that contribute to a lack of adherence in the application of guidelines for diabetes management. OBJECTIVE: The purpose of this qualitative study was to explore family physicians' issues and perceptions regarding the barriers to and facilitators of the management of patients with type 2 diabetes mellitus (DM). METHODS: Four focus groups composed of family physicians (n= 30) explored the participants' experiences in the management of patients with type 2 DM. A semi-structured interview guide began with questions on family physicians' experience of providing care and included specific probes to stimulate discussion about the various barriers to and facilitators of the management of type 2 DM in family practice. RESULTS: Participants clearly identified type 2 DM as a chronic disease most often managed by family physicians. The findings revealed distinct barriers and facilitators in managing patients with type 2 DM which fell into three domains: patient factors; physician factors; and systemic factors. There was a dynamic interplay among the three factors. The important role of education was common to each. CONCLUSIONS: The interactions of patient, physician and systemic factors have implications for the implementation of a diabetes management model. The care of patients with type 2 DM exemplifies the ongoing challenges of caring for patients with a chronic disease in family practice. The findings, while specific to the management of type 2 DM, have potential transferability to other chronic illnesses managed by family physicians. Fam Pract 2002 Aug;19(4):344-9  Presentation  "Targeting Glycemia in Type 2 Diabetes" Prof. Bernard Zinman (biography) English - 2002-11-16 - 27 minutes (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 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  Presentation  "Sustaining Long-Term Glycemic Control" Dr. Stuart A Ross (biography) English - 2002-10-05 - 39 minutes (32 slides) Summary : A lot about diabetes care has changed in recent years. We now have multiple drug therapies, and specific targets and goals to reach as outlined by the CDA. In spite of this, target glucose levels are difficult to achieve. The UKPDS and other studies have shown a deterioration of glucose control after monotherapy with agents such as the sulfonylureas and metformin. Further research has indicated... Learning objectives : The participant will learn about the drawbacks of traditional treatments for Type 2 Diabetes, as revealed by studies such as UKPDS. Introduction to different combination therapies and their long-term success rates; and some insights into the treatment of obesity. Bibliographic references : A comparative study of insulin lispro and human regular insulin in patients with type 2 diabetes mellitus and secondary failure of oral hypoglycemic agents. Ross SA, Zinman B, Campos RV, Strack T; Canadian Lispro Study Group. University of Calgary, Alta. saross@cadvision.com OBJECTIVE: To compare the effects of insulin lispro (LP) and human regular insulin (HR) when given twice daily with NPH insulin on glycemic control (HbA1c), daily blood glucose profiles and rates of hypoglycemia in patients with type 2 diabetes mellitus after failure to respond to sulfonylurea drugs. RESEARCH DESIGN AND METHODS: A 5.5-month randomized, open-label, parallel study of 148 patients receiving either LP (n = 70) or HR (n = 78). Eight-point blood glucose profiles and HbA1c measurements were collected at baseline, 1.5, 3.5 and 5.5 months. RESULTS: Two-hour post-breakfast and 2-hour post-supper blood glucose levels (means [and standard errors]) were significantly lower for LP than for HR at the end point (9.5 [0.4] mmol/L v. 10.9 [0.4] mmol/L and 8.4 [0.4] mmol/L v. 9.7 [0.4] mmol/L, respectively, p = 0.02 in both cases). HbA1c improved from 10.5% (0.2%) (LP) and 10.3% (0.2%) (HR) to 8.0% (0.1%). Hypoglycemia rates were similar during the day; however, there was an overnight trend to reduced rates with LP (0.08 [0.03] episodes/30 d v. 0.16 [0.04] episodes/30 d, p = 0.057). Quality-of life assessment showed significant improvement (p < 0.05) in the diabetes-related worry scale for LP subjects whereas HR subjects slightly worsened. CONCLUSIONS: With traditional twice-daily insulin administration algorithms, LP improves 2-hour