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  Français - August 16, 2011
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  Topic  

Prevention

Prevention includes measures to prevent the development of diabetes. Prevention may also contribute to the stablization of the disease. Many studies show that controlling one's life style, notably through nutrition and physical activity, has a real preventive effect on Type 2 diabetes. Education plays a fundamental role in the results.

Presentations listing

How Prognostic are the UKPDS and DiaCard Diabetes-Specific... - Dr. Wendy Davis
Can We Prevent Progression to Type 2 Diabetes? Recent... - Prof. Hertzel Gerstein
Welcome & Introduction - Prof. François Bonnici
Prevention Trials in Diabetes: A New Era - Dr. James O' Keefe
DREAM Trial Final Results - Prof. Jonathan Shaw
Dreaming About Diabetes Prevention - Prof. Hertzel Gerstein
Preclinical Diagnosis and Prospects for Prevention of Type... - Dr. Peter Colman
Can Glitazones Delay Progression from Dysglycemia to Type 2... - Prof. Hertzel Gerstein
What Should Governments do to Prevent Diabetes/CVD? - Dr. Peter H. Bennett
STOP NIDDM Trial - Prof. Avraham Karasik
Primary Prevention of Type 2 Diabetes - A Matter of... - Dr. Bernt Lindahl
GLP-1 Treatment for the Prevention of Diabetes Occurring... - Dr. Riccardo Perfetti
TheTRIPOD and PIPOD Studies - Prof. Thomas A. Buchanan
The Diabetes Prevention Program: A Randomized Clinical... - Prof. Elizabeth Barrett-Connor
The Diabetes Prevention Program - Dr. William C. Knowler
DREAM Trial - Prof. Hertzel Gerstein
Finnish Prevention Study - Prof. Jaakko Tuomilehto
Societal Approach to DM Prevention in the Young - Prof. Francine Kaufman
Prevention of Diabetes and Cardiovascular Disease - Dr. Lawrence A. Leiter
Closing the Gap in Type 2 Diabetes: Important Clinical... - - Panel Discussion
Lifestyle Intervention - Dr. Robert Sherwin
Diabetes in the US: The Need for Aggressive Disease... - Dr. Richard W. Nesto
Managing the 21st Century Diabetes Epidemic: Treatment and... - Dr. David M. Nathan
Prevention of Type 2 Diabetes: Saving the Pancreatic B-cell - Prof. Thomas A. Buchanan
Endothelial Dysfunction in Diabetes - Dr. Todd Anderson
Preventing Microvascular and Macrovascular Complications of... - Dr. Ehud Ur
Prevention of Diabetes: Results of Recent Clinical Studies - Dr. Robert Josse
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 Presentation 

"How Prognostic are the UKPDS and DiaCard Diabetes-Specific Risk Engines for Predicting 5-year Risk of Events in Type 2 Diabetic Patients Without Prior Cardiovascular Disease? The Fremantle Diabetes Study"

Dr. Wendy Davis (biography)
English - 2006-12-06 - 26 minutes
(24 slides)

Summary :
For patients with type 2 diabetes without a history of cardiovascular disease, the UKPDS provides risk engines for fatal and non-fatal coronary heart disease and stroke (1,2), and for all patients with type 2 diabetes, DiaCard, developed by the Steno Diabetes Center presents equations for all-cause and cardiac mortality.

How well do these risk engines perform in predicting the...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Risk factors for cardiovascular disease (CVD)
- The limitations of CVD risk equations in predicting future events
- Assessment of model performance
- The difference between absolute risk and relative risk

Bibliographic references :
1. Richard J. STEVENS, Viti KOTHARI, Amanda I. ADLER, Irene M. STRATTON and Rury R. HOLMAN on behalf of the United Kingdom Prospective Diabetes Study (UKPDS) GroupThe UKPDS risk engine: a model for the risk of coronary heart disease in Type II diabetes (UKPDS 56) Clinical Science (2001) 101, (671–679).

2. Viti Kothari, MSc; Richard J. Stevens, PhD; Amanda I. Adler, MD; Irene M. Stratton, MSc; Susan E. Manley, PhD; H. Andrew Neil, FRCP Rudy R. Holman, FRCP for the UK Prospective Diabetes Study Group UKPDS 60: Risk of Stroke in Type 2 Diabetes Estimated by the UK Prospective Diabetes Study Risk Engine Stroke. 2002;33:1776.