postprandial glucose levels, quality of life and overnight hypoglycemia rates while delivering an equivalent level of glycemic control (HbA1c) compared with HR to insulin-naive patients with type 2 diabetes who require insulin. Clin Invest Med 2001 Dec;24(6):292-8  Presentation  "Hypoglycemia in Type 2 Diabetes: Impact and Management" Dr. Amir Hanna (biography) English - 2002-10-05 - 17 minutes (25 slides) Summary : One of the major obstacles in attaining euglycemia in type 2 diabetes is the increased risk of hypoglycemia. This concern results in clinicians and patients accepting blood glucose levels below the normal range. The CDA clinical practice guidelines for the prevention and management of hypoglycemia in diabetes were recently published *. These guidelines identified factors... Learning objectives : The participant will learn which treatment therapies and antihyperglycemic drugs when used cause the patient to be more hypoglycemia prone. Treatment recommendations for hypoglycemia are also outlined. Bibliographic references : Prolonged sulfonylurea-induced hypoglycemia in diabetic patients with end-stage renal disease. Krepinsky J, Ingram AJ, Clase CM. McMaster University, Hamilton, Ontario, Canada. Renal impairment is a recognized risk factor for prolonged hypoglycemia, but predisposing characteristics in patients with advanced renal impairment have not been studied. We observed prolonged hypoglycemia in a number of patients with end-stage renal disease (ESRD) and conducted a case-control study at two Canadian centers to identify such risk factors. Through hospital, pharmacy, and dialysis program records, we retrospectively identified 7 case patients and 31 controls with ESRD and type 2 diabetes using oral hypoglycemic monotherapy. Control patients had no history of hospital admission for prolonged hypoglycemia. All case patients and 28 controls were receiving glyburide (glibenclamide in Europe); the remainder were treated with tolbutamide. Duration of intravenous treatment for hypoglycemia ranged from 28 to 256 hours, with 83 g to 2 kg of glucose administered per episode. Preceding treatment with glyburide varied from 2 days to 13 years. Univariate analyses showed a recent decline in oral intake (odds ratio [OR], 81; 95% confidence interval [CI], 3.6 to 1,840), previous hypoglycemic episodes (OR, 15; 95% CI, 0.77 to 297), longer duration of diabetes (22 versus 12 years; P = 0.008), and a history of cerebrovascular disease (OR, 7. 0; 95% CI, 1.0 to 47) to be associated with prolonged hypoglycemia. No association between prolonged hypoglycemia and age, sex, beta blockers, angiotensin-converting enzyme inhibitors, oral hypoglycemic dose, or duration of treatment was identified. This study describes the potentially devastating effect of sulfonylurea-based oral hypoglycemic therapy in ESRD. Patients at greatest risk appear to be those with reduced intake, previous hypoglycemic episodes, and longer duration of diabetes. We describe the mechanisms for observed hypoglycemia and suggest that alternative drugs may be considered in this patient group. Am J Kidney Dis 2000 Mar;35(3):500-5  Presentation  "Type 2 Diabetes: A Multifactorial Syndrome" Dr. Stuart A Ross (biography) English - 2002-04-24 - 49 minutes (40 slides) Summary : In this presentation Dr Ross addresses the current-day notion of type 2 diabetes as a multifactorial syndrome. No longer is control of glycemia the sole goal of treatment, but we now must control dyslipidemia, hypertension, proteinuria, weight gain, insulin resistance and cardiovascular disease. Early in the talk, Dr Ross defines insulin resistance and it’s mechanisms. He then focuses on the... Learning objectives : After viewing this presentation, the participant will be familiar with the mechanisms of insulin resistance and its role in type 2 diabetes. An idea of the treatment goals and strategies targeting all pathological aspects of the disease will also be gained. Bibliographic references : Multifactorial insulin resistance and clinical impact in hypertension and cardiovascular diseases. Harano Y, Suzuki M, Koyama Y, Kanda M, Yasuda S, Suzuki K, Takamizawa I. Koshien University College of Nutrition, 10-1, Momijigaoka, Hyogo, Takarazuka, Japan. Insulin resistance and hyperinsulinemia have been