   


 Presentation 

"Can We Prevent Progression to Type 2 Diabetes? Recent Evidence"

Prof. Hertzel Gerstein (biography)
English - 2006-12-04 - 38 minutes
(33 slides)

Summary :
Type 2 diabetes accounts for 90% of all diabetes and currently affects at least 5% of adults worldwide and is rapidly rising in prevalence. Affected people are at high risk of serious eye, kidney, nerve and vascular diseases which can lead to premature mortality. Large clinical trials have reported that lifestyle interventions (i.e. activity and weight loss), and the drugs metformin, acarbose and...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- What is disease prevention?
- Why prevent type 2 diabetes?
- Evidence for reduced diabetes risk with ACE inhibitors
- The DREAM trial: modest improvement of glycemic status in people with IFG/IGT with ramipril, and reduced diabetes risk with rosiglitazone

   


 Presentation 

"Welcome & Introduction"

Prof. François Bonnici (biography)
English - 2006-12-04 - 5 minutes
(4 slides)

   


 Presentation 

"Prevention Trials in Diabetes: A New Era"

Dr. James O' Keefe (biography)
English - 2006-11-17 - 31 minutes
(37 slides)

Summary :
The incidence of diabetes or prediabetes has been on a steeply rising trajectory that parallels the epidemic of obesity. Diabetes confers a level of cardiovascular risk similar to that associated with a history of prior myocardial infarction; thus, diabetes is considered a “risk equivalent” to established coronary disease. The converse is also true – more than 70% of people who present with...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The burden of prediabetes in the U.S.
- Diabetes mortality in the U.S.
- IGT as a CV risk factor
- Postprandial glucose levels and oxidative stress
- DM prevention: diet and exercise; antidiabetic drugs
- Foods and drugs that reduce postprandial glycemia

   


 Presentation 

"DREAM Trial Final Results"

Prof. Jonathan Shaw (biography)
English - 2006-09-15 - 51 minutes
(45 slides)

Summary :
In this presentation Prof. Jonathan Shaw from the International Diabetes Institute in Melbourne, Australia gives a detailed account of the final results of the DREAM (Diabetes REduction Assessment with ramipril and rosiglitazone Medication) trial presented yesterday at the 42nd EASD meeting in Copenhagen.

There has been growing evidence to suggest that in addition to lifestyle,...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

Final results from the ramipril and rosiglitazone arms of the DREAM trial:
- Primary outcome: Incident DM or death in individuals with IFG and/or IGT at baseline
- Regression to normal glucose levels
- Effects on blood pressure, liver function, weight, cardiovascular outcomes
- Adherence/adverse effects

Bibliographic references :
The DREAM Trial Investigators. Effect of Ramipril on the Incidence of Diabetes Published at www.nejm.org September 15, 2006 (10.1056/NEJMoa065061).

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 2006; DOI:10.1016/S0140-6736(06)69420-8.

   


 Presentation 

"Dreaming About Diabetes Prevention"

Prof. Hertzel Gerstein (biography)
English - 2006-09-13 - 35 minutes
(29 slides)

Summary :
Diabetes is a strong risk factor for ocular, neural, renal, cardiovascular and other consequences and its prevalence is rising steeply throughout the world, especially in developing countries. Research during the last decade has also clearly shown that the link between glucose and cardiovascular risk extends below glucose levels that are in the diabetes range. For example, a) a large 6 year...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Does a rise in glucose above normal predict future CV events in ambulatory people?
- Is IFG/IGT a risk factor for CV events?
- Does G lowering reduce CV events in DM?
- What is the risk of future DM with IFG/IGT?
- Does DM prevention also reduce CV events?

Bibliographic references :
1. Khaw KT,Wareham N, Bingham S, Luben R,Welch A,Day N. Association of hemoglobin A1c with cardiovascular disease and mortality in adults: the European prospective investigation into cancer in Norfolk. Ann Intern Med 141(6):413-20, 2004

2. Lawes CM, Parag V, Bennett DA, Suh I, Lam TH,Whitlock G et al. Blood glucose and risk of cardiovascular disease in the Asia Pacific region.Diabetes Care 27(12):2836-42, 2004.

3. Gerstein HC, Pogue J,Mann JF, Lonn E,Dagenais GR,McQueen M et al.The relationship between dysglycaemia and cardiovascular and renal risk in diabetic and non-diabetic participants in the HOPE study: a prospective epidemiological analysis.Diabetologia 48(9):1749-55, 2005.

4. Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial. JAMA 23;290(4):486-94, 2003.

5. Gerstein HC,Yusuf S, Holman R, Bosch J, Pogue J; The DREAM Trial Investigators. Rationale, design and recruitment characteristics of a large, simple international trial of diabetes prevention: the DREAM trial. Diabetologia 47(9):1519-27, 2004.

   


 Presentation 

"Preclinical Diagnosis and Prospects for Prevention of Type 1 Diabetes"

Dr. Peter Colman (biography)
English - 2006-04-04 - 36 minutes
(41 slides)

Summary :
In this presentation Dr. Colman discusses screening for type 1 diabetes as well as completed and ongoing trials designed to prevent type 1 diabetes.

Type 1 diabetes is a polygenetic disease with significant familial clustering. In the natural history of the disease, an autoimmune response is triggered in a proportion of people who are genetically at-risk, and this is followed by a...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The natural history of type 1 diabetes
- Prediction of type 1 diabetes in first-degree relatives
- Results from trials designed to prevent type 1 diabetes: DPT-1, ENDIT and INIT I
- Ongoing studies in the field

Bibliographic references :
1. Kevan C. Herold, M.D., William Hagopian, M.D., Ph.D., Julie A. Auger, B.A., Ena Poumian-Ruiz, B.S., Lesley Taylor, B.A., David Donaldson, M.D., Stephen E. Gitelman, M.D., David M. Harlan, M.D., Danlin Xu, Ph.D., Robert A. Zivin, Ph.D., and Jeffrey A. Bluestone, Ph.D.Anti-CD3 Monoclonal Antibody in New-Onset Type 1 Diabetes MellitusN Engl J Med. 2002 May 30;346(22):1692-8.

2. Prof Edwin AM Gale and European Nicotinamide Diabetes Intervention Trial (ENDIT) Group. European Nicotinamide Diabetes Intervention Trial (ENDIT): a randomised controlled trial of intervention before the onset of type 1 diabetes The Lancet, Volume 363, Issue 9413, 20 March 2004, Pages 925-93.

   


 Presentation 

"Can Glitazones Delay Progression from Dysglycemia to Type 2 Diabetes? The Evidence"

Prof. Hertzel Gerstein (biography)
English - 2005-09-11 - 40 minutes
(28 slides)
(5 questions)

Summary :
Diabetes is a complex metabolic disorder that is a risk factor for eye, nerve, kidney, cardiovascular and other serious health consequences and that is rapidly rising in prevalence throughout the developing and the developed world. Thus, diabetes represents a significant, expensive and growing public health problem.

Large clinical trials have reported that lifestyle interventions...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

(Outline):

- What is diabetes (DM) & why prevent or delay it?
- What therapies are proven to prevent type 2 DM?
- Why might glitazones prevent diabetes?
- What is known about glitazones and DM prevention?
- What is the DREAM study testing?
- Is there more to it than DM prevention?

Bibliographic references :
The Diabetes Prevention Program Research GroupPrevention of Type 2 Diabetes With Troglitazone in the Diabetes Prevention Program Diabetes 54:1150-1156, 2005

Thomas A. Buchanan, Anny H. Xiang, Ruth K. Peters, Siri L. Kjos, Aura Marroquin, Jose Goico, Cesar Ochoa, Sylvia Tan, Kathleen Berkowitz, Howard N. Hodis, and Stanley P. AzenPreservation of Pancreatic ß-Cell Function and Prevention of Type 2 Diabetes by Pharmacological Treatment of Insulin Resistance in High-Risk Hispanic Women Diabetes 51:2796-2803, 2002

The DREAM Trial InvestigatorsRationale, design and recruitment characteristics of a large, simple international trial of diabetes prevention: the DREAM trial Diabetologia, Volume 47, Issue 9, Sep 2004, Pages 1519 - 1527.

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, MDA 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 25:1737-1743, 2002.

   


 Presentation 

"What Should Governments do to Prevent Diabetes/CVD?"

Dr. Peter H. Bennett (biography)
English - 2005-04-16 - 32 minutes
(39 slides)

Summary :
The extent and magnitude of the present and future burden of diabetes and related cardiovascular diseases is now well recognized by the medical community. While effective treatments exist, their use only benefits those who have developed these diseases. The fundamental problem relates to prevention of these diseases. For type 2 diabetes, there is unequivocal evidence that the most important risk...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The global burden of diabetes and excess deaths due to diabetes;
- The Medical and Public Health models of prevention;
- Evidence for factors driving the diabetes epidemic: obesity and physical inactivity;
- Interventions targeted at children, adolescents and adults;
- Implementation of interventions at the international, national and local levels.

   


 Presentation 

"STOP NIDDM Trial"

Prof. Avraham Karasik (biography)
English - 2005-04-15 - 19 minutes
(22 slides)

Summary :
The STOP NIDDM trial was a multicenter, international, placebo-controlled, randomized clinical trial to assess the effect of acarbose in preventing or delaying conversion of impaired glucose tolerance (IGT) to type 2 diabetes. Patients were recruited through screening of high risk population and those with both IGT and IFG (FBG > 5.6 mmol/L) were included in the study. 714 patients were allocated...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The effect of acarbose in preventing or delaying conversion of impaired glucose tolerance (IGT) to type 2 diabetes.