observed in over 70% of the nonobese, nondiabetic subjects with essential hypertension (HT). Alpha-1 blockers, ACE-antagonists, long-acting Ca blockers including nifedipine CR, some form of beta-blockers, tilisolor, which is reported to increase blood flow, improve insulin sensitivity when blood pressure is better controlled. Decrease of serum potassium during insulin sensitivity test and intraplatelet free Ca2+ concentration is positively and negatively correlated with insulin sensitivity, respectively. Blood pressure is correlated with insulin resistance, which is also observed in secondary HT. The resistance is correlated with salt sensitivity as well as impaired nocturnal fall of blood pressure. These suggest the possible association of insulin resistance with altered intracellular cation metabolism. Insulin resistance and associated hyperinsulinemia have been observed in effort as well as vasospastic angina pectoris(VSAP), atherothrombotic cerebral infarction, and in ASO without obesity, HT, or diabetes, suggesting the resistance resulting from endothelial dysfunction. Insulin resistance has been observed in heart failure and is correlated with angiotensin II. Resistance is also observed in hypertrophic cardiomyopathy and is partially correlated with TNF-alpha. These results indicate that insulin resistance seem to be multifactorial. An effort to normalize insulin sensitivity is crucial to eliminate multiple risk factors as well as to prevent the progression of atherosclerotic vascular lesions. J Diabetes Complications 2002 Jan-Feb;16(1):19-23  Presentation  "Treating Type 2 Diabetes Patients to Target" Dr. Lawrence A. Leiter (biography) English - 2002-03-07 - 42 minutes (52 slides) Summary : This presentation is an excellent source of information on the guidelines used when treating patients with type 2 diabetes. Learning objectives : Upon this presentation, participant should be able to: -List target glucose, BP and lipid level in patients with type 2 diabetes; -Review recommended schedule of monitoring; -Recognize the importance of achieving target level; -Discuss treatment strategies for glucose, BP and lipids. Bibliographic references : Effect of wheat bran on glycemic control and risk factors for cardiovascular disease in type 2 diabetes. Jenkins DJ, Kendall CW, Augustin LS, Martini MC, Axelsen M, Faulkner D, Vidgen E, Parker T, Lau H, Connelly PW, Teitel J, Singer W, Vandenbroucke AC, Leiter LA, Josse RG. Clinical Nutrition and Risk Factor Modification Center, St. Michael's Hospital, Toronto, Ontario, Canada. cyril.kendall@utoronto.ca OBJECTIVE: Cohort studies indicate that cereal fiber reduces the risk of diabetes and coronary heart disease (CHD). Therefore, we assessed the effect of wheat bran on glycemic control and CHD risk factors in type 2 diabetes. RESEARCH DESIGN AND METHODS: A total of 23 subjects with type 2 diabetes (16 men and 7 postmenopausal women) completed two 3-month phases of a randomized crossover study. In the test phase, bread and breakfast cereals were provided as products high in cereal fiber (19 g/day additional cereal fiber). In the control phase, supplements were low in fiber (4 g/day additional cereal fiber). RESULTS: Between the test and control treatments, no differences were seen in body weight, fasting blood glucose, HbA(1c), serum lipids, apolipoproteins, blood pressure, serum uric acid, clotting factors, homocysteine, C-reactive protein, magnesium, calcium, iron, or ferritin. LDL oxidation in the test phase was higher than that seen in the control phase (12.1 +/- 5.4%, P < 0.034). Of the subjects originally recruited, more dropped out of the study for health and food preference reasons from the control phase (16 subjects) than the test phase (11 subjects). CONCLUSIONS: High-fiber cereal foods did not improve conventional markers of glycemic control or risk factors for CHD in type 2 diabetes over 3 months. Possibly longer studies are required to demonstrate the benefits of cereal fiber. Alternatively, cereal fiber in the diet may be a marker for another component of whole grains that imparts health advantages or a healthy lifestyle. Diabetes Care 2002 Sep;25(9):1522-8  Presentation  "Alternative Therapies in the Glycemic Control of Type 2 Diabetes: An Evidence-Based Approach" Dr. Jeannette Goguen (biography) English - 2002-01-19 - 25 minutes (44 slides) Summary : Overview of the most commonly used alternative substances in the treatment of diabetes. Information on different studies regarding substances such as chromium, vanadium, vitamin C and E, ginseng… Learning objectives : By the end of the session, participants should have an appreciation for the following: 1.The frequency of use of alternative therapies for hyperglycemia by patients with diabetes mellitus. 