   


 Presentation 

"Primary Prevention of Type 2 Diabetes - A Matter of Maintaining the New Lifestyle"

Dr. Bernt Lindahl (biography)
English - 2005-04-15 - 16 minutes
(30 slides)

Summary :
Object: To study short- and long-term effects of an intensive lifestyle change programme.

Method: Subjects with IGT and obesity (BMI>27) were randomised to two different intervention programmes based on low-fat, high-fibre diet and regular physical exercise. The intensive group (n=100) participated in a one month learning and training session using behavioural modification...

Learning objectives :
After viewing this presentation, participants will be able to discuss:

- Compliance-oriented and empowerment-oriented approaches to behaviour modification
- The design of the GT-VIP Study
- The short-term effects of an intensive behavioural intervention in the GT-VIP
- The long-term effects of an intensive behavioural intervention in the GT-VIP

   


 Presentation 

"GLP-1 Treatment for the Prevention of Diabetes Occurring After Organ Transplantation"

Dr. Riccardo Perfetti (biography)
English - 2005-04-15 - 23 minutes
(13 slides)

Summary :
BACKGROUND: Glucose intolerance is often observed after pancreatic islet cell transplantation. The administration of immunosuppressive agents (ISD), necessary to avoid tissue rejection, is in part responsible for hyperglycemia.

OBJECTIVES: To investigate whether mouse insulinoma (MIN6) cells transfected with the GLP-1 fragment of the proglucagon gene (RIP/GLP-1 MIN6 cells) are...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The effect of immunosuppressive agents on glucose control
- The effects of GLP-1 on insulin secreting cells exposed to immunosuppressive agents

   


 Presentation 

"TheTRIPOD and PIPOD Studies"

Prof. Thomas A. Buchanan (biography)
English - 2005-04-15 - 24 minutes
(25 slides)

Summary :
The Troglitazone in Prevention of Diabetes (TRIPOD) and Pioglitazone in Prevention of Diabetes (PIPOD) studies were conducted in Hispanic-American women with recent gestational diabetes. TRIPOD was a randomized, placebo-controlled trial in which 236 of 266 randomized subjects had at least one follow-up visit and 126 women completed 3.6 years of treatment and 8 months of post-drug washout. The...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The nature of pre-diabetes (type 2)
- The effects of thiazolidinediones on progression to diabetes

   


 Presentation 

"The Diabetes Prevention Program: A Randomized Clinical Trial to Prevent Type 2 Diabetes in Persons at High Risk"

Prof. Elizabeth Barrett-Connor (biography)
English - 2005-04-15 - 38 minutes
(41 slides)

Summary :
The DPP randomized controlled clinical trial included 3234 participants with impaired glucose tolerance (IGT) who were randomized to ILS, MET, or usual advice. Both ILS and MET significantly reduced the risk of diabetes. A further major benefit of these interventions may be reduction of cardiovascular disease (CVD) risk. Because persons with IGT have a high prevalence of CVD risk factors,...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- The objective, design and outcomes of the Diabetes Prevention Program (DPP);
- Adverse events in the DPP;
- Treatment effect of the DPP on hypertension, dyslipidemia, and the metabolic syndrome;
- The effect of age, sex, ethnicity, and body mass index on the incidence of diabetes.

   


 Presentation 

"The Diabetes Prevention Program"

Dr. William C. Knowler (biography)
English - 2005-04-15 - 28 minutes
(20 slides)

Summary :
The DPP was a randomized clinical trial of type 2 diabetes prevention in high-risk persons conducted in 27 clinics in the U.S.A. From 1996-98, participants were randomly assigned to treatment with placebo, metformin, troglitazone, or intensive lifestyle intervention. Due to concern regarding its liver toxicity, use of troglitazone was discontinued in 1998. Randomization to the other three groups...

Learning objectives :
After viewing this presentation, participants will be able to discuss:
• The objective of the diabetes prevention program (DPP)
• The medical and lifestyle interventions in subjects enrolled in the DPP
• The DPP study design and changes
• The results of the DPP

   


 Presentation 

"DREAM Trial"

Prof. Hertzel Gerstein (biography)
English - 2005-04-15 - 31 minutes
(15 slides)

Summary :
The objective of the dream trial (Diabetes REduction Assessment with ramipril and rosiglitazone Medication) is to determine the efficacy of ramipril and/or rosiglitazone on prevention of diabetes in non-diabetic individuals with impaired glucose tolerance or impaired fasting glucose.

Prof Gerstein presents the design of the DREAM trial in detail and reviews the key questions which...

Learning objectives :
After viewing this presentation, participants will be able to discuss:
- The objectives of the DREAM trial;
- The study design of the DREAM trial.

   


 Presentation 

"Finnish Prevention Study"

Prof. Jaakko Tuomilehto (biography)
English - 2005-04-15 - 33 minutes
(37 slides)

Summary :
In this presentation Prof. Tuomilehto talks about the results of the Finnish Diabetes Prevention Study, which investigated the role of lifestyle guidance in the prevention or delay of type 2 diabetes in overweight, middle-aged subjects with impaired glucose tolerance.

Patients in the intervention group underwent dietary counseling sessions, and followed an individually tailored...

Learning objectives :
After viewing this presentation the participant will be able to discuss the Finnish Diabetes Prevention Study:

- Study design and baseline characteristics of participants
- Detailed description of the lifestyle intervention used
- Results in terms of reduction in the incidence of diabetes and changes in anthropometric and metabolic parameters
- The potential role of genes in the prevention of type 2 diabetes

Bibliographic references :
Jaakko Tuomilehto, M.D., Ph.D., Jaana Lindstrom, M.S., Johan G. Eriksson, M.D., Ph.D., Timo T. Valle, M.D., Helena Hamalainen, M.D., Ph.D., Pirjo Ilanne-Parikka, M.D., Sirkka Keinanen-Kiukaanniemi, M.D., Ph.D., Mauri Laakso, M.D., Anne Louheranta, M.S., Merja Rastas, M.S., Virpi Salminen, M.S., Sirkka Aunola, Ph.D., Zygimantas Cepaitis, Dipl.Eng., Vladislav Moltchanov, Ph.D., Martti Hakumaki, M.D., Ph.D., Marjo Mannelin, M.S., Vesa Martikkala, M.S., Jouko Sundvall, M.S., Matti Uusitupa, M.D., Ph.D., for the Finnish Diabetes Prevention Study Group. Prevention of Type 2 Diabetes Mellitus by Changes in Lifestyle among Subjects with Impaired Glucose Tolerance NEJM. 2001;344:1343-1350.

   


 Presentation 

"Societal Approach to DM Prevention in the Young"

Prof. Francine Kaufman (biography)
English - 2005-04-14 - 33 minutes
(32 slides)

Summary :
Rather than contributing to the emerging epidemic of type 2 diabetes in the global pediatric population, schools, communities and governments must play a role in preventing this disorder. There is ample evidence that lifestyle interventions can prevent diabetes in adults, and similar evidence is emerging of the salutatory effect of lifestyle change in youth.

Breast-feeding has...

Learning objectives :
After viewing this presentation the participant will be able to discuss:

- Measures that can be taken by schools, communities and governments to reduce the incidence of obesity and diabetes in youth.

   


 Presentation 

"Prevention of Diabetes and Cardiovascular Disease"

Dr. Lawrence A. Leiter (biography)
English - 2003-10-31 - 26 minutes
(56 slides)

Summary :
The new 2003 CDA Guidelines show a stronger focus on treating cardiovascular disease, reflecting its important role in the mortality of diabetic patients. Lifestyle intervention should be used to reduce hypertension, failing which, there are a number of antihypertensive agents that have been recommended for use in monotherapy, and if necessary in combination, to achieve target BP levels. It was...

Learning objectives :
The participant will learn how the new CDA Clincal Practice Guidelines 2003 have changed to highlight the prevention of cardiovascular disease, and new information on postprandial hyperglycemia and cardiovascular risk.

Bibliographic references :
1. Bakris GL, Williams M, Dworkin L, Elliott WJ, Epstein M, Toto R, Tuttle K, Douglas J, Hsueh W, Sowers J. Preserving renal function in adults with hypertension and diabetes: a consensus approach. National Kidney Foundation Hypertension and Diabetes Executive Committees Working Group. «» Am J Kidney Dis. 2000 Sep;36(3):646-61.



2.Chiasson JL, Josse RG, Gomis R, Hanefeld M, Karasik A, Laakso M; STOP-NIDDM Trial Research Group. Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance: the STOP-NIDDM trial.«» JAMA. 2003 Jul 23;290(4):486-94.

   


 Presentation 

"Closing the Gap in Type 2 Diabetes: Important Clinical Considerations for Optimal Outcomes"

- Panel Discussion (biography)
English - 2003-09-15 - 31 minutes
(22 slides)

Summary :
With the recently disclosed results of diabetes prevention trials, much information has become available which has the potential to change clinical practice. In this panel discussion Dr Samuel Dagogo-Jack and Dr Steven Edelman talk about how this information could be interpreted and applied towards clinical practice.

Learning objectives :
The participant will hear the opinions of Dr Samuel Dagogo-Jack and Dr Steven Edelman concerning the interpretation of recently disclosed data from the diabetes prevention trials.