2.What actual therapies are being used. 3.What evidence exists Bibliographic references : Lipids and diabetes mellitus: a review of therapeutic options. Goguen JM, Leiter LA. St. Michael's Hospital and Department of Medicine, University of Toronto, Ontario, Canada. Diabetes mellitus ia very common disease with a high cardiovascular morbidity and mortality. This articles reviews the types of lipid disorders that can accompany diabetes mellitus and the evidence that treatment of dyslipidaemia improves primary and secondary endpoints, i.e. lipid levels, cardiovascular events, and mortality. Specific lipid-lowering strategies are discussed, including diet and exercise, treatment of hyperglycaemia, and the use of lipid-lowering therapy such as statins, fibric acid derivatives, bile acid sequestrants, nicotinic acid and its derivatives, fish oil and hormone replacement therapy. An approach to the patient with diabetes mellitus and dyslipidaemia is provided. Curr Med Res Opin 2002;18 Suppl 1:s58-74  Presentation  "Use of Combination Therapy in the Treatment of Type 2 Diabetes" Dr. Amir Hanna (biography) English - 2002-01-19 - 22 minutes (35 slides) Summary : The initiation of intensive treatment at the beginning of the disease provides superior results for the control of glucose levels and the development of complications, contrary to presently accepted guidelines. Learning objectives : LEARNING OBJECTIVES: Upon completion of this presentation, participants should be able to: 1. Review the impact of intensive and early glucose control on the complications of diabetes. 2. Understand the characteristics of different classes of hypoglycemic agents. 3. Provide an overview of recent combination therapy studies. Bibliographic references : Comparison of insulin monotherapy and combination therapy with insulin and metformin or insulin and troglitazone in type 2 diabetes. Strowig SM, Aviles-Santa ML, Raskin P. University of Texas Southwestern Medical Center at Dallas, Dallas, Texas. OBJECTIVE-To evaluate the safety and efficacy of treatment with insulin alone, insulin plus metformin, or insulin plus troglitazone in individuals with type 2 diabetes. RESEARCH DESIGN AND METHODS-A total of 88 type 2 diabetic subjects using insulin monotherapy (baseline HbA(lc) 8.7%) were randomly assigned to insulin alone (n = 31), insulin plus metformin (n = 27), or insulin plus troglitazone (n = 30) for 4 months. The insulin dose was increased only in the insulin group. Metformin was titrated to a maximum dose of 2,000 mg and troglitazone to 600 mg. RESULTS-HbA(lc) levels decreased in all groups, the lowest level occurring in the insulin plus troglitazone group (insulin alone to 7.0%, insulin plus metformin to 7.1%, and insulin plus troglitazone to 6.4%, P < 0.0001). The dose of insulin increased by 55 units/day in the insulin alone group (P < 0.0001) and decreased by 1.4 units/day in the insulin plus metformin group and 12.8 units/day in the insulin plus troglitazone group (insulin plus metformin versus insulin plus troglitazone, P = 0.004). Body weight increased by 0.5 kg in the insulin plus metformin group, whereas the other two groups gained 4.4 kg (P < 0.0001 vs. baseline). Triglyceride and VLDL triglyceride levels significantly improved only in the insulin plus troglitazone group. Subjects taking metformin experienced significantly more gastrointestinal side effects and less hypoglycemia. CONCLUSIONS-Aggressive insulin therapy significantly improved glycemic control in type 2 diabetic subjects to levels comparable with those achieved by adding metformin to insulin therapy. Troglitazone was the most effective in lowering HbA(lc), total daily insulin dose, and triglyceride levels. However, treatment with insulin plus metformin was advantageous in avoiding weight gain and hypoglycemia. Diabetes Care 2002 Oct;25(10):1691-8  Presentation  "The Treatment of Obesity in Type 2 Diabetes" Dr. Lawrence A. Leiter (biography) English - 2002-01-19 - 62 minutes (55 slides) Summary : Presentation that illustrates the association between obesity and the development of Type 2 diabetes. An overview of those treatments and benefits related to weight loss. Learning objectives : LEARNING OBJECTIVES: At the end of the presentation, the participant should be able to: 1. Understand any differences in the response to weight loss interventions in the diabetic versus the non-diabetic individual. 