Bibliographic references :
Diabetes Prevention Program (DPP) Research Group. The Diabetes Prevention Program (DPP): description of lifestyle intervention. Diabetes Care. 2002 Dec;25(12):2165-71.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

   


 Presentation 

"Lifestyle Intervention"

Dr. Robert Sherwin (biography)
English - 2003-08-28 - 54 minutes
(35 slides)
(1 question)

Summary :
Recorded during the 18th IDF Meeting, Paris: The rapid worsening of the diabetes epidemic in the United States can be largely attributed to the radical change in lifestyle in terms of diet and exercise in the last 50 years. Treatment of diabetes, however remains suboptimal. This leaves the question, should clinicians be attempting to prevent diabetes? Five criteria must be met if this is to be...

Learning objectives :
The participant will learn about the results of the recent lifestyle intervention studies, and get an idea of how to proceed in treatment based on this information:

o Substantial effort was necessary to achieve modest changes in body weight and activity in motivated patients.
o These changes had a significant impact on glycemia for at least 3 years.
o Success in meeting lifestyle intervention goals was associated with a lower incidence of diabetes.

The key issues in offering drug therapy if lifestyle intervention fails are:

o safety
o specific CVD benefit
o duration of delay
o cost effectiveness

Bibliographic references :
The Prevention or Delay of Type 2 Diabetes
American Diabetes Association National Institute of Diabetes, Digestive and Kidney Diseases
http://care.diabetesjournals.org/cgi/content/full/26/suppl_1/s62

   


 Presentation 

"Diabetes in the US: The Need for Aggressive Disease Management and Getting to Goal"

Dr. Richard W. Nesto (biography)
English - 2003-06-16 - 24 minutes
(22 slides)

Summary :
In order to prevent some of the death, disability and complications due to type 2 diabetes, it’s important to choose therapies earlier to provide long-term glycemic control, by acting on insulin resistance and beta cell failure. The UKPDS showed a steady decline in beta cell function after diagnosis (Diabetes. 1995; 44: 1249-58). This decline in beta cell function can be avoided if a treatment...

Learning objectives :
The participant will learn how to identify "high risk" metabolic syndrome patients:

Background components:

- Early age at onset
- Strong family history of premature CVD
- First degree relative with type 2 diabetes
- Presence of "other" inflammatory disease
- History or evidence of CVD

Metabolic Syndrome components:

"Very obese"
Fasting glucose > 110 mg/dl
Microalbuminuria (from WHO criteria)
High CRP or PAI-1

Summary:

- Micro/macro vascular disease is present when type 2 diabetes is first diagnosed
- Preceded by years of risk usually in the form of metabolic syndrome
- Natural history is due to a combination of insulin resistance and beta cell decline
- Treatment opportunities now exist that are directed at decreasing insulin resistance and preserving beta cell function.



Bibliographic references :
Hanley AJ, McKeown-Eyssen G, Harris SB, Hegele RA, Wolever TM, Kwan J, Zinman B. Association of parity with risk of type 2 diabetes and related metabolic disorders. Diabetes Care. 2002 Apr;25(4):690-5.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi

Hanley AJ, Karter AJ, Festa A, D'Agostino R Jr, Wagenknecht LE, Savage P, Tracy RP, Saad MF, Haffner S; Insulin Resistance Atherosclerosis Study. Factor analysis of metabolic syndrome using directly measured insulin sensitivity: The Insulin Resistance Atherosclerosis Study. Diabetes. 2002 Aug;51(8):2642-7.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi


   


 Presentation 

"Managing the 21st Century Diabetes Epidemic: Treatment and Prevention"

Dr. David M. Nathan (biography)
English - 2003-06-14 - 50 minutes
(48 slides)

Summary :
In this presentation we will discuss new findings from the DPP presented at the Recent Data from type 2 Diabetes Clinical Trials Symposium at the 63rd ADA Meeting in New Orleans. We will look at our ability to treat diabetes and prevent complications, the limitations of our current means of doing so, and our ability to prevent diabetes. We saw from the UKPDS that stepped treatment resulted in a...

Learning objectives :
- The U.S. sees 800,000 new type 2 diabetes cases per year.
- Combination therapies involving drugs with different mechanisms of action tend to produce more synergistic and additive effects.
- The DPP found lifestyle to have the greatest effect in lowering the incidence of diabetes, followed by metformin and then placebo.
- Weight loss was the most important mediator of lifestyle related Diabetes prevention.
- Conventional risk factors such as BP and triglyceride levels were improved by intensive lifestyle but not by metformin.
- Indices of inflammation and hemorheologic disorders were generally improved with lifestyle, and some factors like TPA and CRP (in women) were also improved by metformin.
- IGT and IFG have been renamed ''pre-diabetes''.

Bibliographic references :
http://www.ncbi.nlm.nih.gov

Goldhaber-Fiebert JD, Goldhaber-Fiebert SN, Tristan ML, Nathan DM.

Randomized controlled community-based nutrition and exercise intervention
improves glycemia and cardiovascular risk factors in type 2 diabetic
patients in rural costa rica.

Diabetes Care. 2003 Jan;26(1):24-9.

   


 Presentation 

"Prevention of Type 2 Diabetes: Saving the Pancreatic B-cell"

Prof. Thomas A. Buchanan (biography)
English - 2003-01-22 - 85 minutes
(26 slides)
(15 slides)
(9 questions)

Summary :
The epidemic of diabetes is occurring at three levels: positive energy balance, insulin resistance and loss of beta cell mass/function. Positive energy balance leads to obesity, and whether an obese person becomes insulin resistant depends on where their fatty acids accumulate and get metabolized. To the extent that fatty acids are spilled over from adipose tissue into liver and muscle, insulin...

Learning objectives :
- Troglitazone reduced the incidence of diabetes by 55% in high-risk Hispanic women

- Protection from diabetes required an increase in insulin sensitivity and was greatest in women who had the largest reduction in B-cell requirements ("B-cell rest")

- Women who were protected during the trial remained protected eight months later and had stable B-cell function over a 54-month period

- Reducing secretory demands placed on B-cells by chronic insulin resistance preserves B-cell function and delays or prevents Type 2 diabetes

- Intervention could be done as early as at the stage of impaired glucose tolerance, or when diabetes is found by doing yearly OGTTs. Stabilization of beta cell function was possible at both time points, but function was stabilized at a lower level when intervention was withheld until diabetes was first detected.

- There are 2 ongoing studies with TZDs. The PIPOD Study is looking at the stability of glucose levels and B-cell function during four years of pioglitazone treatment in women who completed TRIPOD. The DREAM study is looking at the effect of rosiglitazone and ramipril separately and in combination on diabetes rates in adults with impaired glucose tolerance.

- With high-risk people, the best intervention is diet and exercise, with serial glucose testing. If glucose concentrations continue to rise, consider pharmacological treatment either before diabetes or in the beginning of diabetes to achieve a target A1c (probably below 6%, and without stimulating insulin secretion)



Bibliographic references :
Prevention of Type 2 Diabetes: Saving the Pancreatic B-cell
Preservation of pancreatic beta-cell function and prevention of type 2 diabetes by pharmacological treatment of insulin resistance in high-risk hispanic women.

Buchanan TA, Xiang AH, Peters RK, Kjos SL, Marroquin A, Goico J, Ochoa C, Tan S, Berkowitz K, Hodis HN, Azen SP.

Department of Medicine, University of Southern California Keck School of Medicine, Los Angeles, California 90033, USA. buchanan@usc.edu

Type 2 diabetes frequently results from progressive failure of pancreatic beta-cell function in the presence of chronic insulin resistance. We tested whether chronic amelioration of insulin resistance would preserve pancreatic beta-cell function and delay or prevent the onset of type 2 diabetes in high-risk Hispanic women. Women with previous gestational diabetes were randomized to placebo (n = 133) or the insulin-sensitizing drug troglitazone (400 mg/day; n = 133) administered in double-blind fashion. Fasting plasma glucose was measured every 3 months, and oral glucose tolerance tests (OGTTs) were performed annually to detect diabetes. Intravenous glucose tolerance tests (IVGTTs) were performed at baseline and 3 months later to identify early metabolic changes associated with any protection from diabetes. Women who did not develop diabetes during the trial returned for OGTTs and IVGTTs 8 months after study medications were stopped. During a median follow-up of 30 months on blinded medication, average annual diabetes incidence rates in the 236 women who returned for at least one follow-up visit were 12.1 and 5.4% in women assigned to placebo and troglitazone, respectively (P < 0.01). Protection from diabetes in the troglitazone group 1) was closely related to the degree of reduction in endogenous insulin requirements 3 months after randomization, 2) persisted 8 months after study medications were stopped, and 3) was associated with preservation of beta-cell compensation for insulin resistance. Treatment with troglitazone delayed or prevented the onset of type 2 diabetes in high-risk Hispanic women. The protective effect was associated with the preservation of pancreatic beta-cell function and appeared to be mediated by a reduction in the secretory demands placed on beta-cells by chronic insulin resistance.

Diabetes 2002 Sep;51(9):2796-803


   


 Presentation 

"Endothelial Dysfunction in Diabetes"

Dr. Todd Anderson (biography)
English - 2002-10-28 - 21 minutes
(18 slides)

Summary :
The healthy endothelium maintains vascular integrity though the release of a variety of paracrine factors such as nitric oxide. Nitric oxide is produced by endothelial cells from the essential amino acid I-arginine. Nitric oxide is anit-atherogenic by virtue of its ability to relax smooth muscle cells, inhibit platelet aggregation and smooth muscle cell proliferation and prevent leukocyte...