2. Understand the expected weight and glycemic responses to currently available weight loss medications in persons with diabetes. Bibliographic references : Lifestyle modifications to prevent and control hypertension. 2. Recommendations on obesity and weight loss. Canadian Hypertension Society, Canadian Coalition for High Blood Pressure Prevention and Control, Laboratory Centre for Disease Control at Health Canada, Heart and Stroke Foundation of Canada. Leiter LA, Abbott D, Campbell NR, Mendelson R, Ogilvie RI, Chockalingam A. Department of Medicine, University of Toronto, Ont. OBJECTIVE: To provide updated, evidence-based recommendations concerning the effects of weight loss and maintenance of healthy weight on the prevention and control of hypertension in otherwise healthy adults (except pregnant women). OPTIONS: The main options are to attain and maintain a healthy body weight (body mass index [BMI] 20-25 kg/m2) or not to do so. For those at risk for hypertension, weight loss and maintenance of healthy weight may prevent the condition. For those who have hypertension, weight loss and maintenance of healthy weight may reduce or obviate the need for antihypertensive medications. OUTCOMES: The health outcome considered was change in blood pressure. Because of insufficient evidence, no economic outcomes were considered. EVIDENCE: A MEDLINE search was conducted for the years 1992-1996 with the terms hypertension and obesity in combination and antihypertensive therapy and obesity in combination. Other relevant evidence was obtained from the reference lists of the articles identified, from the personal files of the authors and through contacts with experts. The articles were reviewed, classified according to study design and graded according to level of evidence. VALUES: A high value was placed on the avoidance of cardiovascular morbidity and premature death caused by untreated hypertension. BENEFITS, HARMS AND COSTS: Weight loss and the maintenance of healthy body weight reduces the blood pressure of both hypertensive and normotensive people. The indirect benefits of a health body weight are well known. The negative effects of weight loss are primarily the frustrations associated with attaining and maintaining a healthy weight. The costs associated with weight loss programs were not measured in the studies reviewed. RECOMMENDATIONS: (1) It is recommended that health care professionals determine weight (in kilograms), height (in metres) and BMI for all adults. (2) To reduce blood pressure in the population at large, it is recommended that Canadians attain and maintain a healthy BMI (20-25). (3) All overweight hypertensive patients (BMI greater than 25) should be advised to reduce their weight. VALIDATION: These recommendations are similar to those of the World Hypertension League, the National High Blood Pressure Education Program Working Group on Primary Prevention of Hypertension, the Canadian Hypertension Society and the Canadian Coalition for High Blood Pressure Prevention and Control. They have not been clinically tested. SPONSORS: The Canadian Hypertension Society, the Canadian Coalition for High Blood Pressure Prevention and Control, the Laboratory Centre for Disease Control at Health Canada, and the Heart and Stroke Foundation of Canada. CMAJ 1999 May 4;160(9 Suppl):S7-12   Login   Username :   Password :       Lost your password?   Search our website   Would you like to know more about insulin resistance? Are you looking for information pertaining to Type 2 Diabetes? You can find what you are looking for in over 2000 references available on CMEonDiabetes.

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