Learning objectives :
The reader will: Learn to understand that atherosclerosis is the leading cause of death in patients with diabetes.
Learn to understand the pathogenesis of atherosclerosis in general and in diabetes specifically.
Learn the paracrine factors that regulate endothelial function.
Learn that oxidative stress plays a major role in endothelial dysfuntion, particularly diabetes.
Learn the interventions that have been shown to ameliorate endothelial dysfunction- such as lipid lowering, ACE-inhibition, anti-oxidant strategies, and more recently nitric oxide co-factors such as tetrahydrobiopterin and modulation of insulin resistance


Bibliographic references :
1. Diabetes Prevention Program Research Group. Reduction in the incidence of Type 2 diabetes with lifestyle intervention or metformin. New Engl J Med 2002; 346(6):393-403
2. Verma S, Anderson TJ. Fundamentals of endothelial function for the clinical cardiologist. Circulation 2002; 105(5): 546-549


   


 Presentation 

"Preventing Microvascular and Macrovascular Complications of Type 2 Diabetes"

Dr. Ehud Ur (biography)
English - 2002-07-19 - 35 minutes
(48 slides)

Summary :
By planning ahead, Dr Ur shows how it may be possible to prevent Type 2 Diabetes complications such as stroke, retinopathy, heart disease, hypertension, renal disease, peripheral vascular disease , neuropathy and foot problems. Uncontrolled hyperglycemia is a major risk factor for complications. Complications sometimes present shortly after time of diagnosis, eg, retinopathy is present in 21% of...

Learning objectives :
To formulate practical approaches in helping to prevent complications of Type 2 Diabetes in patients who are at risk. These complications include stroke, retinopathy, heart disease, hypertension, renal disease, peripheral vascular disease , neuropathy and foot problems.

Bibliographic references :
Resistin expression and regulation in mouse pituitary.

Morash B, Willkinson D, Ur E, Wilkinson M.

Department of Obstetrics and Gynaecology, Faculty of Medicine, Dalhousie
University, 5980 University Avenue, B3J 3G9, Halifax, NS, Canada

Resistin, a new adipocytokine, is expressed in human, rat and mouse
adipose tissue. Its putative role as a mediator of insulin resistance is
controversial. We hypothesized that resistin, in common with leptin, has
multiple roles in non-adipose tissues. Using reverse transcription
polymerase chain reaction (RT-PCR) we show that the resistin gene (Retn)
is expressed in mouse brain (hypothalamus and cortex) and pituitary gland.
Immunohistochemistry revealed resistin protein in the arcuate nucleus and
pituitary gland. Semi-quantitative RT-PCR analysis indicated that Retn
mRNA is developmentally regulated in the pituitary. Expression was lowest
at birth, increased abruptly between postnatal days 14 and 25 (four-fold;
P<0.001), and declined thereafter. This peak in pituitary Retn mRNA was
unaffected by early weaning but was abolished by neonatal treatment with
monosodium glutamate, suggesting that the basal hypothalamus regulates
pituitary Retn. Although the role(s) of endogenous resistin in mouse brain
and pituitary remains to be determined, it may be distinct from its
controversial involvement in insulin resistance. Our data suggest that
local resistin expression could have functional implications during
prepubertal maturation of the hypothalamic-pituitary system.

FEBS Lett 2002 Aug 28;526(1-3):26


   


 Presentation 

"Prevention of Diabetes: Results of Recent Clinical Studies"

Dr. Robert Josse (biography)
English - 2002-01-19 - 24 minutes
(37 slides)

Summary :
Study demonstrating the importance of the prevention of the development of diabetes. At present, the best possibilities of prevention are exercise, diet and the use of acarbose.

Learning objectives :
Upon completion of this presentation, participants should be able to:
1.Understand the mechanisms and pathophysiology leading to type 2 DM.
2.Learn about recent clinical trials targeting people with IGT aimed at preventing progression to type 2 DM.
3.Understand potential strategies for delaying development of type 2 DM.

Bibliographic references :
Causes of insulin resistance in childhood.

Jeffery A, Voss L, Metcalf B, Wilkin T.

Early Bird Research Centre, Derriford Hospital, Plymouth.
alison.jeffery@phnt.swest.nhs.uk

The increasing incidence of type 2 diabetes worldwide is causing concern.
Genetic and environmental influences have been put forward to explain the
origins of this disease, but perhaps the most convincing contributory
factor is high body weight. The authors review the literature on the
subject to identify some of the predisposing factors influencing
healthcare practitioners' concerns about the issue.

Nurs Stand 2002 May 15-21;16(35):33-7


   


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